Reproductive function in patients with signs of polycystic ovary syndrome

The aim of the study. To study the incidence of polycystic ovary syndrome (PCOS) in the clinical practice of a regional infertility treatment center, to perform a comparative analysis of the clinical characteristics of PCOS phenotypes, and to evaluate the results of fertility restoration depending on the phenotype and treatment tactics. Material and methods. The retrospective, single-center, non-randomized study included 1.273 women with ovulation disorders who sought help from a regional infertility diagnostic and treatment center from April 27, 2001, to December 31, 2021. We excluded 297 (23.3%) patients who did not undergo adequate examination and 237 (18.6%) women with combined forms of infertility. Women were divided into 4 types depending on the causes of anovulation according to the FIGO classification: I — anovulation due to hypothalamic pathology (n=32, 4.2%); Type II — anovulation due to pituitary disorders (n=59, 7.7%); Type III — ovarian anovulation (n=118, 15.5%); Type IV — PCOS (n=530, 71.7%). Women classified as PCOS were divided according to the Rotterdam Consensus based on phenotypes. A comparative assessment of the clinical characteristics of the PCOS phenotypes was performed. Reproductive function was monitored depending on the chosen treatment strategy and phenotype. Results. Pregnancy occurred in 317 (59.8%) of 530 women with PCOS. The effectiveness of patient management models, from expectant management to the use of assisted reproductive technologies (ART), was determined. During the correction of endocrine-metabolic disorders, pregnancy occurred in 38 (26.4%) of 144 women, after ovulation stimulation — in 104 of 337 (30.9%). Endoscopic ovarian drilling contributed to pregnancy in 48 (47.5%) of 101 women. The overall pregnancy rate without the use of ART was 47.2%. A failed pregnancy within 6-8 months, despite the restoration of ovulation, served as a basis for in vitro fertilization, the pregnancy rate was 57.1%. Intrauterine insemination for endocrine infertility had the lowest success rate—pregnancy occurred in 7 (11.7%) of 60 women. Conclusion. The frequency of polycystic ovary syndrome diagnosis in women seeking treatment at a regional infertility center is consistent with rates in other regions of Russia and internationally. Comprehensive treatment of endocrine and metabolic disorders can be considered as a standalone treatment method, as well as preparation for the next stages of infertility management. Ovulation stimulation is the next step after correction of endocrine and metabolic disorders. Ovarian drilling is a backup method for restoring ovulation. If pregnancy has not occurred within 6—8 months, assisted reproductive technologies are indicated.