Prof Homburg, Anil Gudi and Amit Shah
The difference between a normal ovary and a so-called polycystic ovary is that a polycystic ovary contains at least six-times more egg-containing follicles that are ripe to respond to stimulation with follicle stimulating hormone (FSH). That means that when undergoing treatment with FSH in order to induce ovulation and pregnancy, the polycystic ovary is extremely sensitive to stimulation. If we give the doses normally given to women with normal ovaries (conventional treatment) to women with polycystic ovaries, we will achieve an inordinately high number of developing follicles which will often result in a multiple pregnancy or a very unpleasant syndrome known as ovarian hyperstimulation syndrome (OHSS). Both are very undesirable results of ovulation induction and must be avoided. The way we have found to avoid these complications is by giving FSH in a ‘low and slow’ protocol. Starting with a low dose which remains unchanged for a minimum of 14 days and, if necessary, raising the dose by only half of the original dose for a further minimum of 7 days. In this way, the aim is to give just enough FSH to encourage the growth of one follicle and achieve just one ovulation. Although patience is often needed on the part of both the practitioner and the patient, the results justify this. A high pregnancy rate can be achieved with minimal complications. In fact using this method, we have achieved a twinning rate as low as 5% compared with 34% using a conventional protocol and have completely eliminated OHSS compared with a 4-5% rate using conventional dosage. This has now been confirmed as the only method which should be used for the treatment with FSH of infertile patients who have polycystic ovary syndrome.