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Journal of Assisted Reproduction and Genetics

, Volume 35, Issue 1, pp 25–39 | Cite as

Polycystic ovary syndrome throughout a woman’s life

  • José Bellver
  • Luis Rodríguez-Tabernero
  • Ana Robles
  • Elkin Muñoz
  • Francisca Martínez
  • José Landeras
  • Juan García-Velasco
  • Juan Fontes
  • Mónica Álvarez
  • Claudio Álvarez
  • Belén Acevedo
  • Group of interest in Reproductive Endocrinology (GIER) of the Spanish Fertility Society (SEF)
Review

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women and the main cause of infertility due to anovulation. However, this syndrome spans the lives of women affecting them from in-utero life until death, leading to several health risks that can impair quality of life and increase morbidity and mortality rates. Fetal programming may represent the beginning of the condition characterized by hyperandrogenism and insulin resistance which leads to a series of medical consequences in adolescence, adulthood, and old age. Menstrual and fertility problems evolve into metabolic complications as age advances. An early and precise diagnosis is important for an adequate management of PCOS, especially at the extreme ends of the reproductive lifespan. However, many different phenotypes are included under the same condition, being important to look at these different phenotypes separately, as they may require different treatments and have different consequences. In this way, PCOS exhibits a great metabolic complexity and its diagnosis needs to be revised once again and adapted to recent data obtained by new technologies. According to the current medical literature, lifestyle therapy constitutes the first step in the management, especially when excess body weight is associated. Pharmacotherapy is frequently used to treat the most predominant manifestations in each age group, such as irregular menses and hirsutism in adolescence, fertility problems in adulthood, and metabolic problems and risk of cancer in old age. Close surveillance is mandatory in each stage of life to avoid health risks which may also affect the offspring, since fetal and post-natal complications seem to be increased in PCOS women.

Keywords

Polycystic ovary syndrome Childhood Adolescence Perimenopause Fertility Pregnancy complications 

Notes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interest.

References

  1. 1.
    Solomon CG. Polycystic ovary syndrome. N Engl J Med. 2016;375:54–64.CrossRefGoogle Scholar
  2. 2.
    Stein IF, Levethal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181–91.CrossRefGoogle Scholar
  3. 3.
    Zawadzki JK, Dunaif A. Diagnosis criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, et al., editors. Polycystic ovary syndrome. Boston: Blackwell Scientific Publications; 1992. p. 377–84.Google Scholar
  4. 4.
    Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7.CrossRefGoogle Scholar
  5. 5.
    Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456–88.PubMedCrossRefGoogle Scholar
  6. 6.
    National Institutes of Health. Evidence-based methodology workshop on polycystic ovary syndrome. December 3–5, 2012. Executive summary. Available at https/prevention.nih.gov/docs/programs/pcos/FinalReport.pdf. Accesed March 1, 2017.
  7. 7.
    Ning N, Balen A, Brezina PR, et al. How to recognize PCOS: results of a web-based survey at IVF-worldwide.com. Reprod BioMed Online. 2013;26:500–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Dewailly D. Diagnostic criteria for PCOS: is there a need for a rethink? Best Pract Res Clin Obstet Gynaecol. 2016;37:5–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Androgen Excess and PCOS Society Disease State Clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome- part 1. Endocr Pract. 2015;21:1291–300.PubMedCrossRefGoogle Scholar
  10. 10.
    Zhu RY, Wong YC, Yong EL. Sonographic evaluation of polycystic ovaries. Best Pract Res Clin Obstet Gynaecol. 2016;35:25–37.CrossRefGoogle Scholar
  11. 11.
    Dewailly D, Pigny P, Soudan B, et al. Reconciling the definitions of polycystic ovary syndrome: the ovarian follicle number and serum anti-Müllerian hormone concentrations aggregate with the markers of hyperandrogenism. J Clin Endocrinol Metab. 2010;95:4399–405.PubMedCrossRefGoogle Scholar
  12. 12.
