PCOS and Infertility - Diagnosis and Treatment

Polycystic Ovarian Syndrome, usually referred to as PCOS, is a hormonal imbalance that causes a thick coating to be produced around the ovaries, preventing ovulation. This condition, which affects as much as 15% of women of reproductive age, has as its primary symptom irregular or abnormal menstrual cycles.

In order to be clinically diagnosed with PCOS, a patient must meet two of the following criteria: a) presence of male hormone (revealed by examination or blood testing), b) abnormal menstrual cycles, c) a PCOS appearance on an ovarian ultrasound (revealing many small follicles). Other symptoms include obesity, dark patches on the neck or inner thighs, and skin tags.

PCOS is associated with insulin resistance. Insulin affects the reproductive hormones which are released from the pituitary gland, as well as androgens produced in the ovaries. When there is excessive insulin, follicle growth is suppressed, causing excessive amounts of androgens (male hormones) to be released. This causes the increased hair growth or acne often seen in PCOS patients.

Because PCOS’s root cause is insulin resistance, some cases of PCOS can be remedied with increased exercise and reduced carbohydrate intake (under the direction of a doctor).
In addition, many patients that suffer from PCOS have responded well to insulin sensitizing medications, such as metformin (marketed as Glucophage), with a success rate of nearly 20%. Metformin does have some severe gastrointestinal side effects, usually diarrhea.

Another treatment option is clomiphene citrate (Clomid) which is an anti-estrogen medication that induces ovulation. It has had few complications and has successfully helped many women, though it has been shown that the lowest effective dose is the best choice – increased quantities can lower endometrium density, which is of course undesirable for women trying to become pregnant.

If Clomid is unsuccessful, the standard option is fertility medications that work by stimulating a dormant follicle. These medications, while successful in 90% of women, also carry the risk of stimulating several follicles, which can either cancel the cycle or lead to a multiple pregnancy, especially for those using gonadtropins (such as Bravelle, Menopur, Gonal-F, or Follistim). t DNA concoction, such as Gonal-F or Follistim.

Finally, keep in mind that PCOS is not the only hormonal imbalance that could be affecting your fertility. For example, prolactin, the hormone that encourages the production of breast milk, can be affected by a malfunctioning thyroid gland, and go into overproduction, preventing a regular menstrual cycle. This condition can be treated with fertility medications.

Another hormonal imbalance which can reduce fertility is functional hypothalamic amenorrhea (FHA), found in women who, while they have the right number of healthy follicles, have insufficient estrogen production. Through an increase in body weight or a decrease in exercise, many affected women can return to a regular menstrual cycle.
It is important to carefully speak to your doctor about your symptoms and submit to any recommended testing in order to reach an accurate diagnosis and treatment plan.