**2.4. Voluntary contraception for patients**

Although most of PCOS-diagnosed patients complain about the inability to pursue a pregnancy, it is important to have in mind the situation when women diagnosed and treated for PCOS do not want to obtain a pregnancy.

A recent study states that in women aged 28–33 years old, women with PCOS were less likely to be using contraception (61 versus 79%, P < 0.001) and more likely to be trying to conceive (56 versus 45%, P < 0.001), compared with women not reporting PCOS [22]. However, the same study mentions that fewer women with PCOS (61%) were using contraception than women without PCOS (79%) (P = 0.001) [22].

Because women with oligomenorrhea ovulate intermittently and rarely use contraceptionunwanted pregnancy may occur.

#### **2.5. Induced ovulation for patients pursuing pregnancy**

As part of the PCOS, infertility secondary to anovulation is usually the main complaint of patients diagnosed with this metabolic disorder.

Pathological basis of infertility in this particular medical situation resides in the low Folliclestimulating hormone (FSH) serum level, which is responsible for the impossibility of ovarian follicles to reach maturity due to their persistence in final growth stages.

Aiming to treat this frequent cause of anovulation, there are two ways to ensure the wellbeing of the patient based on each woman's choice: evaluating the options for further contraception or starting a therapeutical plan for inducing ovulation.

With respect to the latter, inducing ovulation stillremains a medical challenge in some patients with PCOS. There are a few known therapeutical approaches for achieving this: medical treatment with clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins or surgically management by laparoscopic ovarian drilling [23]; in vitro fertilization is also taken into consideration when all the other options failed to induce pregnancy.