    Dewailly D, Gronier H, Poncelet E, et al. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod. 2011;26:3123–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Dewailly D, Catteau-Jonard S, Reyss AC, et al. Oligoanovulation with polycystic ovaries but not overt hyperandrogenism. J Clin Endocrinol Metab. 2006;91:3922–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Stein S, Jennifer L, Sites CK, Yang D. Environmental determinants of polycystic ovary syndrome. Fertil Steril. 2016;106:16–24.CrossRefGoogle Scholar
  15. 15.
    Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod. 2012;27:3067–73.PubMedCrossRefGoogle Scholar
  16. 16.
    Sirmans SM, Parish RC, Blake S, Wang X. Epidemiology and comorbidities of polycystic ovary syndrome in an indigent population. J Investig Med. 2014;62:868–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Rutkowska AZ, Diamanti-Kandarakis E. Polycystic ovary syndrome and environmental toxins. Fertil Steril. 2016;106:948–58.PubMedCrossRefGoogle Scholar
  18. 18.
    Franks S, Mc Carthy M, Hardy K. Development of polycystic ovary syndrome: involvement of genetic and environmental factors. Int J Androl. 2006;29:278–85.PubMedCrossRefGoogle Scholar
  19. 19.
    De Leo V, Musacchio MC, Cappelli V, Massaro MG, Morgante G, Petraglia F. Genetic, hormonal and metabolic aspects of PCOS: an update. Reprod Biol Endocrinol. 2016;14:38.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    De Melo AS, Dias SV, De Carvalho R, et al. Pathogenesis of polycystic ovary syndrome: multifactorial assessment from the foetal stage to menopause. Reproduction. 2015;150:11–24.CrossRefGoogle Scholar
  21. 21.
    Longo S, Bollani L, Decembrino L, Di Comite A, Angelini M, Stronati M. Short-term and long-term sequelae in intrauterine growth retardation (IUGR). J Matern Fetal Neonatal Med. 2013;26:222–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Delitala AP, Capobianco G, Delitala G, Cherchi PL, Dessole S. Polycystic ovary syndrome, adipose tissue and metabolic syndrome. Arch Gynecol Obstet 2017.Google Scholar
  23. 23.
    Sir-Petermann T, Maliqueo M, Angel B, Lara HE, Pérez-Bravo F, Recabarren SE. Maternal serum androgens in pregnant women with polycystic ovarian syndrome: possible implications in prenatal androgenization. Hum Reprod. 2002;17:2573–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Qiao J, Feng HL. Extra- and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence. Hum Reprod Update. 2011;17:17–33.PubMedCrossRefGoogle Scholar
  25. 25.
    Voulgaris N, Papanastasiou L, Piaditis G, et al. Vitamin D and aspects of female fertility. Hormones (Athens). 2017;16:5–21.Google Scholar
  26. 26.
    Bremer AA, Miller WL. The serine phosphorylation hypothesis of polycystic ovary syndrome: a unifying mechanism of hyperandrogenemia and IR. Fertil Steril. 2008;89:1039–48.PubMedCrossRefGoogle Scholar
  27. 27.
    Krishnan A, Muthusami S. Hormonal alterations in PCOS and its influence on bone metabolism. J Endocrinol. 2017;232:R99–R113.PubMedCrossRefGoogle Scholar
  28. 28.
    Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33:981–1030.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Ibáñez L, Jaramillo A, Enríquez G, et al. Polycystic ovaries after precocious pubarche: relation to prenatal growth. Hum Reprod. 2007;22:395–400.PubMedCrossRefGoogle Scholar
  30. 30.
    Ibáñez L, Díaz R, López-Bermejo A, Marcos MV. Clinical spectrum of premature pubarche: links to metabolic syndrome and ovarian hyperandrogenism. Rev Endocr MetabDisord. 2009;10:63–76.CrossRefGoogle Scholar
  31. 31.
    Idkowiak J, Lavery GG, Dhir V, et al. Premature adrenarche: novel lessons from early onset androgen excess. Eur J Endocrinol. 2011;165:189–207.PubMedCrossRefGoogle Scholar
  32. 32.
    Ibáñez L, Lopez-Bermejo A, Diaz M, Marcos MV, de Zegher F. Early metformin therapy to delay menarche and augment height in girls with precocious pubarche. Fertil Steril. 2011;95:727–30.PubMedCrossRefGoogle Scholar
  33. 33.
