I. The importance of pretreatment before ovulation in patients with polycystic ovary syndrome 1. The pretreatment process must be carried out and cannot be omitted Pretreatment includes reducing androgens and luteinizing hormone and improving sensitivity to insulin. For example, if a patient has taken three boxes of birth control pills to regulate hormones and has her period after the last box, she is expected to come to the hospital for hormone testing within 3-5 days of her period. If it is determined that the hormones have dropped to normal, oral ovulation treatment with clomiphene is recommended as the first line of treatment, starting within 5 days of menstruation. Some patients are able to ovulate normally, have intercourse and become pregnant in the first month, or with the help of other forms of pregnancy assistance, such as artificial insemination. The pretreatment process must be carried out without any rush. 2. Follicle quality If ovulation is forced with drugs, there is a chance that the follicles will not grow. Also. Poor quality of follicles may not conceive, get pregnant but end in miscarriage because such eggs are grown in a very abnormal environment. But sometimes even with very standard pretreatment and ovulation treatment, the chances of conceiving at intercourse are not very high, averaging about 10%, so it is necessary to go through several ovulation treatments. 3. Importance of pretreatment Some patients may stop treatment due to work and other reasons. During this time, if hormone control is continued without oral medication, the hormones will quickly return to their original abnormal state. Because the cause of polycystic ovary syndrome is unknown, clinical treatment cannot correct the cause, but can only bring down the hormone levels that cause the abnormality, but the effect is short-term. If this is the case, the patient is advised to continue taking oral contraceptives during this period. This will allow them to start ovulation treatment again after 2 or 3 months of returning from work without delay. However, if there is no treatment during this period, most patients’ hormone levels return to the abnormal state of the original disease and they need to start pretreatment again from the beginning and start ovulation promotion again after about 3 months of treatment, which will delay the process again for some time. This shows that pretreatment is very important, both for the doctor and the patient, and is worthwhile. 4. There are several things you can do at the same time during the pretreatment waiting period There are several things you can do at the same time during the waiting process. You can perform the examination of the male partner’s semen and the imaging of the female partner’s fallopian tubes, and develop the appropriate plan after the examination. If the female partner has a problem with polycystic ovulation disorder and also has a problem with incompetent fallopian tubes, the patient will need to be operated on or go directly to IVF. There are also some mixed problems, such as the female partner has polycystic ovary syndrome and the male partner has severe abnormal sperm count and morphology, which can only be solved by IVF techniques. This pre-treatment can directly enter the IVF process afterwards, making the whole treatment process more scientific and smoother. Analysis of the causes of repeated implantation failure and endosperm scratching 1. Analysis of the causes of repeated implantation failure Repeated implantation failure is a difficult problem in the field of reproduction. Many patients transfer embryos more than three times, and even if there are good quality embryos, they still cannot obtain a successful pregnancy even after transferring more than 10 embryos. There are many reasons for this situation, which can be generally divided into three aspects: First, embryo problems In the future, embryos with no genetic and chromosomal problems can be selected for transfer through screening of embryos. It can also be done in other ways, such as improving the culture medium and trying to choose blastocysts. There are also relatively new techniques to replace the cytoplasm and retain the part of its genetic material, the cytosol. Secondly, there is the problem of endometrial tolerance such as endometrial polyps, uterine adhesions, etc. Repeated uterine operations, especially abortions, cause a significantly higher incidence of uterine adhesions. With more than three abortions, the chance of cavity adhesions is as high as 30%. Therefore, young women are advised to choose a reasonable form of contraception to reduce the possible damage caused by surgical operations on the uterus until they have completed childbirth. In addition, submucosal fibroids and longitudinal uterine diaphragms should be treated promptly after detection. Many teams in China and abroad have also conducted in-depth studies, such as changes in the corresponding genes in endometrial tolerance, some defects occurring during embryo implantation, and some teams have made progress in the research of new drugs, for example, it has been found that cyclocyte A, an immunosuppressant, can reduce the rate of miscarriage. Thirdly, maternal factors and the existence of immunological problems between the mother and the embryo. For example, the thyroid gland, which is currently a major concern, can be routinely screened for hyperthyroidism or hypothyroidism. It is now considered routine to perform serum testing for thyroid function before conception and before IVF or artificial insemination. Patients who have had more than two failed transplants are recommended to be screened for immunological aspects such as anti-cardiolipin antibodies, beta2 glycoprotein, homocysteine, etc. for the presence of diseases such as antiphospholipid syndrome. Antiphospholipid syndrome can cause recurrent implantation failure, miscarriage, and intrauterine fetal death. 2. Hysteroscopy Hysteroscopy is a relatively basic operation in gynecology. It is now considered that hysteroscopy is an option for patients who have had more than two failed implantations, even if no typical endometrial lesions are found on ultrasound. Even if the intraoperative examination is not problematic, the postoperative clinical pregnancy rate can be significantly improved. The reason for this may be related to the scratching of the endometrium through the uterine operation. 3. Endoscopic scraping It is well documented that patients with repeated implantation failures can try endoscopic scraping around the mid-luteal phase of the previous cycle to the first 7 days of the transplantation cycle, which can significantly increase the clinical pregnancy rate and the rate of carrying the baby home. However, if endoscopic scratching is performed on the day of egg retrieval, the clinical pregnancy rate is significantly reduced. Therefore, the recommended time is seven days after the mid-luteal phase of the previous cycle, or seven days before the transplantation cycle. The method of scraping varies, initially reported in the literature with a spatula, but also with a suction tube or a cytobrush, which is more commonly used clinically. The negative pressure and rotational scraping action of the brush in the uterine cavity can increase the clinical pregnancy rate by brushing a certain amount of endometrium, causing an inflammatory response to the endometrium and even altering its tolerance. Most current Meta-analyses suggest that this increases the clinical pregnancy rate.