Polycystic Ovary Syndrome, commonly known as PCOS, is the most common ovulatory disorder found in women with fertility problems. It affects as many as 10% of all women in their prime childbearing years. Before discussing PCOS treatments, let’s understand what PCOS is in a bit more detail.
What is PCOS?
PCOS or Polycystic Ovary Syndrome is a condition that affects women’s hormone levels. Women who have PCOS produce a higher (more than usual) number of male hormones. This hormonal imbalance can cause women to miss menstrual periods and makes it very difficult for them to get pregnant. PCOS may also cause hair growth on the face and body, and in some extreme cases, baldness.
PCOS directly disrupts the maturation and ovulation of eggs, among other effects on the body. According to RESOLVE, the National Fertility Association, women with PCOS have three main symptoms: irregular periods, excess androgens (the root cause of excess hair growth and acne), and ovaries with multiple small follicles, which is seen through an ultrasound. Women with PCOS have trouble getting pregnant because their ovaries don’t grow and ovulate a mature egg every month. PCOS is also associated with high miscarriage rates and serious medical conditions such as diabetes and heart disease.
Many women have PCOS, but they don’t know it yet. As per a study, up to 70 percent of women with PCOS hadn’t been diagnosed yet.
Causes of PCOS are not clear. Many women who suffer from PCOS are overweight or obese, but it’s also possible they may be thin as well. In any case, obesity worsens the symptoms of PCOS. Insulin insensitivity, which is associated with an excess of male hormones, is also a cause of PCOS. Polycystic Ovary Syndrome is also thought to have a genetic basis and possibly may run in families. If your mother or sister is suffering from PCOS there’s a greater chance for you to have it as well.
What tests are used to diagnose PCOS?
There are a variety of reasons a woman may have difficulty becoming pregnant. It’s advised to consult a doctor to be properly diagnosed. Knowing what to expect during your appointment can make it less stressful. The list below are some things to expect:
- Questions about other people in your family facing similar symptoms.
- Questions about your health and menstrual cycle.
- A physical examination that will include measuring your body mass index (BMI) and waist size.
- Examination of different parts of your reproductive system.
- A blood test to check your blood sugar and hormonal levels.
Treatments for Infertility Related to PCOS
The first line of treatment for women who are overweight with Polycystic Ovary Syndrome (PCOS) is a lifestyle change that results in weight loss. This usually consists of diet and exercise. Reducing your weight by 5% is sometimes enough to restore regular periods and let you ovulate on your own. Weight loss also reduces the chance of miscarriage and will improve your response to fertility medications. Research shows that even losing a small amount of weight improves menstrual function and fertility.
If lifestyle changes haven’t helped improve your fertility after three to six months, then your specialist may suggest a process known as Ovulation Induction. This treatment is designed to stimulate the ovaries and increase egg production. Although, Ovulation Induction treatment is not recommended for women who have a BMI greater than 35. Your fertility specialist may recommend treatment with a variety of fertility medications.
Clomiphene (Clomid) is the most common medication for ovulation induction. It is recommended by the American College of Obstetricians and Gynecologists (ACOG) that clomiphene should be the primary medication for PCOS patients suffering from infertility. Clomiphene citrate blocks the action of estrogen in the brain, which increases follicle stimulating hormone (FSH), causing follicles to mature so you can ovulate. When insulin resistance is found, metformin may be prescribed as well. Clomiphene Citrate is only used for a limited amount of time, since it is only effective within three to six cycles. Using clomiphene for long periods of time may increase the risk of ovarian cancer. However, women treated with clomiphene have a slightly higher chance of multiple births. During treatment some women may require monitoring with an ultrasound. Sometimes a trigger shot is given to cause ovulation to happen once a follicle is mature.
Like clomiphene citrate, letrozole slows estrogen production and causes the body to produce more FSH, which is required for ovulation. Letrozole may be used as the first line of treatment due to recent studies that show higher ovulation rates and live birth rates compared to clomiphene citrate. If there is an adverse reaction to clomiphene citrate, letrozole may be used in its place. There are no differences in pregnancy loss or birth defects whether letrozole or clomiphene is used. Like clomiphene citrate letrozole is only used for a short period of time, that’s because if it is going to work then it is effective within three to six cycles.
Gonadotrophins (also known as Gonal F or Follistim) may also be used. Typically, daily injections are taken 5-12 days. These hormones stimulate eggs within follicles to mature. The dosage will vary from patient to patient in order to prevent OHSS while maximizing the change to get pregnant. Once injections have started, the patient is carefully monitored by ultrasound to avoid over stimulation. Once the hormone injections have ended, ovulation can be implemented by an HCG injection and IUI. If a pregnancy occurs, the chances of twins is approximately 15%, triplets are 5% and there is a 1% chance of more than three births. This treatment is often used if a woman’s body doesn’t respond to Clomiphene or letrozole.
If the medications above do not result in ovulation, then alternatives such as IVF may be considered. There may also be other factors such as blocked Fallopian tubes, male factor infertility, or age. It is highly recommended that you get a full fertility workup if you suspect that you have PCOS. Your fertility specialist will develop a fertility treatment plan to put you on the path to parenthood. If you have PCOS, there is a high chance you get pregnant with the right lifestyle changes and the correct treatment.
Is IVF the right solution?
Reproductive Sciences Medical Center can help if you’re ready to pursue IVF treatment. When it comes to family planning with PCOS you want a specialized clinic to help. We are a top-rated fertility clinic in San Diego. We have a team of excellent reproductive endocrinologists that work for you and recommend the best treatment for PCOS related infertility.
If you are ready to take the next step, then call us at 858-436-7186 or visit www.fertile.com to schedule a free consultation.