PCOS and Infertility

PCOS and Infertility

PCOS – Polycystic Ovarian Syndrome – is a condition affecting 5% to 10% of women of childbearing age. Most women with PCOS are unaware of the condition until they experience difficulty becoming pregnant. It is a major cause of infertility, but it does not cause infertility in all women with the condition.

Women with PCOS have ovaries that contain numerous small cysts and produce fewer female hormones than needed for ovulation. During the menstrual cycle, egg production and maturation in PCOS affected women is disrupted, preventing most pregnancies.

Symptoms of PCOS

Women with PCOS typically experience some of these symptoms:
- Irregular or infrequent menstrual cycles or complete absence of periods
- Excessive hair growth on the face or body, usually beginning between ages 16 and 24
- Multiple cysts or fluid filled sacs on the ovaries (visible in ultrasound examination)
- Thinning hair
- Type II diabetes or elevated insulin levels
- Multiple patches of thick, dark brown or black skin
- Acne or oily skin
- Pelvic pain

Causes

PCOS occurs because of a complex set of hormone imbalances, usually affecting levels of insulin, androgens, estrogens, progesterone, luteinizing hormone, follicle stimulating hormone, adrenal hormones, thyroid hormones, prolactin, and others.

Diagnosis

It is important in diagnosis to consider and rule out other possible causes of PCOS related symptoms. These include:
- adrenal hyperplasia – which keeps the adrenal glands from making some hormones
- Cushing’s syndrome – excessive production of cortisone
- thyroid problems
- excess production of the hormone prolactin

A doctor will diagnose PCOS using these procedures:
– Medical history focused on menstrual pattern, hair loss, obesity, and absence of breast discharge
– Ultrasound exam of ovarian follicles
– Laproscopic exam of the ovaries
– Blood tests for levels of male hormones and the ratio of LH to FSH

Treatment

With treatment, most women can become pregnant. For women under age 35 there are multiple good alternatives to choose from, depending on individual differences. All have a choice of which treatment they prefer or which is most likely to be effective in their specific cases.

Treatment usually begins with medication to induce ovulation, using clomiphene. The latest and largest clinical study revealed a success rates, i.e. live births within 6 months of treatment, of 22.5% using clomiphene alone.

A major complication of clomiphene is the multiple birth rate (mostly twins) – 5% to 10% compared to 1.2% in all live births.

In Vitro Procedures

Women who do not become pregnant using clomiphene can still become pregnant using lab-based procedure:
- in vitro maturation (IVM)
- in vitro fertilization (IVF)

IVM is an extra interim procedure used to avoid loss of healthy eggs before maturity. In IVM, immature eggs are extracted early in the patient’s cycle and allowed to mature in a laboratory. When mature, the eggs are ready for IVF.

IVF is the process using mature eggs, extracted directly from the patient or passed from the IVM process, for fertilization in the laboratory. Fertilization occurs when an egg is exposed to live sperm from the patient’s partner (or a donor) and develops into an embryo. About three days after fertilization, the embryo is implanted into the patient’s uterus and she is pregnant.

Egg Donation

Patients who cannot produce healthy eggs, even with IVF, can consider using donor eggs – healthy eggs from a relative, friend, or other source – for use in the laboratory and implantation within her body.