What is the best reproductive option if a couple is diagnosed with oligozoospermia and PCOS?

To answer this question we have to take into account several aspects.

The first one is the assessment of the malefactor. When we speak of oligozoospermia we refer to a low concentration of sperm in the semen. We consider an altered concentration when there are less than 15 million sperm for each millilitre (mL) of ejaculate.

But although 15 million per mL is the reference parameter for talking about oligozoospermia, when we assess the semen analysis or seminogram we must take into account the degree of deviation from this normality. That is, a concentration of 13 million / mL, where we would speak of a mild oligozoospermia, is not the same as 1 million / mL, where we would speak of a severe oligozoospermia. In addition, we must also assess the other parameters of the semen study (total volume, mobility, etc.).

In order to group all the important parameters of the semen analysis or seminogram into a single value that helps us decide which assisted reproduction technique to use, the concept of REM (Mobile Sperm Count) is established, which tells us the number of sperm with good mobility that there are in each millilitre of ejaculate after semen training in the laboratory.

It is considered that to carry out artificial insemination (AI) it is necessary for the REM to be greater than 3 million sperm.

Thus, with regard to the male-factor, it will depend on the severity of the oligozoospermia and how it influences the REM whether the technique of choice is an AI or, on the contrary, we have to opt for a more complex technique, as is the In Vitro Fertilization (IVF).

The second aspect to take into account is the female factor. In this case, we are presented with a woman with Polycystic Ovarian Syndrome (PCOS). PCOS is an endocrine pathology that usually has difficulty in achieving ovulation. The moment a woman cannot ovulate she will not be able to become pregnant and the clinic will appear for which most women with PCOS usually consult, which is the absence of menstruation.

In this way, what we should do with this patient is to give her a medication that helps her achieve, first, follicular development and, later, ovulation. Once we achieve ovulation, we must add the semen sample either by AI or by directed intercourse. One option or the other will depend on the quality of the semen.

To achieve ovulation in a patient with PCOS, we perform an “ovulation induction” treatment. For this we have several therapeutic options. As first-line drugs we would have drugs for oral administration (Clomiphene Citrate and Letrozole) and, as a second line of treatment, we would have drugs for subcutaneous administration (Gonadotropins).

Even so, before evaluating ovulation induction treatment in a patient with PCOS, we must assess her age. The main reason for this is that ovulation induction treatments end with AI or directed intercourse. It is known that women over 38 years of age do not show benefit with these techniques due to poor oocyte quality. In such cases, the first option should be IVF.

Thus, and responding to the initial question, it is most likely that the treatment of choice for this couple is AI with ovulation induction, but before indicating this technique we must take into account other parameters such as REM and age of the patient.

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