Polycystic Ovary Syndrome (PCOS) and Infertility

Polycystic Ovary Syndrome (PCOS) is a syndrome affecting approximately one in ten women of child bearing age. Sufferers are affected with high levels of androgens, male hormones - which cause serious physical and emotional difficulties. Polycystic ovary syndrome is the leading cause of infertility in women, and can contribute to other serious conditions such as Type 2 Diabetes.

Signs and symptoms of PCOS:

• Missed or irregular periods
• Several small ovarian cysts. These cysts are fluid-filled sacs that may look like a string of pearls on ultrasound.
• Acne, oily skin and/or skin tags
• Weight gain or obesity
• Insulin resistance or Type 2 Diabetes
• High blood pressure
• High cholesterol
• Infertility
• Sleep apnea
• Depression and/or anxiety
• Baldness or thinning hair
• Hirsutism - increased hair growth on the face, chest, back, abdomen, hands and/or feet.

Diagnosing PCOS

Methods in diagnosing Polycystic Ovary Syndrome vary. Initial diagnostic tools will likely include measuring blood pressure and body mass index, a complete medical history - including a menstrual history and a reproductive history, and a pelvic exam. A vaginal ultrasound may be performed, usually by a fertility specialist, to check for mature follicles and ovarian cysts. Not all PCOS sufferers have ovarian cysts and some non-polycystic women may still suffer from occasional ovarian cysts, therefore a series of blood tests may also be performed. These tests are most often ordered by a fertility specialist and/or an endocrine specialist.

Blood tests include:

• FSH (Follicle Stimulating Hormone)
• LH (Lutenizing Hormone)
• LH to FSH ratio
• Prolactin
• Total and/or free Testosterone
• DHEAS
• 17-ketosteroids
• Estrogens
• Sex hormone binding globulin
• Androstenedione
• hCG (Human chorionic gonadotropin)
• Lipid profile (HDL, LDL, cholesterol, triglycerides)
• Glucose test, usually with fasting and/or a glucose tolerance test
• Insulin
• TSH (Thyroid stimulating hormone)

Laproscopy is also sometimes used to evaluate the ovaries and the lining of the uterus.

Treating PCOS

Polycystic Ovary Syndrome treatments are often dependent upon the patient’s desire to become pregnant and the severity of the symptoms. Often, low dose oral contraceptives are used to stabilize hormones, however this is sometimes not a practical solution to a patient wishing to become pregnant. Antiandrogens (spironolactone, Aldactone, flutamide and cyproterone) might also be used in combination with oral contraceptives to help with acne and hair growth symptoms. Metformin is often used to treat PCOS symptoms. It may help to alleviate insulin resistance and help with weight loss. Some experts believe that Metformin also has a positive effect on infertility, although this hasn't been proven.

Treating PCOS and Infertility

Ovulation educing drugs are often used on PCOS patients who wish to become pregnant. A common course of treatment is monitored cycles of Clomid or Serophene. The patient takes the medication on days 3 to 7 of her menstrual cycle. Follicle development is then followed by regular ultrasounds. The patient is counseled when to have intercourse or intra-uterine insemination (IUI) may be performed, wherein warmed and prepared (‘washed’) sperm is inserted into the woman’s uterus. Many sufferers also have low progesterone, a hormone required to support pregnancy. These patients are sometimes asked to take a progesterone supplement, usually in suppository or cream format.

Women who do not become pregnant using Clomid or Serophene may move on to gonadotropins - FSH and LH medications, like Gonal F, that are administered by injection. Patients with elevated LH may be treated with FSH alone. These medications may be administered with or without IUI or are sometimes used in combination with In vitro fertilization (IVF).