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Abstract
PCOS is the most common endocrinopathy in women and most common cause of anovultory infertility. As a syndrome, it has multiple components; reproductive, metabolic and cardiovascular with health implications across the life span.
Androgen excess and insulin resistance, both have strong genetic components that underline much of the clinical presentation. Insulin resistance is present in obese and non-obese patients with PCOS.
The spectrum of clinical presentation includes also; dyslipidemia, endothelial dysfunction, endometrial cancer, breast cancer and ovarian cancer.
Lifestyle modification is a corner stone in the management as it has a striking improvement on ovulatory function and features of hyperandrogenism.
Insulin sensitizers are unique in PCOS as it offers both metabolic and gynecological benefits. The first pharmacological approach of induction of ovulation in infertile women with PCOS is CC because of its safety, effectiveness, simple mode of administration and relatively low cost. The next step in CC resistant patients is the use of gonadotrophin therapy.
The surgical treatment of PCOS is mainly laparoscopic that may be done through electrocauterization or laser techniques.
Benefits of LOD are mainly endocrinological as it results in destruction of a proportion of androgen producing tissue resulting in reduced intraovarian androgen production. Correction of the ovarian pituitary feedback disturbance occurs through decreasing LH levels in few weeks following LOD which inturn restores the hypothalamic pituitary axis.
The other great benefit of LOD is nearly absence of occurance of OHSS and no increased risk of multiple pregnancy.