DefinePK

Abstract

Polycystic ovarian syndrome (PCOS) remains the most common endocrine illness in reproductive-aged women and a major contributor to an ovulatory infertility globally. The burden of infertility is caused by a combination of metabolic and hormonal disturbances, most notably insulin resistance, hyper-insulinemia, and hyper-androgenism, which affect follicular recruitment, ovulation, oocyte competence, and endometrial receptivity. Contemporary diagnostic paradigms, based on the Rotterdam criteria, priorities phenotypic segmentation to facilitate individualized care. Current data supports lifestyle modification as a universal first-line strategy, highlighting its ability to restore ovulation and reduce cardiometabolic risks. Letrozole has emerged as the more effective ovulation-inducing medication than clomiphene citrate, while metformin, low-dose gonadotropins, and laparoscopic ovarian drilling continue to play supporting roles. For refractory instances, assisted reproductive technologies (IVF/ICSI) offer successful solutions, with protocols optimized to reduce ovarian hyper stimulation syndrome (OHSS). Beyond conception, PCOS pregnancies are encumbered by heightened risks of hypertensive disorders and gestational diabetes, necessitating vigilant preconception optimization and individualized antenatal surveillance. This narrative synthesis integrates evolving mechanistic insights, diagnostic refinements, and therapeutic hierarchies from the 2023 International Guideline and contemporary literature, framing PCOS as not only a reproductive disorder but also a systemic condition requiring holistic, multidisciplinary management.
Keywords: Polycystic ovary syndrome, infertility, ovulation induction, letrozole, insulin resistance, assisted reproduction, infertility