Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

• DOI: 10.1016/j.fertnstert.2023.07.025
• Publication Date: 2023-08-14T23:57:25Z
• Authors: Helena J. Teede; Chau Thien Tay; Joop Laven; Anuja Dokras; Lisa J. Moran; Terhi T. Piltonen; Michael F. Costello; Jacky Boivin; Leanne M. Redman; Jacqueline A. Boyle; Robert.J. Norman; Aya Mousa; Anju E. Joham; Wiebke Arlt; Ricardo Azziz; Adam Balen; Lisa Bedson; Lorna Berry; Jacky Boivin; Jacqueline Boyle; Leah Brennan; Wendy Brown; Tania Burgert; Maureen Busby; Carolyn Ee; Rhonda M. Garad; Melanie Gibson-Helm; Cheryce Harrison; Roger Hart; Kim Hopkins; Angelica Lindén H...; Tuong Ho; Kathleen Hoeger; Cailin Jordan; Richard S. Legro; Rong Li; Marla Lujan; Ronald Ma; Darren Mansfield; Kate Marsh; Edgar Mocanu; Ben Mol; Rachel Mormon; Robert Norman; Sharon Oberfield; Malika Patel; Loyal Pattuwage; Alexia Peña; Leanne Redman; Luk Rombauts; Daniela Romualdi; Duru Shah; Poli Mara Spritzer; Elisabet Stener-V...; Fahimeh Ramezani ...; Shakila Thangarat...; Mala Thondan; Eszter Vanky; Chandrika Wijeyar...; Selma Witchel; Dongzi Yang; Bulent Yildiz; Simon Alesi; Snigdha Alur-Gupta; Jodie Avery; Mahnaz Bahri Khomami; Jamie Benham; Hugh Bidstrup; Su Jen Chua; Laura Cooney; Thisara Coster; Carolyn Ee; Victoria Fitz; Madeline Flanagan; Maria Forslund; Geranne Jiskoot; Maryam Kazemi; Punith Kempegowda; Yvonne Louwers; Marla Lujan; Johanna Melin; Eka Melson; Yitayeh Belsti Me...; Negar Naderpoor; Adriana Neven; Hester Pastoor; Thais Rocha; Angelo Sabag; Anuradhaa Subrama...; Katrina Tan
• Keywords: Guideline; Grading (engineering); Evidence-Based Medicine; Evidence-Based Practice; Quality of evidence

STUDY QUESTIONWhat is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on best available evidence, clinical expertise, consumer preference?SUMMARY ANSWERInternational evidence-based guidelines address prioritized questions outcomes include 254 recommendations practice points, to promote consistent, care improve experience health in PCOS.WHAT IS KNOWN ALREADYThe 2018 International PCOS Guideline was independently evaluated as high quality integrated multidisciplinary perspectives from six continents; it now used 196 countries widely cited. It available, but generally very low quality, evidence. applied robust methodological processes addressed shared priorities. The guideline transitioned consensus diagnostic criteria enhanced accuracy diagnosis, whilst promoting consistency care. However, diagnosis still delayed, needs are not being adequately met, evidence evidence-practice gaps persist.STUDY DESIGN, SIZE, DURATIONThe 2023 Evidence-based update reengaged network across professional societies organizations experts women directly involved at all stages. Extensive synthesis completed. Appraisal Guidelines for Research Evaluation-II (AGREEII)-compliant were followed. Grading Recommendations, Assessment, Development, Evaluation (GRADE) framework feasibility, acceptability, cost, implementation ultimately recommendation strength diversity inclusion considered throughout.PARTICIPANTS/ MATERIALS, SETTING, METHODSThis summary should be read conjunction full detailed participants methods. Governance included a six-continent international advisory committee, five development groups, paediatric, consumer, translation committees. engagement informed scope Engaged society-nominated panels paediatrics, endocrinology, gynaecology, primary care, reproductive obstetrics, psychiatry, psychology, dietetics, exercise physiology, obesity public other experts, alongside consumers, project management, synthesis, statisticians experts. Thirty-nine covering 71 engaged process. Twenty meetings face-to-face forums over 12 months 58 involving 52 systematic 3 narrative reviews. developed approved via panels, modified feedback peer review, reviewed rigour, by Australian Government National Health Medical Council (NHMRC).MAIN RESULTS AND THE ROLE OF CHANCEThe has improved past years, remains moderate quality. technical report analyses (∼6000 pages) underpins 77 54 recommendations, 123 points. Key updates include: i) further refinement individual criteria, simplified algorithm anti-Müllerian hormone (AMH) levels an alternative ultrasound adults only; ii) strengthening recognition broader features including metabolic risk factors, cardiovascular disease, sleep apnea, prevalence psychological features, status adverse during pregnancy; iii) emphasizing poorly recognized, diverse burden disease need greater healthcare education, patient information, models decision making experience, research; iv) maintained emphasis healthy lifestyle, emotional wellbeing life, awareness consideration weight stigma; v) medical therapy cheaper safer fertility management.LIMITATIONS, REASONS FOR CAUTIONOverall, strengthened improved, remain Significantly research needed this neglected, yet common condition. Regional system variation acknowledged, process resource adaptation provided.WIDER IMPLICATIONS FINDINGSThe Assessment Management provides clinicians patients clear advice practice, expert input preferences. have been generated comprehensive multifaceted dissemination programme supports evaluation program.STUDY FUNDING/COMPETING INTEREST(S)This effort primarily funded (NHMRC) (APP1171592), supported partnership American Society Reproductive Medicine, Endocrine Society, European Human Reproduction Embryology, Endocrinology. Commonwealth Australia also through Future Fund (MRFCRI000266). HJT AM NHMRC fellowships. JT Royal Australasian College Physicians (RACP) fellowship. group members volunteers. Travel expenses covered sponsoring organizations. Disclosures interest strictly managed according policy guideline, report, review responses (www.monash.edu/medicine/mchri/pcos). Of named authors HJT, CTT, AD, LM, LR, JBoyle, no conflicts declare. JL declares grant Ferring Merck; consulting fees Titus Care; speaker's Ferring; unpaid consultancy Ferring, Roche Diagnostics Ansh Labs; sits boards Diagnostics, Labs, Gedeon Richter. TP Roche; Richter Organon; Exeltis; travel support Diagnostics; Diagnostics. MC travels board Merck. JBoivin grants Merck Serono Ltd.; B.V; Arzneimittell GmbH; Office Economics. RJN received Ferring. AJoham Novo Nordisk Boehringer Ingelheim. special groups our 39 partner collaborating organizations, methodologically assessed against AGREEII NHMRC.