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American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 04     Pages: 01-06 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

 

 

 

 

 

 

 

 

ABSTRACT 

The frequency of PCOS is approximately 11% among women of childbearing age, and in the structure of endocrine 

infertility it reaches 70%. The article presents data on a differentiated approach to the treatment of patients with PCOS 

for the natural restoration of fertility. The study examined 150 patients who applied to the gynecological department 

of clinic No. 1 of the Samarkand State Medical University for infertility in 2017-2021. Using the methods of differentiated 

conservative and surgical treatment of infertility in women with different PCOS phenotypes, based on the study of 

clinical, laboratory and ultrasound parameters, pregnancy occurred in 75.3% of patients. 

KEYWORDS 

Polycystic ovary syndrome (PCOS), normalization of body weight, correction of metabolic disorders, stimulation of 

ovulation, gonadotropin releasing factor antagonists, combined oral contraceptives (COCs). 

INTRODUCTION 

Among women with hirsutism, polycystic ovaries are 

detected in 65-70% of cases [4,12]. At the same time, 

being an endocrine-dependent pathology, PCOS with 

various menstrual irregularities and hirsutism is 

diagnosed in more than 60% of cases [3,7, 15]. 

There is no consensus in the literature on the 

treatment of PCOS. The primary therapy in the 

  Research Article 

 

A DIFFERENTIATED APPROACH TO THE TREATMENT OF INFERTILITY IN 

PCOS 
 

Submission Date: April 20, 2023, Accepted Date:  April 25, 2023,  

Published Date: April 30, 2023  

Crossref doi: https://doi.org/10.37547/ajbspi/Volume03Issue04-01 

 

 

Khasanova Dilafruz Abdukhamidovna 
Assistant Department Of Obstetrics And Gynecology №1 Samarkand State Medical University Samarkand, 

Uzbekistan 

Journal Website: 

https://theusajournals.

com/index.php/ajbspi 

Copyright: Original 

content from this work 

may be used under the 

terms of the creative 

commons attributes 

4.0 licence. 

 

https://theusajournals.com/
https://doi.org/10.37547/ajbspi/Volume03Issue04-01
https://theusajournals.com/index.php/ajbspi
https://theusajournals.com/index.php/ajbspi


Volume 03 Issue 04-2023 2 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 04     Pages: 01-06 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

treatment of anovulatory infertility in patients with 

PCOS is weight loss, of course, in cases of overweight. 

It has been proven that menstrual function returns to 

normal with a loss of 5 to 10% of body weight. With the 

development of obesity, a decrease in body weight of 

less than 5% from the initial one does not lead to the 

expected effect, 5-10% gives a satisfactory effect, and 

more than 10% leads to a good treatment effect [17, 19]. 

The use of insulin sensitizers is not only indicated in the 

presence of insulin resistance, but also helps to reduce 

the risk of developing hyperstimulation syndrome 

during in vitro fertilization in patients with PCOS 

[17,18]. The duration of therapy is 3-6 months, including 

against the background of ovulation stimulation. 

There are a large number of scientific papers in The 

Cochrane Library database proving the beneficial 

effect of COCs on the clinical manifestations of 

hyperandrogenism [16,23]. The main world 

recommendations for the management of patients 

with PCOS provide for the use of clomiphene citrate as 

the first line treatment for anovulatory infertility [2, 8, 

16]. Exogenous gonadotropins in in vitro fertilization 

and laparoscopic drilling are considered as 2nd line 

therapy [13, 17] when clomiphene citrate with or 

without metformin is ineffective. 

MATERIALS AND METHODS 

The study examined 150 patients who applied to the 

gynecological department of clinic No. 1 of the 

Samarkand State Medical University for infertility in 

2017-2021. The age of the examined patients was from 

22 to 35 years, on average 29.8 ± 3.4 years. 

50 patients were attempted to restore fertility without 

surgery. In order to normalize ovulatory function and 

treat infertility, 100 patients underwent endosurgical 

interventions: 64 women had drilling or unilateral 

ovarian resection, 36 women had bilateral ovarian 

resection. 

In the absence of ovulation within three months after 

the operation, ovulation inducers (clomiphene citrate 

and rFSH) were additionally and sequentially used, 

each no more than three cycles according to generally 

accepted methods. While maintaining anovulation, IVF 

was recommended to patients. The IVF procedure was 

also prescribed to patients with restored ovulatory 

function against the background of folliculogenesis 

inducers, but with persistent infertility. 

