O-094 Management of subfertility in women with PCOS: expectations, problems and solutions

Abstract Polycystic ovarian syndrome (PCOS) is a common cause of subfertility particularly when anovulation present. In this circumstance efforts are made to induce ovulation through lifestyle modification, medication, or combination both. Other patients with PCOS may be ovulatory but require IVF/ICSI for other causes, including male factor tubal infertility. all cases, attention needs placed on the underlying metabolic, psychological, and reproductive features that complicate treatment subsequent pregnancy. Pregnancy itself has higher chance complications these can reduced by adequate preconception evaluation intervention. Recently, international evidence-based guideline been updated (1) infertility section subjected literature integrity check exclude publications did not meet highest criteria incorporation into clinical management. A recent individual patient data meta-analysis also clarified relative efficacy fertility treatments (2). The following conclusions recommended; 1. Letrozole first line drug choice induction based its lower multiple pregnancy rate 2. Clomiphene an effective given long experience use cost 3. Metformin valuable some if glucose intolerance present 4. clomiphene metformin effective, in overweight individuals 5. Gonadotrophins experienced clinics which resources undergo monitoring 6. Laparoscopic surgery assist associated have term benefits 7. IVF safely conducted appropriate safeguards reduce hyperstimulation those where failed. It should noted drugs “off-label” many countries recommended several healthcare systems.There areas further information lead altered improved practice: as therapy more allow better control rates. vitro maturation (IVM) shows increasing success no minimal FSH (3). Bariatric readily available significant weight loss related ovulation. Newer GLP1 receptor agonists show dramatic being evaluated PCOS. First gonadotrophin advocated proponents. Higher dose longer standard oral agents help resistant patients. Inositol myoinositol safe, low cost, over counter alternatives. 8. Alternatives hCG cycles. 9. Promising pharmacogenomic approaches individualisation treatment. While genomic environmental aetiology remains uncertain, emphasis assessment therapies advancing rapidly. References https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf Wang R et al Hum Reprod Update. 2019 Nov 5;25(6):717-732. Vuong LN Reprod. 2020 1;35(11):2537-2547.