Lean PCO how to induce ovulation and thereby achieve pregancy

 

·        do 75  gm GTT with 2  hr insulin value .If it  suggest hyperinsulinemia start then one can start metformin though by and large  

·        Not to prescribe Metformin which is  is seldom needed in thin PCOS .

·        , Evaluation of insulin resistance not essential since management wouldn’t change. Metformin no role in ovulation induction or additional use with clomiphene.

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·        Step 1 Step 3:  Vit D 3 however may give for at least 3 months before starting ovulation induction.

·        Step 1 One should consider that the first step 4:  If oligomenorrhoic or having sec amenorrhoea then withdrawal bleeding is a must with progesterone.

·        Step 5 : Then one should put her on cyclical OCPs (preferably with 3rd generation progesterone drospirenone) for 3 months (should bring down the high LH) along with Vitamin D3. Later CC Yoga and brisk  walking.

Step  6: Then after 3 months start ovulation induction with follicular monitoring, ovulation trigger with Recombinant low dose FSH works better in PCOS à HCG & advise timed relations. But do Assess AMH- to avoid OHSS:-Because AMH should be done as these patients (lean PCOS are more prone to OHSS,) clomiphene low dose along with meticulous monitoring and  serum E2 levels or good Color USG. No necessity of Testosterone, Insuin tests.

Summary of lean PCOS: Usually with high LH & High AMH but normo insulinaemic: