Management of<unk>  includes lifestyle modification as well as assisted reproductive technology such as ovulation induction, oocyte release triggering and surgery. Lifestyle modification For overweight women with PCOS who are anovulatory, diet adjustments and weight loss are associated with resumption of spontaneous ovulation. Preliminary evidence suggests that exercise may improve menstrual regularity, pregnancy and ovulation rates, but more research is needed. Ovulation induction For those who after weight loss still are anovulatory or for anovulatory lean women, ovulation induction to reverse the anovulation is the principal treatment used to help<unk>  in PCOS. Letrozole and Clomiphene citrate are the first-line treatment in subfertile anovulatory patients with PCOS. A Cochrane review showed that letrozole (an aromatase inhibitor) appears to improve live birth and pregnancy rates as compared to clomiphene citrate. There appeared to be no difference between letrozole and laparoscopic ovarian drilling. Gonadotrophins such as follicle-stimulating hormone (FSH) are, in addition to surgery, second-line treatments. In vitro fertilization For patients who do not respond to diet, lifestyle modification and ovulation induction, in vitro fertilisation can be performed. This usually includes controlled ovarian hyperstimulation with FSH injections, and oocyte release triggering with human chorionic gonadotropin (hCG) or a GnRH agonist. Surgery Surgery can be attempted in case of inefficient result with medications for ovulation induction. Though surgery is not commonly performed, the polycystic ovaries can be treated with a laparoscopic procedure called "ovarian drilling" (puncture of 4-10 small follicles with electrocautery), which often results in either resumption of spontaneous ovulations or ovulations after adjuvant treatment with clomiphene or FSH. Inefficacy of metformin Previously, metformin was recommended treatment for anovulation. A systematic review and meta-analysis in 2012 concluded that there is insufficient evidence to establish a difference between metformin and clomiphene citrate in terms of ovulation, pregnancy, live birth, miscarriage, and multiple pregnancy rates in women with PCOS and a BMI less than 32 kg/m2. It emphasized that a lack of superiority of one treatment is not evidence for equivalence. Another review in 2012 concluded that metformin improves pregnancy rates in women with PCOS when compared with placebo, and in addition to clomiphene compared with clomiphene alone, but not when compared directly with clomiphene. Also, however, it concluded that metformin does not improve live birth rates, whether used alone or in combination with clomiphene. It therefore concluded that the benefit of metformin in the improvement of reproductive outcomes in women with PCOS is limited. The ESHRE/ASRM-sponsored Consensus workshop does not recommend metformin for ovulation stimulation. Subsequent randomized studies have confirmed the lack of evidence for adding metformin to clomiphene. When taken prior to or during IVF, there is no evidence that metformin treatment improves live birth rate in women with PCOS. However, metformin was found to increase clinical pregnancy rates and reduce the risk of ovarian hyperstimulation syndrome (OHSS) in women with PCOS and undergoing IVF cycles.
Infertility in polycystic ovary syndrome
symptoms of Endometriosis
medical diagnosis of Polycystic ovary syndrome
symptom of Polycystic ovary syndrome
symptom of Pregnancy
Thyroid disease in women
symptom of Endometriosis
medical cause of Precocious puberty