Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome or PCOS is one of the most common causes of ovulatory dysfunction in women. Individuals with PCOS may have irregular menstrual cycles, hirsutism (excessive facial and body hair), acne, obesity, glucose intolerance and infertility. Classically these symptoms become evident within a few years of puberty. The menstrual dysfunction that is seen ranges from amenorrhea, a total lack of menses, to oligomenorrhea which is irregular menses (8 or fewer menstrual cycles per year). In individuals with irregular menses it is important to rule out other causes such as hypothyroidism or hyperprolactinemia.
The initial fertility treatment for PCOS is frequently a trial of an oral medication, clomiphene citrate. Most pregnancies occur on the lower dosages of 50 to 100 mg and most occur in the first four ovulatory cycles. Due to the anti-estrogenic effect of clomiphene citrate, some women may have impaired cervical mucus which will impede the ability for sperm to access the genital tract. IUI or intrauterine insemination overcomes that problem.
Individuals with PCOS may have hyperinsulinemia as a result of insulin resistance. Weight loss, nutrition and exercise are the most effective tools to reduce insulin levels and elevated androgen levels. Oral antidiabetic medications such as metformin have been used for patients with PCOS. A large multi-center trial in 2007 however did not show an improvement in live birth rates in patients with PCOS treated with metformin alone or in conjunction with clomiphene citrate.
Patients who fail to conceive with clomiphene citrate are excellent candidates for gonadotropins. These medications contain FSH (follicle stimulating hormone) and are given as a daily injection. When given at a low dose with a gradual increase in dosage over time is very efficient at inducing monofollicular ovulation. This is typically done in conjunction with intrauterine insemination or IUI to ensure delivery of sperm to the uterine cavity and fallopian tubes.
Patients with PCOS are also candidates for IVF. Individuals with PCOS are excellent candidates for fertility treatment. At CARE Fertility we strive to customize the treatment offered to match the individual couple.
To learn more about treatments for PCOS, contact CARE Fertility today!