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PCOS, Polycystic Ovarian Syndrome
Polycystic ovarian syndrome (PCOS) is a common cause of female infertility being present in up to 20% of women. Its exact cause is unknown, but results in a variety of symptoms that can extend beyond infertility. Some women experience severe symptoms, while others may be only mildly affected. Fortunately, there are treatments that can help most patients.
The effects of PCOS typically result in irregular or complete lack of periods. This is a result of irregular, or complete lack of ovulation. This irregularity of ovulation is the hallmark of PCOS in causing infertility. Originally, this was thought to be due to problems with the ovaries themselves, as they are typically enlarged with a large number of immature eggs. Later studies have shown it to be more complex, involving the pituitary gland in the brain, as well as other endocrine organs in the body.
Surgical removal of part of the ovary was noted many years ago to have a beneficial effect on achieving ovulation and subsequent pregnancy. Fortunately, a medication called Clomiphene Citrate (Clomid) was developed that results in ovulation in a majority of patients without the need for surgery. It is a convenient and inexpensive medication.
Recently, two other fertility drugs have been used by many infertility specialists to induce ovulation. Metformin (Glucophage) is a medication that alters blood sugar (glucose) levels in the body and was originally developed to treat diabetes. It was noticed, however, that it has a beneficial effect on women with PCOS in achieving ovulation. Letrozole (Femara) is a medication that is known to alter estrogen levels in the body. It was originally developed to alter the hormones in an effort to treat patients with breast cancer.
Researchers noticed that it, too, had beneficial effects on achieving ovulation in those with PCOS. For those resistant to these medications, injectable gonadotropins (FSH)will achieve ovulation, but should be monitored carefully as multiple pregnancies are a significant concern.
Currently Clomid is considered the “first line” of therapy, where the other medications are reserved in a backup role in patients that are resistant to Clomid, or to treat patients where Clomid has undesirable side effects. Due to the complexity of the medication choices discussed above, the appropriate management decisions are usually best managed by an infertility specialist.
The symptoms associated with PCOS may not be confined to ovulation and conception. Some patients will experience unwanted cosmetic consequences such as unwanted hair growth on the face, or acne outside to the teenage years, and/or weight gain. Changes in cholesterol, as well as ovarian and adrenal hormones, can lead to an increased lifetime potential for diabetes and heart disease. For those who do not want to conceive, oral contraceptive pills and metformin may help the cosmetic issue.
A conversation with your primary care provider is recommended to discuss the lifetime options for prevention of diabetes or heart disease that are more common in patients with PCOS.
We provide services for the diagnosis and treatment of infertility.
Our services include an outstanding IVF and donor egg program.
We offer all levels of treatment including infertility testing intrauterine insemination (IUI), medical treatment, and advanced laparoscopic surgery. Most of our patients become pregnant without requiring IVF.
Monday-Thursday 8AM - 5PM
Friday 8AM - 1PM
Our patients can reach us for emergencies 24 hours a day by calling our main number, and selecting choice #1, which pages our medical or nursing staff.
If your situation is life threatening, dial 911 or go directly to your local ER.