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Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovary Syndrome and Infertility

Polycystic ovarian syndrome (PCOS) is caused by an excess of testosterone and is the most frequent cause of infertility in reproductive-aged women. Conception is difficult for women with PCOS, as most experience irregular menstrual periods, often having only a few per year. High insulin levels are another symptom that can further contribute to menstrual irregularities. Additionally, Polycystic Ovary Syndrome may increase the risk of miscarriage because of the hormonal imbalance.

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Polycystic Ovary Syndrome is the most common hormonal abnormality causing infertility in women. It affects fertility by suppressing ovulation. Egg follicles may begin to mature but do not ovulate or release the egg into the fallopian tube. These follicles remain as cysts in the ovaries. In women with PCOS, the ovaries also produce excessive amounts of testosterone (male hormone) that can lead to acne and hair growth. In the fat cells, testosterone is converted to estrogen, leading to excessive buildup of the uterine lining which may contribute to heavy or irregular bleeding.

Like most medical problems that are referred to as “syndromes”, Polycystic Ovary Syndrome is made up of a cluster of signs and symptoms. Women with polycystic ovary syndrome may have some or all of the following features:

  • Irregular or skipped menstrual periods
  • Obesity and difficulty controlling weight gain
  • Male pattern hair growth
  • Acne and other chronic skin conditions
  • Dark brown or black patches on the skin

Other symptoms are oily skin, acne, facial hair growth and weight problems.

Polycystic Ovary Syndrome is diagnosed based on a patient’s history, blood testing and ultrasound examination during which doctors may identify multiple small cysts on the ovaries. Diagnosis is made by evaluating the presence of multiple symptoms and ruling out other conditions.

Fertility Treatment for PCOS

High levels of insulin associated with obesity interfere with ovulation and also worsen PCOS symptoms. Minimizing insulin resistance via a healthy, safe weight loss regimen is a common first step for patients with Polycystic Ovary Syndrome who want to make conception more likely. Insulin regulating medications may also be prescribed. Some women are able to begin ovulating more normally at this point and may be able to conceive naturally.

Fertility enhancing drugs such as Clomid, Metformin and gonadotropins may be used to stimulate ovulation. This approach is tried after other potential causes of infertility have been ruled out. In Vitro Fertilization can also be used for some women with PCOS.

For women who are not trying to get pregnant, birth control pills can regulate the menstrual cycle and control the hormonal imbalance. If necessary, other medications can also be used in combination with oral contraceptives. For women who are trying to conceive, we use medications to induce ovulation and to reduce the risk of miscarriage. Weight loss also plays an important role in treatment, as it can help restore regular menstrual periods.

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