Polycystic Ovarian Syndrome (PCOS): an infertility issue that is little understood.
Polycystic Ovarian Syndrome (PCOS) is one of the primary causes of a woman’s infertility. Between the age of 20 to 40, PCOS affects somewhere between 5% to 10% 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 patient to patient, PCOS is known as the ‘Silent Killer’ and can result in misdiagnosis, with 30% of women never being diagnosed.
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 hair and sometimes male-pattern hair loss.
■ Irregular menses, with prolonged periods between cycles.
■ Polycystic ovaries, as seen on an ultrasound.
Regrettably, PCOS is one of those reproductive syndromes that often goes undiagnosed.
Early diagnosis of PCOS is important to avoid long term complications such as increased risk for developing insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, heart disease and endometrial cancer.
Treatment of PCOS
Patients with PCOS who don’t wish to conceive.
Patients with PCOS who don’t want 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.
In many cases, birth control is prescribed in order to decrease hormone levels, normalize the menstrual cycle and minimize acne appearances.
Due to the fact that insulin-resistance is common in women who have been diagnosed with PCOS, medications such as metformin are 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 improves 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 and Infertility – Patients with PCOS who are trying to conceive.
More than 95% of women with PCOS do not ovulate regularly, have irregular menstrual cycles and struggle to conceive naturally. With Inanovulatory cycles, the ovarian follicles fail to mature and release eggs. Treatment to promote the recruitment and release of the egg is required (ovulation induction).
PCOS requires management to conceive in most of the cases. Optimal management means we rule out coexisting causes i.e. tubal assessment and semen analysis, ovulation induction strategies are closely monitored on a time line.
Ovulation induction programs are very successful in PCOS:
* 80% of patients achieve the goal of follicular development and egg maturation with oral agents such as clomid.
* 15 % of patients needs injectable agents
* Only 5% of PCOS cases need IVF, and are usually successful!
Reach out to us if you need to discuss IVF help if you suffer from PCOS.
– Dr Corona
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