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PCOS is a common cause of female infertility being a key factor in up to 20% of women with difficulty conceiving. Importantly, PCOS is a clinical syndrome consisting of ovulatory dysfunction (usually irregular or absent menses), relatively increased androgen (male hormone) levels, and the presence of multiple small follicles/ cysts on the ovaries on sonogram.
One finding in PCOS is that of elevated levels of androgens, or male hormones, such as testosterone. This can be manifested by excess body hair (hirsutism), and sometimes, increased acne. Although many PCOS patients are overweight, thin women can also have the syndrome.
PCOS is frequently associated with increased levels of insulin, a condition known as hyperinsulinemia. Elevated insulin levels can be associated with the overproduction of androgens by the ovary, which ultimately leads to impaired follicle growth and ovulatory dysfunction. In some  overweight patients with PCOS, the hyperinsulinemia may signify a predisposition to diabetes, or impaired glucose tolerance.
Current medical treatment of PCOS is targeted to reduce the levels of insulin with drugs such as metformin, an insulin sensitizing agent. As insulin levels decline the production of androgens by the ovaries also decreases and normal ovulation is often established. Many specialists prescribe long term treatment with metformin to reduce long term health risks associated with the condition. Long-term health consequences may include type II diabetes, cardiovascular disease, and increased risk for some types of cancer.
For ovulation induction, Clomid is also sometimes used as a first line treatment, and it is also sometimes used in combination with metformin. Follicle stimulating hormone (FSH) can also be used to induce ovulation, either in combination with IUI or IVF. However, PCOS patients often have an exaggerated response to FSH and the drug should only be administered by a reproductive endocrinologist , fertility specialist, thoroughly trained in its use.
Surgical treatment (“ovarian diathermy” or “ovarian drilling”) is sometimes performed, essentially removing portions of the ovary in order to reduce androgen production. Surgery is rarely performed today due to the effectiveness of medical therapies.
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