Polycystic Ovarian Syndrome

     Polycystic Ovary Syndrome or PCOS is a relatively common hormone disorder that can have a serious impact on the quality of life for women at all stages of their life, from the teen years, through menopause.
     While the exact cause of PCOS is not known, medical experts do know that this syndrome is associated with women having abnormally high levels of two categories of male hormones - testosterone and androgens. These high levels of male hormones can cause a variety of distressing side effects, including excess body hair, male pattern baldness, severe acne, obesity, missed or irregular periods, enlarged ovaries, multiple cysts on the ovaries, high blood pressure, dark, patchy skin and infertility.
     PCOS can also cause insulin disorders, which interferes with the body's ability to metabolize sugar, leading to excessive weight gain and adult-onset diabetes. In addition, PCOS raises the risk for women developing heart disease later in life.

Treatment for PCOS
     A comprehensive examination is required for a diagnosis of PCOS. A variety of treatment methods may be suggested, including birth control pills to control irregular menstrual cycles, medication to control excess hair growth, nutritional counseling to help manage obesity and drugs to manage insulin disorders. In the case of infertility, the results of a complete infertility work-up will determine which therapies will be prescribed.

PCOS and Infertility
     The high levels of androgens associated with PCOS can cause the ovaries not to release the eggs that have matured each month. This in turn, results in both infertility, and multiple cysts forming in the ovaries.
     The first step in diagnosing PCOS for infertility problems is to conduct a vaginal ultrasound to determine the presence of enlarged ovaries and an increased number of small follicles around the perimeter of the ovaries.
     For women with irregular or absent menstrual cycles, the hormone Clomid can be taken daily for five days to increase the potential for ovulation. If Clomid fails to induce ovulation or pregnancy within four menstrual cycles, then a more potent injectible hormone (gonadotropin) may be prescribed. Both medications require careful monitoring by a qualified fertility specialist since there is an increased risk of multiple pregnancy with these drugs.
     Women with PCOS who have an insulin disorder (but not diabetes) are less likely to ovulate using the traditional Clomid. However, medications such as Glucophage which are used to treat diabetes, are now being given to lower the level of insulin in the body first, before prescribing Clomid. This new method has a very high success rate.
     A third method for treating PCOS related infertility is called laparoscopic laser drilling of the ovarian capsule. This outpatient surgical procedure has a good success rate of restoring ovarian function, although irregular menstrual cycles can recur at some point in the future.
     Finally, women who do not get pregnant with any of these methods may be successful using In Vitro Fertilization.
     The physician in consultation with the patient will determine which method or combination of methods is used.