We used the following definitions. PCOS according to the Rotterdam diagnostic criteria, specified by the presence of two out of three features; oligo/amenorrhoea, hyperandrogenism and polycystic ovaries on ultrasound [29, 30]. Associated endocrine features for PCOS included elevated LH [31], which is strongly associated with infertility (p = 0.0003) [32] and miscarriage [33] and elevated fasting glucose which is prevalent in approximately 31% of women with PCOS including normal weight women [34].
The IUI is performed with the same dose of gonadotropins recommended for timed intercourse (combined or not with clomiphene). However, for this treatment modality, the recombinant hCG is administered for final oocyte maturation when the dominant follicle has a mean diameter of 17 to 18 mm via US examination and capacitated sperm can be injected into the uterine cavity 36 hours later. Beta hCG is measured 14 days later to confirm pregnancy 25.

Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects about 5 to 10 percent of women during their childbearing years. Typically, the ovaries contain multiple small cysts, which are often slightly enlarged. About 1 in 5 women have polycystic ovaries appearing on ultrasound scans but do not have the other features of this syndrome. These cysts do not require surgical removal. Polycystic ovaries make more male hormones (androgens) than do normal ovaries. The exact cause for PCOS is not known, but sometimes it is hereditary.
Other medications with anti-androgen effects include flutamide,[91] and spironolactone,[74] which can give some improvement in hirsutism. Metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is often used if there are other features such as insulin resistance, diabetes, or obesity that should also benefit from metformin. Eflornithine (Vaniqa) is a medication that is applied to the skin in cream form, and acts directly on the hair follicles to inhibit hair growth. It is usually applied to the face.[74] 5-alpha reductase inhibitors (such as finasteride and dutasteride) may also be used;[92] they work by blocking the conversion of testosterone to dihydrotestosterone (the latter of which responsible for most hair growth alterations and androgenic acne).
PCOS-related hormonal dysfunction can result in irregular or absent ovulation (anovulation). A variety of drugs can be used to treat this, enhancing the quality of both the egg (oocyte) and ovulation. Typical, first-line treatments include the fertility drugs Clomid (clomiphene citrate) and Femara (letrozole). While Clomid is commonly used to enhance ovulation, Femara may work better in women with PCOS as it neither raises estrogen levels nor increases the risk of multiple births to the same degree as Clomid.
Lack of ovulation (monthly release of an egg from the ovary) is the predominant cause for infertility in PCOS women, although some individuals also may have a higher rate of miscarriage. In some PCOS women who are overweight, diet combined with exercise can restore ovulation without the use of medications. Otherwise, several medications are available to restore ovulation in PCOS women. Oral clomiphene citrate stimulates FSH secretion from a woman’s own pituitary (located at the base of the skull) to induce ovarian follicle growth. Subcutaneous injections of gonadotropins with FSH and LH can induce the same events, if necessary. Both medications increase the chance of multiple births, although FSH injections are the most powerful. Other medications include metformin, an insulin sensitizer that slowly lowers insulin and androgen levels to gradually induce ovulation with a lower chance of multiple births. Medications that block estrogen production to stimulate FSH secretion (letrozol) also exist, but additional studies are needed before they can be routinely recommended for ovulation induction. Since most PCOS women ovulate following medical therapy, surgery or in-vitro fertilization (IVF) are generally reserved for PCOS women who fail to ovulate with medication or have other fertility problems.
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