    Ibáñez L, López-Bermejo A, Díaz M, Marcos MV, de Zegher F. Early metformin therapy (age 8-12 years) in girls with precocious pubarche to reduce hirsutism, androgen excess, and oligomenorrhea in adolescence. J Clin Endocrinol Metab. 2011;96:E1262–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Rosenfield RL. Identifying children at risk of polycystic ovary syndrome. J Clin Endocrinol Metab. 2007;92:787–96.PubMedCrossRefGoogle Scholar
  35. 35.
    Marsh CA, Grimstad FW. Primary amenorrhea: diagnosis and management. Obstet Gynecol Surv. 2014;69:603–12.PubMedCrossRefGoogle Scholar
  36. 36.
    Witchel SF, Oberfield S, Rosenfield RL, et al. The diagnosis of polycystic ovary syndrome during adolescence. Horm Res Paediatr. 2015;87:376–89.CrossRefGoogle Scholar
  37. 37.
    Glueck CJ, Woo JG, Khoury PR, Morrison JA, Daniels SR, Wang P. Adolescent oligomenorrhea (age 14–19) tracks into the third decade of life (age 20–28) and predicts increased cardiovascular risk factors and metabolic syndrome. Metabolism. 2015;64:539–53.PubMedCrossRefGoogle Scholar
  38. 38.
    Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol. 2010;203:201.e1–5.CrossRefGoogle Scholar
  39. 39.
    Fruzzetti F, Campagna AM, Perini D, Carmina E. Ovarian volume in normal and hyperandrogenic adolescent women. FertilSteril. 2015;104:196–9.Google Scholar
  40. 40.
    Johnstone EB, Rosen MP, Neril R, et al. The polycystic ovary post-Rotterdam: a common, age-dependent finding in ovulatory women without metabolic significance. J Clin Endocrinol Metab. 2010;95:4965–72.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Welt CK, Carmina E. Clinical review: lifecycle of polycystic ovary syndrome (PCOS): from in utero to menopause. J Clin Endocrinol Metab. 2013;98:4629–38.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Fauser BC, Tarlatzis RW, Rebar RS, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97:28–38.e25.PubMedCrossRefGoogle Scholar
  43. 43.
    Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98:4565–92.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Tsikouras P, Spyros L, Manav B, et al. Features of polycystic ovary syndrome in adolescence. J Med Life. 2015;8:291–6.PubMedPubMedCentralGoogle Scholar
  45. 45.
    van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N. Interventions for hirsutism (excluding laser and photoepilation therapy alone). Cochrane Database Syst Rev. 2015;4:CD010334.Google Scholar
  46. 46.
    Buggs C, Rosenfield RL. Polycystic ovary syndrome in adolescence. Endocrinol MetabClin North Am. 2005;34:677.CrossRefGoogle Scholar
  47. 47.
    Bhattacharya SM, Jha A, DasMukhopadhyay L. Comparison of two contraceptive pills containing drospirenone and 20 μg or 30 μg ethinyl estradiol for polycystic ovary syndrome. Int J Gynaecol Obstet. 2016;132:210–3.PubMedCrossRefGoogle Scholar
  48. 48.
    Fruzzetti F, Perini D, Lazzarini V, Parrini D, Genazzani AR. Adolescent girls with polycystic ovary syndrome showing different phenotypes have a different metabolic profile associated with increasing androgen levels. Fertil Steril. 2009;92:626–34.PubMedCrossRefGoogle Scholar
  49. 49.
    de Zegher F, Ibáñez L. Therapy: low-dose flutamide for hirsutism: into the limelight, at last. Nat Rev Endocrinol. 2010;6:421–2.PubMedCrossRefGoogle Scholar
  50. 50.
    Ibáñez L, López-Bermejo A, Díaz M, Enríquez G, del Río L, de Zegher F. Low-dose pioglitazone and low-dose flutamide added to metformin and oestro-progestagens for hyperinsulinaemic women with androgen excess: add-on benefits disclosed by a randomized double-placebo study over 24 months. Clin Endocrinol. 2009;71:351–7.CrossRefGoogle Scholar
  51. 51.
    Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017;32:1075–91.PubMedCrossRefGoogle Scholar
  52. 52.
    Michelmore KF, Balen AH, Dunger DB, et al. Polycystic ovaries and eating disorders: are they related? Hum Reprod. 2001;16:765–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Bachelot A. Polycystic ovarian syndrome: clinical and biological diagnosis. Ann Biol Clin (Paris). 2016;74:661–7.Google Scholar
  54. 54.
    Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2011;7:CD007506.Google Scholar
  55. 55.
    Radon PA, McMahon MJ, Meyer WR. Impaired glucose tolerance in pregnant women with polycystic ovary syndrome. Obstet Gynecol. 1999;94:194–7.PubMedGoogle Scholar
  56. 56.
    Naderpoor N, Shorakae S, de Courten B, Misso ML, Moran LJ, Teede HJ. Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Hum Reprod Update. 2015;21:560–74.PubMedCrossRefGoogle Scholar
  57. 57.
    Qublan HS, Yannakoula EK, Al-Qudah MA, El-Uri FI. Dietary intervention versus metformin to improve the reproductive outcome in women with polycystic ovary syndrome. A prospective comparative study. Saudi Med J. 2007;28:1694–9.PubMedGoogle Scholar
  58. 58.
    Tang T, Glanville J, Hayden CJ, White D, Barth JH, Balen AH. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized, placebo-controlled, double-blind multicentre study. Hum Reprod. 2006;21:80–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Karimzadeh MA, Javedani M. An assessment of lifestyle modification versus medical treatment with clomiphene citrate, metformin, and clomiphene citrate-metformin in patients with polycystic ovary syndrome. Fertil Steril. 2010;94:216–20.PubMedCrossRefGoogle Scholar
  60. 60.
    Domecq JP, Prutsky G, Mullan RJ, et al. Lifestyle modification programs in polycystic ovary syndrome: systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98:4655–63.PubMedCrossRefGoogle Scholar
  61. 61.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes-3-year outcomes. N Engl J Med. 2014;370:2002–13.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Malik SM, Traub ML. Defining the role of bariatric surgery in polycystic ovarian syndrome patients. World J Diabetes. 2012;3:71–9.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Johansson K, Cnattingius S, Näslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372:814–24.PubMedCrossRefGoogle Scholar
  64. 64.
    Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016;22:687–708.PubMedCrossRefGoogle Scholar
  65. 65.
    Mihailidis J, Dermesropian R, Taxel P, Luthra P, Grant-Kels JM. Endocrine evaluation of hirsutism. Int J Womens Dermatol. 2017;3(1 Suppl):S6–S10.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Homburg R, Insler V. Ovulation induction in perspective. Hum Reprod Update. 2002;8:449–62.PubMedCrossRefGoogle Scholar
  67. 67.
    Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2012;16(5):CD003053.Google Scholar
  68. 68.
    Huang X, Wang P, Tal R, Lv F, Li Y, Zhang X. A systematic review and meta-analysis of metformin among patients with polycystic ovary syndrome undergoing assisted reproductive technology procedures. Int J Gynaecol Obstet. 2015;131:111–6.PubMedCrossRefGoogle Scholar
  69. 69.
    Goodman NF, Cobin RH, Futterweit W, et al. American association of clinical endocrinologists, American college of endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 2. Endocr Pract. 2015;21:1415–26.PubMedCrossRefGoogle Scholar
  70. 70.
    Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC. A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Fertil Steril. 2002;77:91–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Brown J, Farquhar C, Beck J, Boothroyd C, Hughes E. Clomiphene and anti-estrogens for ovulation induction in PCOS. Cochrane Database Syst Rev. 2009;4:CD002249.Google Scholar
  72. 72.
    Rostami-Hodjegan A, Lennard MS, Tucker GT, Ledger WL. Monitoring plasma concentrations to individualize treatment with clomiphene citrate. Fertil Steril. 2004;81:1187–93.PubMedCrossRefGoogle Scholar
  73. 73.
    Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008;23:462–77.CrossRefGoogle Scholar
  74. 74.
