Every patient who comes to the Fertility Center is very anxious, but we cannot rush for the sake of our own health and that of our next generation. Especially for women who have been identified as having polycystic ovary syndrome (hereinafter referred to as “polycystic”), you are unfortunate but also lucky. The success is not far from us, but we have to take every step in the right direction. The first step – adjusting lifestyle When it comes to adjusting lifestyle, some people often do not think so, but in fact, this step should never be ignored in the treatment of polycystic patients. Although the cause of polycystic is still unclear, most people believe that it is the result of the interaction between genetic and environmental factors, and obesity, high androgen and insulin resistance are those three factors that are causative and mutually reinforcing. To combat these three factors, we need to do “no sugar, less oil, more exercise, lower weight”, these points do a good job, some patients may even resume menstruation on their own, normal conception! Even if normal menstruation is not restored, lifestyle adjustments will lay a solid foundation for later treatment. Step 2 – Adjust endocrine and metabolism The purpose of endocrine adjustment is not to adjust menstruation, but to allow the follicles to develop and mature so that they can discharge good quality eggs and reduce the probability of miscarriage, and also to improve the endometrial problems caused by long-term menstrual irregularities. Good seeds (fertilized eggs), good soil (endometrium) and good environment (hormone levels and metabolism in the woman’s body) are the conditions under which a better pregnancy attempt can be made. Before starting treatment, polycystic patients are subjected to blood hormone measurements, including androgens, luteinizing hormone, follicle stimulating hormone, and lactogen, etc. High androgens and high prolactin can cause non-ovulation. An abnormal ratio of luteinizing hormone to follicle stimulating hormone may cause miscarriage. In addition, recent studies have found that vitamin D deficiency, like insulin resistance, may cause a number of complications during pregnancy and may affect egg quality and thus cause miscarriage. Therefore, according to the test results, the doctor will tailor a treatment plan to adjust the endocrine and metabolism of the patient, and after the internal environment of the body is normalized, the medication can be stopped under the guidance of the doctor, and the patient can try to conceive with intercourse. Step 3 – Medication to promote ovulation After the previous step, 20%-30% of patients may still be unable to conceive, and then medication is needed to promote ovulation. There are two types of ovulation-promoting drugs in common use: oral and injectable. The simplest and most commonly used are oral clomiphene or letrozole. Clomiphene is usually taken from 3 to 5 days into the menstrual cycle, taking 50-100mg per day for 5 days. To prevent excessive follicle growth and to observe the exact efficacy, it should be combined with ultrasound monitoring of follicle development (for more details, please see “Notes on Ultrasound Monitoring of Ovulation at Chaoyang Hospital”). On one hand, the doctor can adjust the medication according to the efficacy, and on the other hand, he/she can guide the patient on the timing of intercourse. However, there are still 15% of patients who do not ovulate after taking clomiphene or letrozole. At this time, a second form of ovulation promotion can be used – gonadotropin injections. The efficacy of gonadotropin injections is positive, but some patients may grow multiple follicles at once after taking the drug, which may in turn trigger ovarian hyperstimulation syndrome. Ovarian hyperstimulation syndrome causes enlargement of the ovaries, causing ascites, hydrothorax, local or generalized edema, blood concentration and oliguria, so patients who take gonadotropin shots must have ultrasound to monitor ovulation. If there is still no effect after 3 cycles of injections, further treatment may be needed. The next step of treatment includes: surgery and IVF. However, surgery has some damage and may result in ineffective treatment, pelvic adhesions, low ovarian function or even premature ovarian failure, so we do not recommend surgery for patients at this time.