The prevalence of polycystic ovarian syndrome (PCOS) is currently estimated at 5-10% and is one of the most common causes of irregular menstruation in women of childbearing age. As the name implies, PCOS are ovaries with more follicles than the average person, making the ovaries appear to have many hollows under ultrasound (follicles appear as black hollows in ultrasound). The cause of the syndrome may be related to chronic anovulation and increased androgens due to insulin resistance. According to the 2018 European Society of Reproductive Medicine clinical guidelines, PCOS is diagnosed when two of the following three conditions are met：

One of the main reasons for the effects of polycystic ovarian syndrome on pregnancy is ovulation disorders. Other factors such as higher embryo elimination rate and decreased embryo implantation rate due to maternal metabolism have also been mentioned. Therefore, couples who have tried unsuccessfully for six months with regular intercourse may consider further oral ovulation medication to increase their chances of pregnancy. Before using ovulation medication, the status of the fallopian tubes and the spermatozoa of the partner can be checked according to the individual's condition. The following conditions are strongly recommended for hysterosalpingogram：

• History of abdominal or pelvic cavity infection

• History of sexually transmitted diseases

• History of abdominal or pelvic surgery

• Endometriosis patients

The cause of PCOS is still not fully understood and may be related to genetics. Although it is a condition that cannot be cured, symptoms can be controlled through medication or lifestyle adjustments. In our clinic, most of the reasons for consultation were irregular menstruation, acne, weight gain, and infertility. However, the chronic health problems caused by polycystic ovarian syndrome include blood sugar, cardiovascular disease, endometrial cancer, and chronic depression due to its appearance. Therefore, early diagnosis and regular follow-up can help prevent subsequent complications.

About 15 to 40% of polycystic patients are resistant to oral medication, therefore, it is recommended to confirm the effectiveness of ovulation medication at least 2-3 cycles with the ultrasound examination. If the effect is stable, you can consider trying ovulation pills and natural intercourse for one year, because the cumulative pregnancy rate of fewer than 35 years old can reach 70% in one year. For drug-resistant individuals, combining oral hypoglycemic drugs may be considered to increase ovulation rates, but in the current study, combining oral ovulation drugs with hypoglycemic drugs did not increase live birth rates in the long term. When oral ovulation medication does not work or when couples have not had a pregnancy after one year of trying, further treatment can be discussed, including ovulation injections combined with natural intercourse, artificial insemination, or in vitro fertilization.

Folic acid and vitamin D supplements may be considered before entering in vitro treatment, and the polycystic population may have the following characteristics during in vitro treatment：

• Higher ovarian response：There may be an increased risk of complications associated with egg retrieval, including bleeding, infection, and ovarian hyperstimulation syndrome. Among these, the increased risk of ovarian hyperstimulation syndrome (Note) is the most significant. For this reason, antagonist therapy combined with pituitary stimulants is more commonly used as the final injection for ovulation. It is also recommended to avoid the risk of ovarian hyperstimulation syndrome by avoiding fresh implantation and using whole embryo freezing.
• Higher embryo elimination rate：During the IVF procedure, the average egg maturity of patients with the polycystic ovarian syndrome is lower, resulting in a slight increase in the elimination rate during embryo culture. However, due to the high number of eggs retrieved, a 50% live birth rate is still statistically achievable for those younger than 35 years old, while for those older than 35 years old, the pregnancy rate is comparable to that of the general population.
• Higher rates of early miscarriage, gestational diabetes and preeclampsia risk in the later stages of pregnancy：Most commonly seen in people with combined metabolic syndrome, so consider combining exercise or lifestyle modification before treatment or pay attention to weight gain during pregnancy. Early screening for preeclampsia risk can be considered during pregnancy, and early blood glucose testing can be considered for those with a BMI >25 or a family history of diabetes.

Although patients with PCOS have these characteristics during IVF treatment, on average they are still considered to have a good prognosis. In the treatment of infertility, we still need to consider age, weight, tubal factors, husband's sperm status, life plan, and other conditions to discuss the appropriate treatment for each individual.

(Note) Ovarian hyperstimulation syndrome means that the ovulation medication stimulates the production of more follicles, resulting in other complications, including abdominal distention, ascites, nausea, ovarian enlargement, etc. For more information, please refer to the official website.

Medical conduct should be discussed with your doctor, this article only reflects the current treatment status and recommendations.