•  

PCOS – Definition, Diagnosis and Treatment

 

Do you think that reaching a clear definition of the ovarian state is important for the treatment?
  • Yes
  • No

 

Do you define 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)
  • Yes
  • No

 

If you do not use the Rotterdam Criteria do you use any of the below:
  • NIH 1990 criteria? (Chronic anovulation, Clinical and/or biochemical evidence of androgen excess, after exclusion of other pathologies)
  • Androgen Excess Society (AES) 2006 criteria, which allow ultrasound findings of 3-PCOS as substitute for irregular menses
  • I use the Rotterdam criteria
  • Other

 

Do you measure LH/FSH ratio and androgens to define patients with PCOS?
  • Yes
  • No

 

In your opinion is androgen excess is a prerequisite for the definition of PCOS?
  • Yes
  • No

 

Which androgens do you measure?
  • Total testosterone
  • Free testosterone
  • Free androgen index
  • Androstenedione
  • DHEAS
  • (17-OH) progesterone
  • Combination of the above
  • Other
  • None of the above

 

Do you routinely measure anti-Mullerian hormone (AMH)?
  • Yes
  • No

 

If you measure AMH, does this help you to define PCOS?
  • Yes
  • No
  • I do not measure

 

Should ultrasound appearance of PCO in the presence of anovulation, with normal prolactin be enough for the definition?
  • Yes
  • No

 

Should a definition of PCOS is important for the treatment?
  • Yes
  • No

 

If the patient presents with anovulation and PCO on ultrasound, is the LH/FSH ratio important?
  • Yes, I need to know the androgen and LH/FSH status to initiate treatment
  • Yes, I need to know the LH/FSH ratio
  • No, I do not need it to start treatment

 

Do you assess for Impaired Glucose Tolerance (IGT)?
  • Yes
  • No

 

If you assess for IGT is this in:
  • All patients
  • Obese patients only
  • I do not assess IGT

 

How do you assess IGT?
  • Fasting Glucose
  • Oral GTT
  • Fasting insulin (I)
  • Insulin:Glucose ratio
  • HOMA-IR (homeostasis model assessment–insulin resistance)
  • QUICKI (quantitative insulin-sensitivity check index)
  • Combination of the above
  • None of the above

 

In the workup for diagnosis would you look for non-classical congenital adrenal hyperplasia?
  • Yes
  • No

 

In case of primary infertility in anovulatroy PCOS patient what is your first line of treatment?
  • Metformin for all with no O.I. drugs
  • Metformin to those who are diagnosed with insulin intolerance
  • CC with or without Metformin
  • Aromatase inhibitors with or without Metformin
  • Gonadotropins with or without Metformin
  • IVF with or without Metformin
  • IVM with or without Metformin
  • Laparascopic cauterization / ovarian drilling
  • Other

 

If you use clomiphene citrate do you monitor with:
  • Ultrasound
  • Ultrasound plus luteal phase progesterone measurement
  • Ultrasound plus Estrogen plus luteal phase progesterone measurement
  • Luteal phase progesterone measurement
  • No monitoring

 

If you use Gonadotorpin therapy, which protocol do you use?
  • Classical step-up
  • Low dose step-up
  • Step-down
  • Sequential
  • Other

 

Is there a limit to BMI above which you will not give IVF treatment?
  • NO, we do not stop treatment in any case, related to obesity
  • BMI above 30
  • BMI above 35
  • BMI above 40
  • BMI above 45

 

Do you recommend treatment with Metformin (Glucophage) before starting the IVF treatment (for at least one month)?
  • Yes
  • No

 

Would you prefer to do IVF using GnRH agonists, GnRH antagonists, natural cycle or IVM?
  • In most of the cases I use GnRH agonists
  • In most of the cases I use GnRH antagonists
  • I prefer to start with the OC pill and continue with GnRH agonist
  • I prefer Natural cycle
  • In most of the cases I do IVM
  • None of the above

 

Which drug do you use for stimulation in IVF?
  • I use CC with gonadotropins
  • I use FSH only (recombinant FSH)
  • I use FSH and add LH if necessary (recombinant drugs)
  • I always start with a combination of FSH and LH (recombinant drugs)
  • I always start with FSH and add mini dose of hCG
  • I always use hMG
  • I use different protocols with different stimulation drugs

 

What dose of gonadotopin you usually start in IVF cycles?
  • I do not reduce the starting dose in PCOS patients
  • I usually start with 150 IU of FSH and in PCOS patients I reduce the dose to be in between 75 to 150IU
  • I usually start with 225 IU of FSH and in PCOS patients I reduce the dose to be in between 150 to 225IU
  • None of the above

 

Can you estimate the percentage of PCOS patients in your clinic?
  • Less than 10 percent
  • Less than 10-15 percent
  • Less than 15-20 percent
  • More than 20%

 

Can you estimate the pregnancy rate among these patients in comparison to the other population you treat?
  • No change in pregnancy rate
  • Lower pregnancy rate
  • Higher pregnancy rate

 

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?
  • Go ahead with hCG and aspirate the follicles
  • Administer 0.5 of the usual dose of hCG and go ahead with aspiration
  • Give hCG and aspirate the follicles and give albumin
  • Administer 0.5 of the usual dose of hCG and go ahead with aspiration and give albumin
  • Costing until the estraiol level decrease to the usual range in my unit
  • Cancel the cycle
  • Aspirate the eggs, freeze any embryos created and avoid fresh transfer
  • Aspirate the eggs, give albumin, freeze any embryos created and avoid fresh transfer
  • Administer dopamine agonists and continue with IVF
  • Other not specified above