Infertility Education - Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome (PCOS) occurs in up to 10 percent of reproductive age women. PCOS is a frequently diagnosed disorder of the endocrine system – that part of the body responsible for producing and balancing hormones. In PCOS, women produce a higher level of androgens, or male hormones (women normally make male hormones, but at a lower level). This hormonal imbalance interferes with regular ovulation and also results in the presence of multiple non-maturing follicular cysts in the ovaries, hence the name. Women with PCOS commonly present with infertility due to irregular and infrequent menstrual cycles.
Additional symptoms of PCOS may include unwanted facial or body hair, acne, and often issues with weight gain. The physical symptoms of PCOS are highly variable. Sometimes, the lack of a regular menstrual period is the only symptom.
PCOS is often characterized by insulin resistance, which can lead to long term problems like heart disease, diabetes and high cholesterol. While there is no cure for PCOS, its symptoms can be addressed and managed, enabling women with this condition to have successful pregnancies and long-term good health.
Physical examination, health history and blood testing can help your doctor diagnose PCOS.
A diagnosis will include:
- Health history to determine frequency and regularity of ovulation
- Blood testing to measure hormone levels
- Ultrasound to view ovaries (polycystic ovaries will appear to be enlarged with multiple small (antral) follicles)
- Physical exam to assess characteristics including male pattern hair growth, acne and excessive weight gain
Lifestyle modifications to diet and exercise to attain a more ideal body weight can often be enough to restore ovulation and fertility in PCOS patients who are overweight.
For women desiring fertility treatments, the first line of therapy includes oral medications such as clomiphene or letrozole (Femara). If the patient does not respond to these medications, the patient can be treated with injectable fertility medications. Ultrasound monitoring is performed while taking these medications to ensure the appropriate response is occurring.
If there is significant evidence of insulin resistance, your doctor may recommend a medication such as metformin (Glucophage) be used in conjunction with the fertility medications. Metformin is a drug used to treat diabetes, and helps patients become more sensitive to insulin. This can make the ovaries in PCOS patients more responsive to ovulation induction.
In some cases of severe polycystic ovarian syndrome, it may be very difficult to induce only one or two follicles to develop with either oral or injectable medications. In these cases, IVF may be recommended to reduce the chance of multiple gestation. Pregnancy rates are very good with this option, and patients may have a number of extra embryos to freeze for possible future pregnancies as well.