In polycystic ovarian syndrome (PCOS), patient has any two criteria out of oligo/ anovulation, clinical &/or biochemical hyperandrogenism and polycystic ovaries on scan. Dr. Patki discusses the phenotypes of PCOS and the various causes of anovulation. Almost 75% of women with irregular menses and/or infertility may have polycystic ovaries. Anovulation is the main cause of infertility in women with PCOS.
Dr. Patki gives an in-depth review of the mechanism of action, indications, dosage, and disadvantages of ovulation induction with clomiphene citrate and letrozole. The use of insulin sensitizers - metformin in polycystic ovary syndrome, combined metformin and clomiphene citrate in clomiphene citrate resistant PCOS is reviewed. Newer agents include Myo-inositol which has shown to improve ovarian activity in PCOS patients. The indications and risks of ovarian drilling and role of gonadotrophins are discussed. Antagonists are used in IUI. Dr. Patki also discusses the management of anovulatory PCOS, use of anti-obesity drugs such as orlistat, bariatric surgery and OCs in managing PCOS patients.
Dr. Ameet Patki
MD, DGO, DNB,FCPS,FICOG,FRCOG