We analyzed the effect of surgical treatment of PCOS, 

taking into account the volume of the operation, on 

the levels of homocysteine, AMH, total testosterone, 

FSH, LH, the ratio of FSH/LH and total estradiol, which 

were determined before and three months after the 

intervention. 

RESULTS AND DISCUSSIONS 

All patients presented with unsuccessful infertility 

treatment. A history of 138 (92%) had already been 

treated to correct menstrual irregularities with the 

help of hormonal and non-hormonal agents. But no 

effect. In order to stimulate ovulation, 87 (58%) 

patients were prescribed clomiphene citrate in the 



Volume 03 Issue 04-2023 3 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 04     Pages: 01-06 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

past (for 3-6 cycles). 81 patients (54%) were prescribed 

hysteroscopy to exclude the uterine form of infertility 

and in the presence of abnormal uterine bleeding to 

exclude the pathology of the uterine cavity. In all cases, 

a histological examination of the endometrial scraping 

was additionally performed. At the same time, the 

following pathological conditions were diagnosed in 

39.3%: endometrial hyperplasia - in 20 (13.3%) patients; 

endometrial polyps - in 5 (3.3%) patients; hypotrophy or 

atrophy of the endometrium - in 34 (22.7%) patients 

(similar changes were recorded among patients with 

secondary amenorrhea and with severe 

oligomenorrhea with delayed menstruation from 3 to 

6 months); submucous myoma - in 1 (0.7%) patients. 

During laparoscopy performed in 100 (66.7%) patients 

for the purpose of surgical stimulation of ovulation, the 

following concomitant factors of infertility were 

found: adhesive process of the 1st degree according to 

the classification of Hulka J.F - in 9 patients (6%); 

external genital endometriosis I-II degree according to 

AFSCE classification in 3 patients (2%); subserous 

uterine myoma - in 4 patients (2.7%); ovarian cysts - in 3 

patients (2%) 

In total, during laparoscopy, these pathological 

manifestations were detected in 19 (12.7%) patients, 5 

(26.3%) of them had a combination of several types of 

pathology. 

Using the tactics of reducing body weight to a BMI 

level below 29.9 and prescribing metformin in the first 

cycle after the abolition of COCs, we managed to 

induce ovulatory cycles in 43 (28.7%) patients. 

However, we observed spontaneous pregnancy only in 

three women of phenotype C (before treatment, they 

had an ovulatory cycle, but were overweight). 

In 40% of patients with PCOS, ovulation does not occur 

after multiple cycles of CC treatment, they are 

considered resistant (resistant) to CC. In our study, out 

of 47 patients who underwent ovulation stimulation 

with clomiphene citrate for 6 cycles, 16 women were 

clomiphene-resistant (34% in relation to the group with 

this method of treatment, and 10.7% in relation to all 

examined ). 

Conducted only 1 course of stimulation of ovulation 

with gonadotropins, which resulted in ovulatory cycles 

in 15 out of 21 women (71.4%). However, clinical 

pregnancy occurred only in 11 patients of this group, 

which was 7.3% in relation to all examined and 52.4% in 

this group. All patients with the D phenotype (4 

women) and 7 patients with the A phenotype became 

pregnant. The protocol was canceled in 6 women who 

had more than 3 follicles larger than 16 mm in the 

middle of the protocol. 10 patients in this group (47.6%) 

were referred for IVF. 

In total, we observed 100 patients with various PCOS 

phenotypes who underwent surgical treatment for 

anovulation. In the postoperative period, the patients 

were observed for three menstrual cycles. 

Spontaneous clinical pregnancy occurred in 67% of 

women. 33% of patients from this group after the 

diagnosis of anovulation 3 months after surgical 



Volume 03 Issue 04-2023 4 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 04     Pages: 01-06 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

treatment were again prescribed clomiphene citrate 

for 3 months. As a result, it was possible to achieve 

natural conception in 8 patients with phenotype B, two 

patients with phenotype A. In total, 10% of women with 

PCOS became pregnant after repeated use of 

clomiphene citrate after surgery. 

Thus, we achieved a natural restoration of fertility in 

only 133 women with PCOS. 

CONCLUSION 

Using the methods of differentiated conservative and 

surgical treatment of infertility in women with PCOS 

based on the study of clinical, laboratory and 

ultrasound parameters, pregnancy occurs in 75.3% of 

patients. 

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American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 04     Pages: 01-06 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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Volume 03 Issue 04-2023 6 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 03 ISSUE 04     Pages: 01-06 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

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