Polycystic ovarian syndrome
Polycystic ovary syndrome (PCOS) is a common disease affecting 3-5% of women of reproductive age. Despite the fact that it was first recognised in 1935, the exact cause of the syndrome remains elusive and there is no 'one-treatment-fits-all' answer to its management. Common symptoms include irregular periods, weight gain, hirsutism and infertility.
There are several reasons why PCOS can cause subfertility, but anovulation (not being able to ovulate) is the most important one. Several strategies can be used to induce ovulation, from drugs to surgery. Ovulation induction with clomiphene is generally considered the first-line treatment; the anti-diabetic drug, metformin, is also increasingly being used particularly if anovulation is accompanied by obesity.
If this strategy fails to regulate the menstrual cycle and induce ovulation, the choice is between using more powerful drugs with a risk of hyperstimulation and multiple pregnancies or laparoscopic surgery, commonly referred to as "ovarian drilling".