PCOS – Definition, Diagnosis and Treatment
The definition, diagnosis and treatment of patients with PCOS are still controversial. The below survey, conducted by Prof. Adam Balen, Leeds Centre for Reproductive Medicine, Seacroft Hospital, Leeds, U.K is looking at the clinical applications related to this issue.   Your time and efforts are very much appreciated and your contribution will obviously support better treatment for patients worldwide. The personal data requested aims only to assure the safety and authenticity of the data submitted. No personal data will be published.
Name
Name of IVF Center
Email
1. Country
2. Estimated number of total IVF cycles performed by the unit annually
Less Than 100 cycles 100-200 cycles 200-300 cycles 300-400 cycles 400-500 cycles 500-600 cycles 600-700 cycles 700-800 cycles 800-900 cycles 900-1000 cycles 1000-1200 cycles 1200-1400 cycles 1400-1600 cycles 1600-1800 cycles 1800-2000 cycles 2000-2500 cycles 2500-3000 cycles 3000-3500 cycles 3500-4000 cycles >4000 cycles
3. Do you think that reaching a clear definition of the ovarian state is important for the treatment?
1-Yes 2- No
4. Do you define a patients with PCOS based on the Rotterdam ESHRE/ASRM Consensus Criteria? (Two of three criteria: Chronic anovulation; Clinical and/or biochemical evidence of hyperandrogenism, and Polycystic ovaries)
1-Yes 2-No
5. If you do not use the Rotterdam Criteria do you use any of the below:
1-NIH 1990 criteria? (Chronic anovulation, Clinical and/or biochemical evidence of androgen excess, after exclusion of other pathologies) 2-Androgen Excess Society (AES) 2006 criteria, which allow ultrasound findings of 3-PCOS as substitute for irregular menses 3-I use the Rotterdam criteria 4-Other
6. Do you measure LH/FSH ratio and androgens to define patients with PCOS?
1-Yes 2-No
7. In your opinion is androgen excess is a prerequisite for the definition of PCOS?
1-Yes 2-No
8. Which androgens do you measure?
1-Total testosterone 2-Free testosterone 3-Free androgen index 4-Androstenedione 5-DHEAS 6-(17-OH) progesterone 7-Combination of the above 8-Other 9-None of the above
9. Do you routinely measure anti-Mullerian hormone (AMH)?
1-Yes 2-No
10. If you measure AMH, does this help you to define PCOS?
1-Yes 2-No 3-I do not measure
11. Should ultrasound appearance of PCO in the presence of anovulation, with normal prolactin be enough for the definition?
1-Yes 2-No
12. Should a definition of PCOS is important for the treatment?
1-Yes 2-No
13. If the patient presents with anovulation and PCO on ultrasound, is the LH/FSH ratio important?
1-Yes, I need to know the androgen and LH/FSH status to initiate treatment 2-Yes, I need to know the LH/FSH ratio 3-No, I do not need it to start treatment
14. Do you assess for Impaired Glucose Tolerance (IGT)?
1-Yes 2-No
15. If you assess for IGT is this in:
1-All patients 2-Obese patients only 3-I do not assess IGT
16. How do you assess IGT?
1-Fasting Glucose 2-Oral GTT 3-Fasting insulin (I) 4-Insulin:Glucose ratio 5-HOMA-IR (homeostasis model assessment–insulin resistance) 6-QUICKI (quantitative insulin-sensitivity check index) 7-Combination of the above 8-None of the above
17. In the workup for diagnosis would you look for non-classical congenital adrenal hyperplasia?
1-Yes 2-No
18. In case of primary infertility in anovulatroy PCOS patient what is your first line of treatment?
1-Metformin for all with no O.I. drugs 2-Metformin to those who are diagnosed with insulin intolerance 3-CC with or without Metformin 4-Aromatase inhibitors with or without Metformin 5-Gonadotropins with or without Metformin 6-IVF with or without Metformin 7-IVM with or without Metformin 8-Laparascopic cauterization / ovarian drilling 9-Other
19. If you use clomiphene citrate do you monitor with:
1-Ultrasound 2-Ultrasound plus luteal phase progesterone measurement 3-Ultrasound plus Estrogen plus luteal phase progesterone measurement 4-Luteal phase progesterone measurement 5-No monitoring
20. If you use Gonadotorpin therapy, which protocol do you use?
1-Classical step-up 2-Low dose step-up 3-Step-down 4-Sequential 5-Other
21. Is there a limit to BMI above which you will not give IVF treatment?
1-NO, we do not stop treatment in any case, related to obesity 2-BMI above 30 3-BMI above 35 4-BMI above 40 5-BMI above 45
22. Do you recommend treatment with Metformin (Glucophage) before starting the IVF treatment (for at least one month)?
1-Yes 2-No
23. Would you prefer to do IVF using GnRH agonists, GnRH antagonists, natural cycle or IVM?
1-In most of the cases I use GnRH agonists 2-In most of the cases I use GnRH antagonists 3-I prefer to start with the OC pill and continue with GnRH agonist 4-I prefer Natural cycle 5-In most of the cases I do IVM 6-None of the above
24. Which drug do you use for stimulation in IVF?
1-I use CC with gonadotropins 2-I use FSH only (recombinant FSH) 3-I use FSH and add LH if necessary (recombinant drugs) 4-I always start with a combination of FSH and LH (recombinant drugs) 5-I always start with FSH and add mini dose of hCG 6-I always use hMG 7-I use different protocols with different stimulation drugs
25. What dose of gonadotopin you usually start in IVF cycles?
1-I do not reduce the starting dose in PCOS patients 2-I usually start with 150 IU of FSH and in PCOS patients I reduce the dose to be in between 75 to 150IU 3-I usually start with 225 IU of FSH and in PCOS patients I reduce the dose to be in between 150 to 225IU 4-None of the above
26. Can you estimate the percentage of PCOS patients in your clinic?
1-Less than 10 percent 2-Less than 10-15 percent 3-Less than 15-20 percent 4-More than 20%
27. Can you estimate the pregnancy rate among these patients in comparison to the other population you treat?
1-No change in pregnancy rate 2-Lower pregnancy rate 3-Higher pregnancy rate
28. In case of finding on the day of hCG an ultrasound scan in which the ovaries contain around 30 follicles in between 12-25 mm in diameter (in both ovaries), and estradiol level of 8000 pg/ml (29,000 pmol/l) what would you do?
1-Go ahead with hCG and aspirate the follicles 2-Administer 0.5 of the usual dose of hCG and go ahead with aspiration 3-Give hCG and aspirate the follicles and give albumin 4-Administer 0.5 of the usual dose of hCG and go ahead with aspiration and give albumin 5-Costing until the estraiol level decrease to the usual range in my unit 6-Cancel the cycle 7-Aspirate the eggs, freeze any embryos created and avoid fresh transfer 8-Aspirate the eggs, give albumin, freeze any embryos created and avoid fresh transfer 9-Administer dopamine agonists and continue with IVF 10-Other not specified above
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