Infertility Management in Lean Versus Obese PCOS

Abstract

Polycystic ovary syndrome (PCOS) is a common polygenic endocrinopathy in women of reproductive age. PCOS is associated with menstrual irregularities, hyperandrogenism, polycystic ovarian morphology and fertility issues. It is the cause of anovulatory infertility in almost 70% of women in the reproductive age group.1 PCOS also has a high prevalence of metabolic disorders, obesity, increased anxiety and depression which can have a negative impact on women’s health. Insulin resistance and hyperinsulinemia are common and are responsible for hormonal and metabolic dysfunction. The presentation can be heterogeneous as the diagnosis of PCOS is based on the Rotterdam criteria, which include two of the three findings – polycystic ovarian morphology (PCOM), chronic anovulation (CA) and hyperandrogenism (HA). Other features, which have been associated with PCOS, include insulin resistance (IR) and metabolic syndrome (MS). Different PCOS phenotypes differ significantly in their metabolic risk due to insulin resistance and dyslipidaemia which worsens with the severity of androgen excess. PCOS can significantly affect a woman’s ability to conceive and her quality of life. There are two types of PCOS patients, one obese and other non-obese or lean. The two groups differ in their clinical, metabolic and hormonal parameters and also respond differently to treatment. Although a majority of cases with PCOS are obese/over- weight, a small but significant proportion of patients present with normal or low body mass index (BMI; ≤25 kg/M2).