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Hirschberg has investigated the disorders of reproductive function to understand long-term health in women. She collaborated to develop international PCOS guidelines that offered recommendations, emphasizing refined diagnostics, reduced testing, lifestyle focus, and evidence-based medical therapy to enhance care for affected women. [9]
A review of international evidence found that the prevalence of PCOS could be as high as 26% among some populations, though ranges between 4% and 18% are reported for general populations. [20] [21] [22] According to the World Health Organization (WHO), PCOS affects over 8-13% of reproductive-aged women. [23] [19]
Not all women with PCOS have difficulty becoming pregnant. For those who do, anovulation is a common cause. The mechanism of this anovulation is uncertain, but there is evidence of arrested antral follicle development, which, in turn, may be caused by abnormal interaction of insulin and luteinizing hormone (LH) on granulosa cells.
Diagnosis of PCOS is based on meeting two of the three clinical criteria based on the Rotterdam Criteria: chronic anovulation (the ovum is not released from the ovary during menstrual cycle), hyperandrogenism (increased levels of androgen hormones, such as testosterone), and large number of ovarian cysts. [37]
Based upon the work of the international AGREE Collaboration for the quality of clinical practice guidelines, [3] an organised network for organisations and experts working in the field of evidence-based guidelines was proposed in early 2002 at the first international guideline conference in Berlin, Germany. [4]
It is well recognized that insulin resistance can be part of the sequelae of PCOS and if present, contribute to anovulation. Metformin, a biguanide, is a common insulin sensitizer often given to treat women with PCOS. [10] No other insulin sensitizers have evidence of effective and safe use of fertility treatment. [10]
The JBI Model of Evidence-based Healthcare was developed in 2005 and updated in 2016. [4]It is described by reference to a pictogram, with one circle inside another. [5] The 'inner circle' represents the pebble of knowledge while the 'inner wedges' provide the organisation's conceptualization of the steps involved in the process of achieving an evidence-based approach to clinical decision-making.
There is some evidence that letrozole can improve the rate of live births and the rate of pregnancy rate for people who experience anovulatory PCOS, and this treatment may be more effective than SERMs. [63] There is high quality evidence that the rate of people developing ovarian hyperstimulation syndrome is similar between SERMs and letrozole ...