The most common problem effecting fertility that we see in our office is polycystic ovarian syndrome (PCOS). It is very prevalent in the general population and is seen more frequently in the infertile women. The ovaries of women affected by PCOS have multiple small cysts, which cause them to produce an excessive amount of testosterone, a male hormone. High levels of testosterone throw off the body’s normal hormone balance, interfering with ovulation. On the first visit a series of detailed questions about the regularity of the patient’s menstrual cycle and other symptoms help us make the diagnosis of PCOS.
Some common indicators of PCOS:
- Are your menstrual cycles irregular instead of every 28-30 days?
- Do you have hair in places that you shouldn’t?
- Do you have adult acne?
- Do you gain weight, especially in the mid-section?
To rule out other reasons for cycle irregularity, we can order simple blood tests, such as a thyroid test or a test for prolactin, the hormone that causes milk production. With PCOS, the testosterone level will be elevated. If the testosterone is too high, it causes ovulation not to occur properly.
Over the years, doctors have discovered that most women with polycystic ovary will also have insulin resistance. Simply put, these patients require more insulin to regulate their sugar than the average person. In these cases, the high insulin levels go to the ovary and cause it to make more testosterone, which aggravates the polycystic ovary symptoms.
Because of the insulin connection, one of the treatments for polycystic ovary is a medicine used mainly for diabetics called Metformin®, or Glucophage®. Metformin® sensitizes the insulin so not as much has to be released. Decreased insulin levels also lower the testosterone in the ovary, which makes it easier for ovulation to occur. Metformin® does have side effects, usually related to the gastrointestinal system; gas, bloating, diarrhea, and abdominal cramping. Because of these symptoms, not all patients can tolerate the medicine. Also, if the patient has a history of any liver damage, this condition can aggravate the problems. Liver function tests need to be performed while a patient takes Metformin®.
For patients trying to become pregnant, the mainstay treatment of polycystic ovary is to use Clomid, an ovulation induction medicine. 85% percent of all women with PCOS will ovulate on Clomid®. The other 15 percent will require a stronger stimulation such as a combination of Metformin with Clomid, or gonadotropins.
Oral Contraception (birth control pills)
Birth control pills are the most common form of treatment for polycystic ovarian syndrome. Oral contraception can lower the testosterone and regulate the menstrual cycles of women with PCOS. Birth control pills also improve the appearance of acne and excessive hair growth. In addition, oral contraception will lower the risk of endometrial cancer, which remains high for women who do not ovulate regularly.
Another form of polycystic ovarian syndrome treatment uses a diabetes medication, Metformin®, to regulate the production of insulin. Lowering the insulin will many times lower the ovarian testosterone and in some women, ovulation can return. Anyone taking Metformin® must be carefully screened and monitored throughout treatment.
For women who want therapy for female factor infertility as well as treatment for PCOS, we can use hormone therapy and ovulation induction medications. Because the primary concern with PCOS is lack of ovulation, which can lead to infertility, Dr. Douglas can prescribe various fertility medications and hormone treatments to bring on ovulation (ovulation induction). Fertility medications have a high success rate of helping women with PCOS conceive; however, these medications may increase the risk of a multiple pregnancies. If ovulation induction fails, patients can move on to in-vitro fertilization treatment.
Read more about PCOS