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