Modern PCOS Management and Infertility Treatment
Predisposition and Diagnosis
Polycystic ovarian syndrome (PCOS) may simply be defined as a hormonal imbalance; women with PCOS have ovaries that produce more androgens (male hormones) than normal. This is due to elevated levels of insulin which leads to the increase in production of androgen within the ovary. These high levels of androgen can hinder the development and release of eggs during ovulation causing PCOS infertility.
PCOS affects 1 in 20 women of childbearing age, or 5 million women in the United States. The exact cause of PCOS is unknown, but it is believed PCOS may be linked to genetics*.
To diagnose a patient with PCOS they must have 2 out of the 3 following symptoms:
- Little to no ovulation with possible irregular menstrual cycles or consistent bleeding (menses greater than 35 days or urine ovulation predictor kit never turning positive despite regular menses)
- Excess male hormone:
- Total testosterone/ free T level equal-or-greater to 50 or DHEAS levels greater than 250
- Can also be observed by male-pattern baldness or hair thinning; hirsutism (increased hair growth on face/jaw line, chest, back, stomach, upper arms, and/or upper legs); acne
- Ultrasound of ovaries indicates more than 12 follicles in an ovary
Treatment and Success
Although there is no cure for PCOS, it can be effectively managed in patients not looking to conceive with a treatment including oral birth control, metformin (glucophage), with diet and exercise.
Birth control can help control menstrual cycles, reduce male hormone levels, and help to clear acne and other skin problems. Metformin affects how insulin controls blood glucose and can lower testosterone production and delay/prevent diabetes. It may also reduce the rate of abnormal hair growth and can also help ovulation return to normal.
Lifestyle changes with diet and exercise are also great ways to manage PCOS. Limiting processed foods, foods with added sugars, adding more healthy fats, whole-grains, and lean meats to the diet can help lower blood glucose levels and improve the body’s use of insulin. Although 50% of PCOS patients are normal or even under weight, maintaining a healthy diet is still vital to the management of PCOS.
According to Dr. Samuel E. Brown, “Most women with PCOS actively trying to conceive will experience difficulty getting pregnant. Treatment for these patients with PCOS infertility can include cycles of timed intercourse with Clomid or Femara (8% average pregnancy success rate per cycle) or IUI cycles with Clomid or Femara (20% average pregnancy success rate per cycle). PCOS patients that have found no success with timed intercourse or IUI with Clomid/Femara may find increased success rates with IVF.
Even though PCOS is strongly associated with infertility, not all women with PCOS are infertile. Although there is no cure for PCOS, patients can successfully manage symptoms with proper care and treatment. Most women suffering from PCOS can carry babies to full term.
To learn more about PCOS infertility and strategies used to conceive, contact our office at (407) 244-5515 or use our online contact form.