IVF and polycystic ovaries

The polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women of childbearing age. This endocrine disorder is associated with hormonal imbalance, irregular menstrual cycles, and absence of ovulation. In vitro fertilization (IVF) appears to be an effective method for achieving pregnancy in women with PCOS. This approach bypasses the problems related to ovulation disorders by fertilizing eggs in the laboratory and transferring the embryos into the woman's uterus. Let’s examine the specifics of the procedure and the factors that influence its success.

Why does polycystic ovary syndrome make conception difficult?

Polycystic ovary syndrome is characterized by ovulation disorders due to hormonal imbalance. High levels of androgens (hyperandrogenism) and insulin resistance create unfavorable conditions for follicle maturation. Despite having a high egg reserve, the egg maturation process is often disrupted, making natural conception extremely difficult.

Is IVF always necessary in the case of PCOS?

IVF is not always the first treatment option for women with PCOS. The initial choice may be ovulation stimulation using hormonal medications or ovulation induction. If these methods are ineffective and other infertility factors are present, doctors recommend IVF.

Before IVF, a laparoscopy is sometimes prescribed. This surgical procedure helps to reduce the amount of ovarian tissue producing androgens and restore ovulation. Laparoscopy can be particularly useful for patients for whom hormone therapy has failed.

How does IVF proceed for polycystic ovaries?

IVF for polycystic ovaries has its own specificities. The main problem is the high risk of ovarian hyperstimulation syndrome (OHSS) due to the large egg reserve. This requires

• a special approach to hormone dosing;
• regular monitoring of follicle development;
• continuous monitoring of the patient's condition.

The first step involves follicular stimulation. Due to their high ovarian reserve, women with PCOS often respond well and sometimes excessively to hormonal medications. This increases the risk of complications, such as OHSS, which can be accompanied by pain and abdominal swelling. Therefore, doctors use low doses of hormones to reduce these risks.

Once mature eggs are obtained, they are fertilized in the laboratory, and then the highest quality embryos are transferred into the uterine cavity. This approach minimizes risks and maximizes safety.

The role of metformin in treating PCOS with insulin resistance

Metformin is a medication used to reduce insulin resistance. According to studies, it improves hormonal balance, reduces insulin levels, and increases the ovaries' sensitivity to stimulation. For example, a study published in the journal Fertility and Sterility showed that the use of metformin before IVF increased pregnancy rates by 20%. This medication is often used as an adjunct before IVF to increase the chances of successful conception.