Fertility Chronicles is proud to present a special blog series, “From the Fertility Experts,” where leading fertility experts answer commonly asked questions for patients about their fertility health and treatment options. We hope this series can help patients navigate their personal fertility journeys.—Catherine T. Yang, Editor, Fertility Chronicles
Univfy’s “Fertility Chronicles” guest blogger Dr. Wendy Chang shares her advice on polycystic ovarian syndrome (PCOS):
Normally, a woman’s female hormones – estrogen and progesterone -- fluctuate in a regular pattern to support ovulation once every 28 to 30 days. With polycystic ovarian syndrome (PCOS), a woman has abnormal levels of male hormones that can lead to irregular or no ovulation – a clear barrier to getting pregnant.
PCOS affects 5% to 10% of women. The condition is also linked to a 20% to 40% risk of early miscarriage, twice the rate in the general population. Researchers think this may be due to a thickened uterine lining or poor egg quality from ovulation that’s too early or too late. PCOS may also put you at risk for a pre-cancerous condition of the endometrium and metabolic syndrome, where a combination of high blood sugar, blood pressure, cholesterol, and body fat around the waist increase the risk of heart disease, stroke and diabetes.
A PCOS diagnosis usually includes two of the following conditions: 1) Irregular ovulation (usually less than once every 28 to 30 days) or no ovulation; 2) higher than normal levels of androgens (male hormones), which may or may not cause her to have excess body hair; 3) polycystic ovaries on ultrasound examination. Other accompanying indicators include acne and obesity. Indeed, 50% of women with PCOS are obese.
Women with PCOS may have ovaries that contain many small follicles, often resembling a string of pearls. Within each of those small follicles is an immature egg that has the potential to grow. Without medical help, the follicles are often in limbo and do not result in ovulation. The small follicles may become ovarian cysts, which further disrupt the hormonal balance to interfere with ovulation.
Although having those small follicles alone do not necessarily get in the way of conceiving and don’t necessarily point to PCOS, they do increase the risk of overstimulation of the ovaries during infertility treatment. If you do not ovulate regularly or at all, you should see an infertility specialist to determine if you have PCOS. Your infertility doctor will likely perform a diagnostic workup to rule out other causes of irregular ovulation, higher male hormone levels, and excess body hair before making the diagnosis of PCOS. Typically, your doctor will perform an ultrasound of your ovaries before starting any treatment to determine the safest effective dose of ovarian stimulation medication.
If you have PCOS and are trying to get pregnant, your fertility specialist may recommend taking the oral medication clomiphene citrate (brand name Clomid) to induce ovulation. Gonadotropins (injectable hormonal medications) are usually the next line of drugs if clomiphene doesn’t help. However, to a different extent, clomiphene citrate and gonadotropins can lead to overstimulation of the ovaries and ovulation of more than one egg, leading to multiple births, so women on these drugs must be closely monitored.
If these drugs fail or if you and your doctor want better control over the number of embryos that can implant, your physician may recommend in vitro fertilization (IVF). With IVF, the woman is given drugs to stimulate egg production. Then the eggs are harvested from her ovaries, and in a laboratory, the sperm and eggs are combined and grow into embryos. After that, the doctor and patient determine the exact number of embryos to be transferred directly into the woman’s uterus.
Although there are many aspects to maintaining health and treating infertility in women with PCOS or polycystic ovaries, these conditions are extremely amenable to treatments such as ovulation induction and IVF. Patients whose only diagnosis is PCOS have excellent chances of having a baby with treatment, and the challenge is to minimize the risk of complications.
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