Do Patients With Polycystic Ovarian Syndrome Need IVF To Conceive?

In patients with polycystic ovarian syndrome, the underlying defect causing infertility is sometimes referred to as chronic anovulation.  If the male has a normal sperm count and there are no mechanical problems such as occluded fallopian tubes or pelvic scar tissue, the management should consist of ovulation induction.  The currently available medications for correcting failure to ovulate are quite good and can almost always correct the underlying ovulation disorder.  However, it is important to recognize that each time ovulation occurs, in spite of properly timed intercourse or insemination, the chances of pregnancy are slightly less than 20%.  This is related to the inherent inefficiency of reproduction in humans.  In addition, some of the ovulation stimulating agents have adverse effects on the developing uterine lining and therefore may not be successful.  However, the pure pituitary stimulating hormones (gonadotropins) do not have negative effects, but are associated with significant multiple birth rates (approximately 20%).  When PCOS (polycystic ovarian syndrome) is the cause of infertility, and the couple would like to avoid in-vitro fertilization (IVF), patience is mandatory!  There is no doubt that IVF works faster and is quite effective for infertility caused by PCOS. However, a patient, careful approach utilizing gonadotropin medications sometimes in conjunction with other medications to better control PCOS hormonal irregularities, will usually prove successful!! Patience is the key to success since each ovulation yields just a 20% success rate at best.