Polycystic ovary syndrome (PCOS) affects between five and ten percent of women. This common endocrine disorder can disrupt ovulation and the menstrual cycles. It can also lead to an excess production of male hormones. These conditions all can cause infertility. The cause of PCOS is likely a combination of genetic and environmental factors. Women with a family history of PCOS in their mother or sister are more likely to have PCOS than other women.
PCOS symptoms
Women with PCOS may present with a range of symptoms, including:
- Obesity
- Acne
- Hirsutism (male-type hair growth of face)
- Oligomenorrhea (few periods)
- Insulin resistance
- Enlarged multicystic ovaries.
PCOS diagnosis
There’s no a specific test to diagnose PCOS. Initially, tests are performed to rule out any other disorders that may mimic the findings of PCOS, such as adrenal disorders or endocrine-active tumors of the ovary. Ultrasound can help diagnose the condition since the ovaries of patients with PCOS are often enlarged with a multiple cysts. However, the absence of these findings does not rule out PCOS.
“Approximately 50 to 60 percent of women with PCOS are obese, and as many as 30 to 40 percent of these women will develop impaired glucose intolerance or Type 2 diabetes.”
Treatment options
At the Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery, the following treatment options are available to restore regular ovulation and menstrual cycles in women with PCOS and other menstrual irregularities. Individualized treatment plans are developed after a detailed medical history and evaluation take place.
- Weight loss – For obese and overweight women with PCOS, weight loss can restore ovulation and reduce the risk of developing Type 2 diabetes and cardiovascular disease.
- Medications – Clomiphene citrate (clomid) is a medication that causes an increase in production of follicle-stimulating hormone (FSH), which promotes development of a mature follicle and ovulation. Approximately 80 percent of women will ovulate with clomid therapy. The risks include a modest increase in a multiple pregnancy (eight percent for twins and less than one percent for a multiple pregnancy higher than twins). Aromatase inhibitors are another class of drugs that may induce ovulation. If patients do not ovulate with clomid, it is unlikely that an aromatase inhibitor will help. Certain forms of FSH can be administered via a subcutaneous injection to induce ovulation. This type of medication must be monitored with blood work and ultrasound to prevent over-response of ovaries, which is a high risk for women with PCOS. There is also a significant increase in the risk of a multiple pregnancy compared to clomid therapy.
- Laparoscopic surgery – Ovarian diathermy is a minimally invasive surgical treatment that can trigger ovulation. This procedure has the benefit of promoting single egg ovulation, thus reducing the risk of multiples. The drawbacks include the short- and long-term risks of surgery.
- In vitro fertilization (IVF) – In vitro fertilization involves fertilizing egg cells with sperm cells in a laboratory, rather than in the body. Once fertilization occurs, the embryos are transferred into the mother’s uterus. Several different medications may be given to encourage the production of multiple eggs. Benefits of IVF include an increased pregnancy rate and lower risk of a multiple pregnancy. Drawbacks include the invasive nature of the procedure. Further, young women with PCOS are at increased risk for ovarian hyperstimulation syndrome.
In summary, the diagnosis and management of PCOS can be complex, but many treatment options exist. From an infertility perspective, PCOS is frequently successfully treated and thus has a truly positive prognosis.
