DIAGNOSIS, PATHOGENESIS, AND MANAGEMENT OF PCOS-RELATED INFERTILITY: A COMPREHENSIVE LITERATURE REVIEW
Abstract
Polycystic ovary syndrome (PCOS) is the most prevalent endocrine and metabolic disorder affecting women of reproductive age, with a global prevalence estimated between 5% and 20% depending on the diagnostic criteria applied. It is a leading cause of anovulatory infertility and is characterized by a heterogeneous constellation of reproductive, endocrine, and metabolic abnormalities. This literature review synthesizes current evidence on the genetic underpinnings, complex pathogenic mechanisms, and evidence-based management strategies for PCOS-related infertility. Key topics include the polygenic architecture of PCOS, epigenetic and transgenerational transmission, the central roles of hyperandrogenism, insulin resistance, chronic low-grade inflammation, mitochondrial dysfunction, and endoplasmic reticulum stress in disease pathophysiology, as well as the impact of elevated anti-Müllerian hormone and ovarian microenvironment dysregulation. Management strategies encompass lifestyle modification, pharmacological ovulation induction with clomiphene citrate and letrozole, metformin and GLP-1 receptor agonist therapy, gonadotropin protocols, and advanced assisted reproductive technologies including IVF with tailored stimulation. Understanding the multidimensional nature of PCOS is critical for optimizing fertility outcomes.
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