A Structured Literature Review on Current Protocols for In Vitro Fertilization in Women with Polycystic Ovary Syndrome

Background: Polycystic Ovary Syndrome (PCOS) represents a serious endocrine disorder affecting women of reproductive age, frequently leading to anovulatory infertility. Major clinical approaches to in Vitro Fertilization (IVF) currently in clinical practice include Gonadotropin-Releasing Hormone (GnRH) antagonist and long GnRH agonist stimulation regimens, Progestin Primed Ovarian Stimulation (PPOS), In Vitro Maturation (IVM) protocols with prematuration strategies, trigger strategies (hCG, GnRH agonist, and dual triggers), adjunctive metabolic and antioxidant therapies (metformin, myo inositol, N acetylcysteine, thiazolidinediones, statins), individualized gonadotropin dosing, and freeze all embryo transfer policies. However, despite therapeutic advances, IVF for women with PCOS remains complicated, especially by a persistent risk of Ovarian Hyperstimulation Syndrome (OHSS). Methods and Findings: We performed a focused literature review (2015â??2025), prioritizing randomized trials, cohort studies, and meta analyses to evaluate oocyte yield and maturity, duration of stimulation and gonadotropin consumption, clinical pregnancy and live birth rates, cycle cancellation and embryo utilization, and maternal and perinatal adverse events including OHSS incidence and severity, across treatment modalities. Findings from the literature revealed that GnRH antagonist protocols consistently reduce OHSS incidence and overall treatment burden while maintaining comparable clinical pregnancy and live birth outcomes to long agonist regimens; antagonists also permit individualized dosing and routine use of GnRH agonist triggers. Additional evidence supports PPOS as an oral alternative with similar live birth outcomes and practical advantages when paired with planned freeze all strategies. Studies based on IVM cohorts indicated substantial mitigation of OHSS risk and improved oocyte maturation with prematuration techniques, although cumulative live birth rates remain generally lower than with conventional IVF in most series. Findings further showed that GnRH agonist triggers markedly reduce OHSS compared with Human Chorionic Gonadotropin (hCG), that dual triggers increase oocyte maturity but may elevate OHSS risk in susceptible patients, and that freeze all approaches further mitigate OHSS while preserving transfer outcomes. Conclusions: The findings of this literature review indicate that management of women with PCOS undergoing IVF should prioritize OHSS prevention, adopt phenotype driven stimulation (preferential antagonist or PPOS), consider IVM where appropriate, routinely plan freeze all for high risk patients, implement preconception metabolic optimization, and pursue targeted trials and cost effectiveness analyses to refine practice and maximize safe, cumulative live birth.
Author(s): Gautam V Daftary1, Sanjay N. Patil1 Gaurang S. Daftary2, Nikita N. Patil3*

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