Anovulatory infertility due to polycystic ovarian syndrome (PCOS)

PCOS (polycystic ovarian syndrome) is present in up 25 per cent of normal women.The diagnosis of PCOS is made on any combination of characteristic clinical,biochemical and ultrasound features.It is a morphological description of enlarged ovaries with an increased number of follicles and dense stroma.

PCOS is one of the commonest causes of infertility.Both parters must be investigated prior to treat the PCOS.
This includes:
-semen analysis;
-tubal patency test (hysterosalpingogrom is usually sufficient);
-laparoscopy and dye test if pelvic inflammatory disease,adhesions or endometriosis are suggested from the history).

Testing for rubella is also necesary,as in recommendation to take folic acid if this is not alresdy taken.General advice:minimizing alcohol intake,avoiding smoking and ensuring regular intercourse (preferably 2-3 times per week).The women should aim to reduce weight as this commonly induces ovulation in high-BMI women with PCOS.
Anovulation is shown by the progesterone level below 30nmol/l and PCOS is suggested by several features including BMI,acne,oligomenorrhoea,polycystic ovaries on transvaginal ultrasound examination,increased androgen level and increased LH.