Fertility Chronicles is proud to present a special blog series, “From the Fertility Experts,” where leading fertility experts answer commonly asked questions from patients about their fertility health and treatment options. We hope this series can help patients navigate their personal fertility journeys.
This week’s guest blogger Dr. Shahab Minassian, an expert on PCOS, continues from his blog, "What's New in Treatment for Polycystic Ovarian Syndrome (PCOS), Part I" to discuss fertility treatment for PCOS patients. In addition to his work at the Reading Health System in West Reading, Pa., Dr. Minassian is a Clinical Associate Professor at Jefferson Medical College and at Drexel University College of Medicine, both in Philadelphia.
Q: How do you treat infertility (and insulin resistance) in PCOS patients?
Dr. Minassian: Patients of younger reproductive age (for example, less than 30 years old) may opt for metformin as a primary treatment that I described in my other blog. For patients with ovulation problems, clomiphene citrate (Clomid, Serophene), the oral fertility drug, is usually prescribed. If the patient is insulin resistant, some specialists will add metformin to clomiphene as an option. Patients may have adverse reactions to clomiphene, may not ovulate optimally or not ovulate at all.
Injectable fertility medications (gonadotropins) are the next treatment option for these patients. These medications must be used cautiously in patients with PCOS. Low-dose gonadotropins have been shown in recent studies to be the preferred choice to reduce the risk of ovarian hyperstimulation and high order multiple births. Patients should discuss this choice with their reproductive endocrinologist.
Q: Are there treatments to make periods more regular?
Dr. Minassian: Ovarian drilling, a same-day laparoscopic surgery procedure, has been shown to at least temporarily make periods regular. However, this approach does lead to scarring of the ovaries in up to 20% of women, may reduce the woman’s ovarian reserve, and has not been proven to help against insulin resistance. In addition, many patients will eventually return to irregular periods.
Q: What other fertility treatments are available for PCOS patients?
Dr. Minassian: In vitro fertilization (IVF) may be a very effective treatment option for some women, especially if they do not respond safely to gonadotropin treatment. IVF would reduce the risk of having triplets and ovarian hyperstimulation syndrome. It can provide a more controlled way to stimulate the ovaries and by limiting the number of embryos transferred.
Q: Will losing weight help PCOS patients combat infertility?
Dr. Minassian: Yes, a great way to manage PCOS-related infertility is by lifestyle alterations, including diet, exercise, and stress reduction. Weight loss in women with excessive weight can help their response to fertility medications and may even eliminate the need for them. Low carbohydrate (probably more effective) or low calorie diets can be very useful for weight loss.
Q: What kind of exercise is best?
Dr. Minassian: Exercise is an excellent tool for weight loss, and diet and exercise should be used together for the best results. Cardio exercise is most effective, and adding a small percentage of resistance to exercise regimens is also beneficial.
Q: Can reducing stress be helpful?
Dr. Minassian: Yes, stress reduction can be accomplished in many ways. “Western” methods like biofeedback have been advocated, as well as “Eastern” methods, such as meditation, tai chi, qigong, and yoga. Anything to reduce stress that is enjoyable and therefore can be counted on for long-term use is advisable.
In the complementary medicine area, acupuncture has been shown to be useful in some small Mainland Chinese and European studies, and one acupuncture study from our group was the first in North America to report a pregnancy in a PCOS patient. The goals of fertility and a safe pregnancy are now well within reach for women with PCOS.