PCOS (Polycystic Ovary Syndrome)

PCOS is diagnosed by the Rotterdam criteria: at least 2 of 3 features — irregular or absent ovulation, elevated androgens (clinical or biochemical), and polycystic ovarian morphology on ultrasound (≥20 follicles per ovary or ovarian volume >10 mL). It affects 5–10% of reproductive-age women and is the leading cause of anovulatory infertility.

The hormonal pattern typically includes elevated LH relative to FSH, high androgens, and insulin resistance. Treatment for fertility focuses on achieving ovulation with letrozole (first-line), clomiphene, or gonadotropins. Weight loss of even 5–10% in women with obesity can restore ovulation. IVF with careful stimulation is used when simpler treatments fail, with attention to OHSS prevention due to characteristically high AFCs.