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In vitro fertilization (IVF) is the last and most expensive fertility treatment but sometimes the single most successful fertility treatment for women who have PCOS (polycystic ovarian syndrome). Although chances for success diminish with the woman's age, overall about one in three IVF procedures results in the birth of a healthy child. And for women with PCOS, especially women under 40, the percentages are even higher. About one in two women with PCOS who undergoes IVF subsequently gives birth. The main concern in using IVF for achieving pregnancy in women who have PCOS is avoiding overstimulation of the ovaries before harvesting the egg.

Ovarian hyperstimulation syndrome can result in unmistakable symptoms. In addition to causing bloating and abdominal pain, the woman undergoing this pre-IVF procedure may gain as much as 10 pounds (4.5 kilos) in just 2-3 days. The extra fluid can interfere with both breathing and urination. To avoid this syndrome, the OB-GYN may administer "antagonistic" hormones every day after starting ovulation therapy. The idea is to stimulate the maturing of the egg so that it can be harvested for IVF, but not to stimulate it too much. Giving more antagonistic hormones results in more women being "hormonally pregnant," that is, they would get a positive reading with a urine test, but actually results in fewer live births. Doctors also sometimes allow women to "coast" for a few days without any hormone treatment at all.

This results in fewer eggs available for IVF, but the long-term result is that these women are actually more likely to get pregnant and deliver a child. There is a delicate balance between enough stimulation and too much. Most physicians offering in vitro fertilization know this and are available 365 days a year to make sure the Aspiring mother receives just the right amounts of the drugs that start and stop the maturing of the egg. The most important thing women with PCOS can do to assist the IVF procedure is to have achieved normal weight before attempting to become pregnant. Women who are not overweight are more likely to have normal insulin sensitivity and greater hormonal stability. This makes it easier for the doctor to "fine-tune" medications to result in the greatest possible chance for releasing the egg and later receiving the embryo.

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