Dear Charlie

The diagnosis is most likely that of PCOS which will probably require careful ovulation induction. The choice of ovulation induction agents depends on the severity of the PCOS. Advanced cases of PCOS i.e. multiple cysts together with hormonal imbalances may require significant monitoring to prevent the condition of ovarian hyper stimulation syndrome, which can be potentially life threatening. Therefore such ovulation induction should be under the supervision of a fertility specialist skilled in the management of ovulation induction and also one who understands the risks involved and is also who is able to manage hyper stimulation syndrome should this arise. The main aim is to stimulate the ovaries sufficiently to allow a few follicles to reach maturation but at the same time not too vigorously so that too many cysts or follicles are formed which may then carry the risk of hyper stimulation syndrome.