    Legro RS, Brzysli RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371:119–29.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Wang R, Kim B, van Wely M, et al. Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis. BMJ. 2017;356:j138.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Melo AS, Ferriani RA, Navarro PA. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics (Sao Paulo). 2015;70:765–9.CrossRefGoogle Scholar
  77. 77.
    Homburg R. Choices in the treatment of anovulatory PCOS. Current management of polycystic ovary syndrome. London: RCOG Press; 2010. p. 143–52.CrossRefGoogle Scholar
  78. 78.
    Palomba S. Aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab. 2015;100:1742–7.PubMedCrossRefGoogle Scholar
  79. 79.
    Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril. 2001;75:305–9.PubMedCrossRefGoogle Scholar
  80. 80.
    Biljan MM, Hemmings R, Brassard N. The outcome of 150 babies following the treatment with Letrozole or Letrozole and gonadotropins. Fertil Steril. 2005;84:S95.CrossRefGoogle Scholar
  81. 81.
    Committee Opinion No. 663 Summary: Aromatase Inhibitors in Gynecologic Practice. Obstet Gynecol. 2016.  https://doi.org/10.1097/AOG.0000000000001478.
  82. 82.
    Orvieto R, Homburg R. Chronic ultra-low dose follicle-stimulating hormone regimen for patients with polycystic ovary syndrome: one click, one follicle, one pregnancy. Fertil Steril. 2009;91:1533–5.PubMedCrossRefGoogle Scholar
  83. 83.
    Calaf Alsina J, Ruiz Balda JA, Romeu Sarrió A, et al. Ovulation induction with a starting dose of 50 IU of recombinant follicle stimulating hormone in WHO group II anovulatory women: the IO-50 study, a prospective, observational, multicentre, open trial. BJOG. 2003;110:1072–7.PubMedCrossRefGoogle Scholar
  84. 84.
    Weiss NS, Nahuis M, Bayram N, Mol BW, Van der Veen F, van Wely M. Gonadotropins for ovulation induction in women with polycystic ovarian syndrome. Cochrane Database Syst Rev. 2015;9:CD010290.Google Scholar
  85. 85.
    Lin H, Li Y, Li L, Wang W, Yang D, Zhang Q. Is a GnRH antagonist protocol better in PCOS patients? A meta-analysis of RCTs PLoS One. 2014;9:e91796.PubMedCrossRefGoogle Scholar
  86. 86.
    Hueb CK, Dias Junior JA, Abrão MS, Filho EK. Drilling: medical indications and surgical technique. Rev Assoc Med Bras. 2015;61:530–5.PubMedCrossRefGoogle Scholar
  87. 87.
    Youssef H, Atallah MM. Unilateral ovarian drilling in polycystic ovarian syndrome: a prospective randomized study. Reprod BioMed Online. 2007;15:457–62.PubMedCrossRefGoogle Scholar
  88. 88.
    Lebbi I, Ben Temime R, Fadhlaoui A, Feki A. Ovarian drilling in PCOS: is it really useful? Front Surg. 2015;2:30.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Birch Petersen K, Pedersen NG, Pedersen AT, Lauritsen MP, la CourFreiesleben N. Mono-ovulation in women with polycystic ovary syndrome: a clinical review on ovulation induction. Reprod BioMed Online. 2016;32:563–83.PubMedCrossRefGoogle Scholar
  90. 90.
    Wiser A, Shalom-Paz E, Reinblatt SL, Holzer H, Tulandi T. Controlled ovarian hyperstimulation in women with polycystic ovarian syndrome with or without intrauterine insemination. Gynecol Endocrinol. 2012;28:502–4.PubMedCrossRefGoogle Scholar
  91. 91.
    Heijnen EM, Eijkemans MJ, Hughes EG, et al. A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12:13–21.PubMedCrossRefGoogle Scholar
  92. 92.
    Sahu B, Ozturk O, Ranierri M, Serhal P. Comparison of oocyte quality and intracytoplasmic sperm injection outcome in women with isolated polycystic ovaries or polycystic ovarian syndrome. Arch Gynecol Obstet. 2008;277:239–44.PubMedCrossRefGoogle Scholar
  93. 93.
