Causes of Impaired Fertility in Women with Polycystic Ovary Syndrome

Objective: To review recent literature regarding the potential causes of impaired fertility in women with polycystic ovary syndrome. Design: Medline review and cross-reference of published literature. Results: The underlying pathophysiology of polycystic ovary syndrome has significant negative impact on reproductive potential. Yet no single pathogenic alteration can completely account for its negative reproductive impact. Excessive LH secretion increases the follicular androgen concentration and in combination with hyperinsulinemia alters the follicular fluid microenvironment. These endocrine aberrations may result in a reduction in oocyte quality. Conclusion: Infertile PCOS patients have unique alterations in the underlying physiology that results in impaired fertility. Recent data from ART cycles is leading to an improved understanding of the underlying abnormalities and may direct future therapy to improve reproductive outcomes among these patients. Keywords: Polycystic ovary syndrome, PCOS, assisted reproductive technology, infertility, etiology