Polycystic ovary syndrome (PCOS) is a condition which can affect women during their fertile years. It affects how the ovaries work, and can reduce their function and effectiveness. It is a common hormonal condition, present in as many as one in five of the relevant population, although many women with PCOS do not experience any symptoms and it remains undiagnosed in around 70% of those who have it.
In this IVI blog article, we take a look at PCOS and what it can mean for individuals. We explain exactly what PCOS is, what PCOS symptoms are and the possibilities for reducing or alleviating the negative outcomes. PCOS treatment can come in the form of self-help measures as well as direct medical intervention in the shape of medication or surgery. Lastly, we look at the options for those experiencing infertility as a result of PCOS and what help is available.
What is PCOS?
The ‘syndrome’ in the name PCOS indicates that it is not an isolated medical condition, but rather a combination of symptoms which add up to the syndrome. These symptoms mainly affect the ovaries and ovulation. ‘Polycystic’ (which means many cysts) -looking ovaries is one of the three main features. The ovaries have a multiple number of follicles containing an egg (these are like multiple fluid-filled sacs in the ovaries. The other two main features are high levels of male hormones and irregular or missed periods.
These last two features are closely connected, in that the lack of ovulation itself has an impact on levels of the hormones oestrogen and progesterone, as well as the follicle-stimulating hormone (FSH) and luteinising hormone (LH) which stimulate and trigger ovulation. At the same time, levels of the male hormones, called androgens, are elevated.
What are the symptoms of PCOS?
PCOS symptoms often start to appear around puberty, at the time of the first period. The syndrome can sometimes develop later, especially in cases where there is a lot of weight gain. In fact, symptoms of PCOS are frequently more severe if the patient is obese. Any diagnosis of PCOS would need for an individual to show at least two of the three main symptoms:
• Irregular, infrequent or prolonged periods. This is the most common sign of PCOS and typically patients could have fewer than nine periods in a year, 35 or more days between periods, or experience unusually heavy periods.
• A higher than normal level of androgen. Elevated levels of this male hormone can result in excess hair on the face and body, male pattern baldness and sometimes acne.
• Polycystic ovaries, meaning ovaries are often enlarged and contain multiple follicles.
PCOS treatment: how to reduce negative outcomes
PCOS treatment falls broadly into three categories. In some instances, lifestyle changes alone can bring about improvement; in others, treatment with medication and/or surgery may be required. There is also the question of how to deal with the negative outcome if PCOS has resulted in low fertility or infertility. We will look at these three areas in turn.
Since PCOS is regularly associated with being overweight, it’s no surprise that treatment often begins with lifestyle changes like losing weight, a healthy diet and increased exercise. Medical advice suggests that losing even a modest amount, say 5% to 10% of body weight, can help to stabilise the menstrual cycle and improve the symptoms of PCOS. Some studies have also found that a combination of diet and moderate exercise a minimum of three days per week can improve ovulation regularity and insulin levels.
Medical and surgical treatments for PCOS
The contraceptive pill, which delivers a daily dose of oestrogen and progesterone, can restore hormonal disbalance due to anovulation/disovulation, as well as helping to alleviate symptoms like excess hair. Some drugs used to treat type 2 diabetes can also help by improving levels of insulin.
The surgical solution, a surgical procedure known as laparoscopic ovarian drilling (LOD), can be an option where medication is ineffective. Using a laparoscope, the ovaries are surgically heat or laser treated to destroy the androgen-producing tissue and follicles. This treatment corrects the hormone imbalance and can restore normal ovarian function. Nonetheless, nowadays this is not a first line therapy.
Fertility treatment if PCOS has led to infertility
Of course, the contraceptive pill is not going to be the solution of choice if you are trying to get pregnant. The good news is that other medical treatments are available, and with the appropriate treatment, most women with PCOS can become pregnant. Among the treatment options there is a drug called clomifene, which encourages ovulation and can help to induce ovulation in some women. If this is not successful, other medications, such as metformin or myo-inositol, could be recommended. It is commonly used to treat type 2 diabetes, but can also encourage regular periods, stimulate ovulation and reduce the risk of miscarriage.
When the strategies below are unsuccessful, the most likely recommendation is assisted reproduction. Both intrauterine insemination and in-vitro fertilisation (IVF) are valid options. In some situations, IVF could be the best option to start with and the starting point is a series of injections that stimulate the ovaries to produce a multiple number of oocytes that will be then fertilised in the laboratory using either conventional IVF or ICSI (in which a selected sperm is directly injected into the oocyte for fertilisation to take place). The best embryos are then selected and placed into the maternal uterus.
Getting in touch with IVI
At IVI we have had a high success rate with IVF treatments and other assisted reproduction techniques, which we are developing all the time. Indeed, we have recently carried out research into the possible causes of PCOS which could lead to the development of a drug to correct, rather than simply treat, the disease.
If you would like to know more about how the IVF process works and what to expect when you make an appointment with IVI, why not browse our website and have a look at our independently audited clinical results? When you feel ready, do get in touch.