    Munné S, Dailey T, Sultan KM, Grifo J, Cohen J. The use of first polar bodies for preimplantation diagnosis of aneuploidy. Hum Reprod. 1995;10:1014–20.PubMedCrossRefGoogle Scholar
  94. 94.
    Gianaroli L, Magli MC, Ferraretti AP, Lappi M, Borghi E, Ermini B. Oocyte euploidy, pronuclear zygote morphology and embryo chromosomal complement. Hum Reprod. 2007;22:241–9.PubMedCrossRefGoogle Scholar
  95. 95.
    Weghofer A, Munne S, Chen S, Barad D, Gleicher N. Lack of association between polycystic ovary syndrome and embryonic aneuploidy. Fertil Steril. 2007;88:900–5.PubMedCrossRefGoogle Scholar
  96. 96.
    Wood JR, Dumesic DA, Abbott DH, Strauss JF III. Molecular abnormalities inoocytes from women with polycystic ovary syndrome revealed by microarray analysis. J Clin Endocrinol Metab. 2007;92:705–13.PubMedCrossRefGoogle Scholar
  97. 97.
    Diamanti-Kandarakis E. Polycystic ovarian syndrome: pathophysiology, molecular aspects and clinical implications. Expert Rev Mol Med. 2008;10:e31–21.CrossRefGoogle Scholar
  98. 98.
    Nejad ES, Saedi T, Saedi S, Rashidi BH, Nekoo ZA, Jahangiri N. Comparison of in vitro fertilisation success in patients with polycystic ovary syndrome and tubal factor. Gynecol Endocrinol. 2011;27:117–20.PubMedCrossRefGoogle Scholar
  99. 99.
    Li HW, Lee VC, Lau EY, Yeung WS, Ho PC, Ng EH. Cumulative live-birth rate in women with polycystic ovary syndrome or isolated polycystic ovaries undergoing in-vitro fertilisation treatment. J Assist Reprod Genet. 2014;31:205–11.PubMedCrossRefGoogle Scholar
  100. 100.
    McCormick B, Thomas M, Maxwell R, Williams D, Aubuchon M. Effects of polycystic ovarian syndrome on in vitro fertilization-embryo transfer outcomes are influenced by body mass index. Fertil Steril. 2008;90:2304–9.PubMedCrossRefGoogle Scholar
  101. 101.
    Bellver J, Martinez-Conejero JA, Labarta E, et al. Endometrial gene expression in the window of implantation is altered in obese women especially in association with polycystic ovary syndrome. Fertil Steril. 2011;95:2335–41.PubMedCrossRefGoogle Scholar
  102. 102.
    Fong SA, Palta V, Oh C, Cho MM, Loughlin JS, McGovern PG. Multiple pregnancy after gonadotropin-intrauterine insemination: an unavoidable event? Obstet Gynecol. 2011;2011:465483.Google Scholar
  103. 103.
    Harbottle S, Hughes C, Cutting R, Roberts S, Brison D. Association of Clinical Embryologists & the (ACE) British Fertility Society (BFS). Elective single embryo transfer: an update to UK best practice guidelines. Hum Fertil (Camb). 2015;18:165–83.CrossRefGoogle Scholar
  104. 104.
    Fatemi HM, Garcia-Velasco J. Avoiding ovarian hyperstimulation syndrome with the use of gonadotropin-releasing hormone agonist trigger. Fertil Steril. 2015;103:870–3.PubMedCrossRefGoogle Scholar
  105. 105.
    Garcia-Velasco JA. Agonist trigger: what is the best approach? Agonist trigger with vitrification of oocytes or embryos. Fertil Steril. 2012;97:527–8.PubMedCrossRefGoogle Scholar
  106. 106.
    Al-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotropin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2016;4:CD001750.PubMedGoogle Scholar
  107. 107.
    Kollmann M, Klaritsch P, Martins WP, et al. Maternal and neonatal outcomes in pregnant women with PCOS: comparison of different diagnostic definitions. Hum Reprod. 2015;30:2396–403.PubMedCrossRefGoogle Scholar
  108. 108.
