Polycystic Ovary Syndrome
Commonly known as PCOS. In Women’s fertility, PCOS is the most common ovulatory disorder. 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.
PCOS is a condition that affects women’s hormone levels. Women who have PCOS produce a higher (more than usual) number of male hormones. Such a 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.
The causes of PCOS
PCOS directly disrupts the maturation and ovulation of eggs, among other effects on the body. According to RESOLVE (the National Fertility Association) PCOS has three main symptoms: Irregular periods, excess androgens and ovaries with multiple small follicles. Women with PCOS have trouble getting pregnant because their ovaries don’t grow and ovulate a mature egg every month. PCOS is also a reason for high miscarriage rates and serious medical conditions. On fertility treatment, we use an ultrasound to find PCOS symptoms.
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.
The 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 is also a cause of PCOS. Insulin insensitivity is associated with an excess of male hormones. PCOS 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 PCOS.
What tests doctors use to diagnose PCOS?
There are a variety of reasons a woman may have difficulty becoming pregnant. To get a proper diagnosis, we advise consulting a doctor. Knowing what to expect during your appointment can make it less stressful. The below list are potential questions you may ask and some of the testing you may go through.
- 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 level 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 helps 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 for PCOS with a variety of fertility medications.
Clomiphene (Clomid)
This is the most common medication for ovulation induction. The American College of Obstetricians and Gynecologists (ACOG) recommends clomiphene as 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 number of cycles, since it is only effective within three to six cycles. Using clomiphene for long period 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. Doctors require a trigger shot to make ovulation once a follicle is mature.
Letrozole
Letrozole is also a medication for PCOS. 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, doctors use letrozole for a short period of time, because if it is going to work then it is effective within three to six cycles.
Gonadotrophins (also known as Gonal F or Follistim)
Typically, daily injections for 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 chance to get pregnant. Once injections start the patient needs careful monitoring by ultrasound to avoid overstimulation. After when all hormone injections are complete, doctors will implement ovulation by an HCG injection and IUI. If pregnancy occurs, the chances of twins are approximately 15%, triplets are 5% and there is a 1% chance of more than three births. Doctors recommend Gonadotrophins 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. If you suspect that you have PCOS, we highly recommend that you get a full fertility workup. 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 peruse IVF treatment. When it comes to family planning with PCOS you would 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.
