How to manage the reproductive issues of PCOS: A 2015 integrated endocrinological and gynecological consensus statement of the Italian Society of Endocrinology

Reproductive alterations are a mainstay of the classic definition of polycystic ovary syndrome (PCOS), as defined in 1992 by the NIH consensus statement on PCOS [1]. These abnormalities still represent one of the three cardinal aspects used for diagnosing PCOS according to the current criteria, as defined by the Rotterdam ESHRE/ASRM consensus workshop [2] and by the AE-PCOS Society [3]. In addition, the reproductive alterations of PCOS are a key point in the treatment of this condition. Although there are several guidelines on the management of infertility in PCOS women, this issue remains controversial. Moreover, most of the documents on this topic were produced, by both the human reproduction societies and the endocrinology societies, with pregnancy as an immediate objective. However, reproductive abnormalities are frequently a central problem in these women beyond this specific aim, and come before and after this goal. Physicians are thus called to manage the reproductive alterations of PCOS women also when a pregnancy is not on the program, while taking into account comprehensively the whole spectrum of clinical problems of these patients. This concept is especially important for endocrinologists, who need to manage the many problems of these women for long periods, ideally for all of their lives. With the objective of reviewing the literature on the treatment of the reproductive alterations of PCOS, and developing evidence-based guidelines aimed at improving the management of these abnormalities, The Italian Society of Endocrinology (SIE) Board appointed a panel of experts, selected from researchers who published relevant articles in the field. The project and panel composition was also steered by the conviction that the clinical issues of PCOS should be managed with a network-oriented approach, primarily through strict interaction between endocrinologists and gynecologists.