PCOS: an infertility issue little understood

Polycystic ovarian syndrome, which is known as PCOS for short, is one of the primary causes of a woman’s infertility. Between 20 and 40 years of age, PCOS affects somewhere between five and 10 percent of women. This makes it the most widespread reproductive syndrome for this age group of women. Since PCOS cannot be diagnosed with one test alone and symptoms vary from woman to woman, PCOS is often misdiagnosedor will never be diagnosed with it although they have it. Importantly these are typically the milder cases of PCOS.

What Exactly is PCOS?

PCOS is a complex, heterogeneous disorder of uncertain etiology although recurrence in the same family is often observed supporting a genetic  origin.

According to the so-called Rotterdam criteria, a woman with any two of the following conditions may have the condition:

 

• Symptoms of elevated levels of androgens, or male sex hormones, which can include acne, excessive hairiness and sometimes male-pattern hair loss.
• Irregular menses, with prolonged periods between cycles.
• Polycystic ovaries, as seen on an ultrasound.

 

Regrettably, polycystic ovarian syndrome is one of those reproductive syndromes that often go un-diagnosed.

Early diagnosis of PCOS is important to avoid long term complications as increased risk for developing insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, heart disease and endometrial cancer.

 

PCOS and Infertility – What’s the Connection?

More than 95% of women with PCOS do not ovulate regularly, having irregular menstrual cycles and difficulty to conceive. Inanovulatory cycles, ovarian follicles fail to mature fully and to release eggs. Treatment to promote the recruitment and release of the egg is required (ovulation induction).

 

Treatment of PCOS

Patients with PCOS not willing to conceive should be treated to control immediate symptoms and to avoid long term complications. Consuming a healthy diet and regular exercise, controlling weight, glucose and insulin levels is effective and  recommended as first approach. Due to the fact that insulin-resistance is common in women who have been diagnosed with PCOS, medications as  metforminare typically prescribed as well  affecting how insulin controls glucose and reducing testosterone. Metformin improves menstrual cycling, slows hair growth, reduces body mass, reduces cholesterol levels and improve ovulation induction response. Surgery called ovarian drilling is one option for PCOS although it is only recommended as a last resort and in most of the cases the effects are only temporary.

PCOS women requires management  to conceive in most of the cases. Optimal management includes rule out of coexisting causes i.e. tubal assessment and semen analysis, ovulation induction strategies with close monitoring and a time line. Ovulation induction programs are very successful in PCOS: 80% of patient achieves the goal of follicular development and egg maturation with oral agents such as clomid, 15 % of patients needs injectable agents and only few cases needs IVF.

– Dr. Corona

Keypoints:

PCOS requires management to conceive in most case.
Ovulation induction programs are very successful in PCOS.
Optimal management includes
*    Rule out coexisting causes – tubal assessment + SA
*    Ovulation induction with monitoring
*    Time line

IVF is sometimes needed but with very good success rate!!