ABSTRACT
KEY WORDS: polycystic ovary syndrome, insulin resistance, androgen excess, polycystic ovaries, anovulatory infertility, obesity, bariatric surgery, ovulation induction, clomiphene citrate, metformin, laparoscopic ovarian surgery, multiple pregnancy, ovarian hyperstimulation syndrome, cardiometabolic risk
Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies among women of reproductive age, making it a common cause, or component, of subfertility.1 The prevalence ranges from 8.7% to 17.8% depending on the clinical criteria used, with over two-thirds of the affected population unaware of their diagnosis.2 The rst of the multiple diagnostic criteria proposed (Table 9.1) was created by the National Institutes of Health in 1990 requiring a combination of irregular anovulatory periods and either hirsutism or raised serum testosterone.3 The more inclusive Rotterdam criteria require two of three factors to be fullled: oligo-or anovulation, clinical and/or biochemical hyperandrogenism, and polycystic ovaries (PCO) on ultrasonography.4 Both denitions require the exclusion of differential diagnoses such as hyperprolactinaemia and congenital adrenal hyperplasia. More recently, the Androgen Excess-PCOS Society criteria have renewed focus on the hyperandrogenic prole of the condition, requiring clinical and/or biochemical hyperandrogenism in combination with ovarian dysfunction, dened as oligo-or anovulation and/or polycystic ovaries.5
