Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Counselling a patient with polycystic ovary syndrome (PCOS) regarding fertility options and reproductive health impact involves several key points:
- Explain the impact of PCOS on fertility: PCOS is a common cause of ovulatory dysfunction (WHO Group 2 ovulation disorder), leading to anovulatory infertility due to hormonal imbalances and insulin resistance NICE CG156.
- Emphasize lifestyle modification: Encourage a healthy lifestyle including weight management, healthy eating, and regular physical activity, as weight loss of as little as 5% can improve insulin resistance, reduce androgen levels, restore spontaneous ovulation, and improve response to ovulation induction treatments NICE CKS.
- Discuss first-line pharmacological treatments: For women with PCOS-related anovulatory infertility, first-line ovulation induction options include clomifene citrate, metformin, or a combination, with choice tailored to the woman’s BMI, preferences, and side effect profiles NICE CG156.
- Inform about treatment monitoring and duration: Clomifene citrate treatment should be monitored by ultrasound during the first cycle to minimize multiple pregnancy risk and should not be continued beyond 6 months NICE CG156.
- Address second-line treatments if resistant to clomifene: Options include laparoscopic ovarian drilling, combined clomifene and metformin, or gonadotrophins, depending on clinical circumstances and patient preference NICE CG156.
- Highlight the importance of managing menstrual irregularities and hyperandrogenism: Combined oral contraceptives (COCs) are recommended to manage hyperandrogenism and irregular cycles when pregnancy is not planned, but are not fertility treatments NICE CKS.
- Discuss the risks and benefits of ovulation induction: Inform patients that ovulation induction and ovarian stimulation have not been associated with increased cancer risk in the short to medium term, but long-term data are awaited; use the lowest effective doses and durations NICE CG156.
- Refer to fertility specialists as needed: For complex cases or if initial treatments fail, referral to secondary or tertiary fertility services is appropriate NICE CG156.
- Provide information on long-term reproductive health: PCOS increases risks of type 2 diabetes and cardiovascular disease, so ongoing management and screening are important to optimize overall health and fertility outcomes NICE CKS.
- Offer sources of support and information: Direct patients to reputable resources such as the Royal College of Obstetricians and Gynaecologists, NHS, and PCOS support groups NICE CKS.