    Palomba S, de Wilde MA, Falbo A, Koster MP, La Sala GB, Fauser BC. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update. 2015;21:575–92.PubMedCrossRefGoogle Scholar
  109. 109.
    Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12:673–83.PubMedCrossRefGoogle Scholar
  110. 110.
    Kjerulff LE, Sanchez-Ramos L, Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a metaanalysis. Am J Obstet Gynecol. 2011;204:558.e1–6.CrossRefGoogle Scholar
  111. 111.
    Qin JZ, Pang LH, Li MJ, Fan XJ, Huang RD, Chen HY. Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2013;11:56.Google Scholar
  112. 112.
    Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS). HumReprod. 2012;27:14–24.Google Scholar
  113. 113.
    Sterling L, Liu J, Okun N, Sakhuja A, Sierra S, Greenblatt E. Pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization. Fertil Steril. 2016;105:791–7.e2.PubMedCrossRefGoogle Scholar
  114. 114.
    Palomba S, Falbo A, Chiossi G, et al. Low-grade chronic inflammation in pregnant women with polycystic ovary syndrome: a prospective controlled clinical study. J Clin Endocrinol Metab. 2014;99:2942–51.PubMedCrossRefGoogle Scholar
  115. 115.
    Maliqueo M, SundströmPoromaa I, Vanky E, et al. Placental STAT3 signaling is activated in women with polycystic ovary syndrome. Hum Reprod. 2015;30:692–700.PubMedCrossRefGoogle Scholar
  116. 116.
    Roos N, Kieler H, Sahlin L, Ekman-Ordeberg G, Falconer H, Stephansson O. Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study. BMJ. 2011;343:d6309.PubMedPubMedCentralCrossRefGoogle Scholar
  117. 117.
    Naver KV, Grinsted J, Larsen SO, et al. Increased risk of preterm delivery and pre-eclampsia in women with polycystic ovary syndrome and hyperandrogenaemia. BJOG. 2014;121:575–81.PubMedCrossRefGoogle Scholar
  118. 118.
    Joham AE, Ranasinha S, Zoungas S, Moran L, Teede HJ. Gestational diabetes and type 2 diabetes in reproductive-aged women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2014;99:447–52.CrossRefGoogle Scholar
  119. 119.
    Vanky E, Stridsklev S, Heimstad R, et al. Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study. J Clin Endocrinol Metab. 2010;95:448–55.CrossRefGoogle Scholar
  120. 120.
    Feng L, Lin XF, Wan ZH, Hu D, Du YK. Efficacy of metformin on pregnancy complications in women with polycystic ovary syndrome: a meta-analysis. Gynecol Endocrinol. 2015;31:833–9.PubMedCrossRefGoogle Scholar
  121. 121.
    van der Spuy Z, Dyer S. The pathogenesis of infertility and early pregnancy loss in polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2004;18:755–71.PubMedCrossRefGoogle Scholar
  122. 122.
    Joham AE, Boyle JA, Ranasinha S, Zoungas S, Teede HJ. Contraception use and pregnancy outcomes in women with polycystic ovary syndrome: data from the Australian Longitudinal Study on Women's Health. Hum Reprod. 2014;29:802–8.PubMedCrossRefGoogle Scholar
  123. 123.
    Wang Q, Luo L, Lei Q, et al. Low aneuploidy rate in early pregnancy loss abortuses from patients with polycystic ovary syndrome. Reprod BioMed Online. 2016;33:85–92.PubMedCrossRefGoogle Scholar
  124. 124.
    Løvvik TS, Wikström AK, Neovius M, Stephansson O, Roos N, Vanky E. Pregnancy and perinatal outcomes in women with polycystic ovary syndrome and twin births: a population-based cohort study. BJOG. 2015;122:1295–302.PubMedCrossRefGoogle Scholar
  125. 125.
    Han AR, Kim HO, Cha SW, et al. Adverse pregnancy outcomes with assisted reproductive technology in non-obese women with polycystic ovary syndrome: a case-control study. Clin Exp Reprod Med. 2011;38:103–8.PubMedPubMedCentralCrossRefGoogle Scholar
  126. 126.
