27 Sep Achieving Fertility With PCOS
Polycystic ovary syndrome (PCOS) is a health condition that affects women, by causing changes to the menstrual cycle and decreasing their ability to have children. Around 1 out of 15 women of childbearing age has PCOS, which is approximately 5 million women in the U.S.
Experts do not fully understand the PCOS, but they believe genetics and insulin play an integral role. Women who have PCOS have hormonal imbalances, and the ovaries tend to produce excess androgens. This alters egg development, and ovulation. Therefore menstrual cycles may be irregular or absent. Without regular ovulatory menstrual cycles conception is more difficult.
Leading experts on PCOS feel women with PCOS must meet 2 of 3 criteria in order to be sure they have the disease:
- Irregular cycles preferably since the time of puberty
- Signs of androgen excess (acne or excessive hair growth) or a elevated serum testosterone level
- PCOS appearing ovaries by ultrasound with an experienced ultrasonographer.
Once PCOS is diagnosed, doctors will start with correcting the hormone imbalance, in attempt to regulate the menstrual cycle, decrease hair growth and acne. Depending upon the age of the women at diagnosis and their current desires for a baby treatment is either geared to correcting the hormone imbalance and preventing pregnancy or using medications to improve fertility. Regardless of desires for fertility, therapy should also be aimed at decreasing the risk for diabetes, cancer, depression and heart disease. Treatment should start with lifestyle modifications such as diet and exercise. To improve the chance of ovulation, most women with PCOS will need to lose at least 10 percent of their total body weight.
For those that do not desire fertility oral contraceptives are often used to reduce androgens, control menstrual cycles, and clear acne. Obviously this is not the treatment of choice for those being evaluated for infertility due to PCOS. Antiandrogens/Spironolactone, 5-alpha reductase inhibitors (Finasteride), and Ornithine decarboxylase inhibitors (Vaniqa) are often used in addition to oral contraceptives to help control acne and hair growth in women with PCOS that do not desire fertility.
Medications that have been use for women with PCOS that desire fertility include:
- Metformin, which can control insulin resistance and possibly decrease the chance that a women develops diabetes. About 7% of women with PCOS using metformin alone will achieve pregnancy.
- Clomiphene is an oral fertility drug used to stimulate ovulation in women with PCOS. About 60% of women will achieve pregnancy with Clomiphene (it may take 3-4 cycles of treatment). Some women with PCOS will take both Clomiphene and Metformin. There is no data to suggest that the combination of metformin and clomiphene is any better than clomiphne alone, however the metformin my correct sugar imbalances and lead to weight loss which is often needed in PCOS patients.
- Low dose FSH
Treatment for PCOS through the US Fertility Network can help treat the symptoms and prevent long term problems. Treatment should start as soon as the diagnosis is made. In addition, the vast majority of women with PCOS are able to achieve a successful pregnancy with the modern treatment options available.