Polycystic ovary syndrome (PCOS), a hormonal disorder that impacts around 10-15% of women in their reproductive years, stands as one of the leading causes of infertility. Women affected by PCOS typically experience the presence of multiple small cysts (follicles) in their ovaries, resulting in irregular ovulation. Additionally, the condition manifests through enlarged ovaries and heightened production of androgens.
The exact cause of PCOS remains elusive, but early detection coupled with appropriate care can help mitigate the risk of long-term complications such as heart disease and type 2 diabetes.
What are the symptoms?
The most common symptoms are:
- Acne
- Obesity
- Irregular periods
- Excess facial and body hair (hirsutism)
- Infertility
Diagnosis
There is no concrete way or test to diagnose polycystic ovary syndrome.
A detailed medical history (menstrual periods, weight changes)and a physical exam checking excess hair growth and acne are of great importance. Then a transvaginal ultrasound and hormone tests (FSH, LH, Estradiol, testosterone, DHEA, Androstenedione) should be done to diagnose the syndrome.
What are the causes?
The precise cause of this condition remains uncertain, although several factors are believed to contribute to its development. These factors include excessive levels of androgens (male hormones), elevated insulin levels, and genetic predisposition.
How we treat infertility in women with PCOS?
The primary cause of infertility in women with PCOS is the lack of regular ovulation or the absence of ovulation altogether.
- Weight loss
Achieving weight loss can help restore menstrual cycle regularity and promote ovulation in women with PCOS. However, shedding excess weight can be particularly challenging for individuals with this condition. It is advisable to follow a dietary plan that is high in protein, moderate in carbohydrates, and low in fat. Incorporating aerobic exercises such as running, swimming, and walking into one’s routine can also be beneficial. Seeking guidance from a registered dietitian is recommended for personalized advice and support.
- Oral medication
Clomiphene citrate is the primary medication prescribed for women with PCOS who are seeking to induce ovulation. Throughout the treatment process, particularly during the initial month, the woman’s ovarian response to the medication is monitored through ultrasound examinations. Typically, clomiphene is taken for a period of 6 months, and if pregnancy does not occur, alternative treatment options are considered. Other medications commonly utilized in such cases include letrozole and metformin.
- Injectable medications
Gonadotrophin injections are the next step for women who failed to ovulate with oral medication. Again the woman should be monitored carefully because there is a small risk of ovarian hyperstimulation. In many cases, we perform IUI (intrauterine insemination) to increase the chances of pregnancy.
- Surgery (ovarian drilling)
Ovarian drilling is a surgical procedure where we perform laparoscopy and we create small holes with diathermy in the ovaries.The results are excellent and most of the women ovulate the first month after the operation.
- IVF treatment
If the aforementioned approaches prove ineffective, the next recommended course of action with high success rates is undergoing in vitro fertilization (IVF) treatment. Due to the increased risk of ovarian hyperstimulation in women with PCOS, close monitoring is essential. In cases where a significant number of eggs are produced, it is common practice to freeze all the embryos and perform the embryo transfer in a subsequent cycle for optimal results.
