Polycystic ovary syndrome -a hormonal disorder which affects 10-15% of women of reproductive age-is one of the most common causes of infertility. Women with polycystic ovary syndrome have numerous small cysts in their ovaries (follicles)and fail to regurarly ovulate.The ovaries are enlarged and there is an increased production of androgens.
The exact cause is unknown and early diagnosis with adequate care can reduce the risk of long term complications like heart disease and type 2 diabetes.
What are the symptoms?
The most common symptoms are:
- Irregular periods
- Excess facial and body hair (hirsutism)
There is no test to definitely 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, Androstendione) should be done in order to diagnose the syndrome.
What are the causes?
The exact cause is not known
Factors that may play a role are excess androgen,excess insulin and heredity.
How we treat infertility in women with PCOS?
The main reason women with PCOS are infertile is because they don’t ovulate or they ovulate irregurarly.
- Weight loss
Weight loss alone can bring back cycle regularity and ovulation.Women with PCOS have great difficulty to lose weight and the diet should be high in protein, moderate in carbohydrates and low in fat.Aerobic exercise like running, swimming and walking helps a lot.Advise from a dietitian is also recommended.
- Oral medication
Clomiphene citrate is the first choice for women with PCOS trying to ovulate.During treatment especially the first month the woman should be monitored with ultrasound to check the ovarian response to the medication.Usually women take clomiphene for 6 months and if there is no pregnancy then another treatment should be applied.Other medications in use are 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 methods we mentioned above have failed then the next step with high success rates is IVF treatment.Because women with PCOS have a greater risk of ovarian hyperstimulation they should be monitored closely and if they produce many eggs usually we freeze all the embryos and we perform embryotransfer in another cycle.