    Palomba S, Santagni S, Falbo A, La Sala GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Womens Health. 2015;7:745–63.PubMedPubMedCentralCrossRefGoogle Scholar
  127. 127.
    Winter S, Talbott E, Guzick D, Zborowski J, McHugh K. Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome. Fertil Steril. 2000;73:724–7229.CrossRefGoogle Scholar
  128. 128.
    Brown ZA, Louwers YV, Fong SL. The phenotype of polycystic ovary syndrome ameliorates with aging. Fertil Steril. 2011;96:1259–65.PubMedCrossRefGoogle Scholar
  129. 129.
    Schmidt J, Brannstrom M, Landin-Wihelmsen K, Dahigren E. Reproductive hormone levels and anthropometry in postmenopausal women with polycystic ovary syndrome (PCOS): a 21-year-follow-up study of women diagnosed with PCOS around 50 years ago and their age-matched controls. J Clin Endocrinol Metab. 2011;96:2178–85.PubMedCrossRefGoogle Scholar
  130. 130.
    Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in woman withpolycystic ovary syndrome: a systematicreview and meta-analysis. Hum Reprod Update. 2012;18:618–37.PubMedCrossRefGoogle Scholar
  131. 131.
    Randeva HS, Tan BK, Weickert MO, et al. Cardiometabolic aspects of the polycystic ovary syndrome. Endocr Rev. 2012;33:812–41.PubMedPubMedCentralCrossRefGoogle Scholar
  132. 132.
    Echiburú B, Crisosto N, Maliqueo M, et al. Metabolic profile in women with polycystic ovary syndrome across adult life. Metabolism. 2016;65:776–82.PubMedCrossRefGoogle Scholar
  133. 133.
    Lo JC, Feigenbaun SL, Yang J, Pressman AR, Selby JV, Go AS. Epidemiology and adverse cardiovascular riskprofile of diagnosedpolycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91:1357–63.PubMedCrossRefGoogle Scholar
  134. 134.
    Gutierrez-Grobe Y, Ponciano-Rodríguez G, Ramos MH, Uribe M, Méndez-Sánchez N. Prevalence of nonalcoholic fatty liver disease in premenopausal, posmenopausal and polycystic ovary syndrome women. The role of estrogens. Am Hepatol. 2010;9:402–9.Google Scholar
  135. 135.
    Veltman-Verhulst SM, Boivin J, Eijkemans MJ, Fauser BJ. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Hum Reprod Update 2012; 18:638–651.Google Scholar
  136. 136.
    Barry JA, Mallika MA, Hardiman PJ. Risk of endometrial, ovarian and breast cancer with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014;20:748–58.PubMedPubMedCentralCrossRefGoogle Scholar
  137. 137.
    Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose intolerance in polycystic ovary syndrome- a position statement of the Androgen Excess Society. J Clin Endocrinol Metab. 2007;92:4546–56.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • José Bellver
    • 1
  • Luis Rodríguez-Tabernero
    • 2
  • Ana Robles
    • 3
  • Elkin Muñoz
    • 4
  • Francisca Martínez
    • 5
  • José Landeras
    • 6
  • Juan García-Velasco
    • 7
  • Juan Fontes
    • 8
  • Mónica Álvarez
    • 9
  • Claudio Álvarez
    • 10
  • Belén Acevedo
    • 11
  • Group of interest in Reproductive Endocrinology (GIER) of the Spanish Fertility Society (SEF)
  1. 1.IVI-ValenciaUniversity of ValenciaValenciaSpain
  2. 2.Hospital Clínico UniversitarioValladolidSpain
  3. 3.Hospital del MarBarcelonaSpain
  4. 4.IVI-VigoVigoSpain
  5. 5.Salud de la MujerHospital Universitario DexeusBarcelonaSpain
  6. 6.IVI-MurciaMurciaSpain
  7. 7.IVI-MadridRey Juan Carlos UniversityMadridSpain
  8. 8.Hospital Virgen de las NievesGranadaSpain
  9. 9.Hospital Materno InfantilLas PalmasSpain
  10. 10.URE Centro GutenbergMálagaSpain
  11. 11.Fundación Jiménez DíazMadridSpain

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