YOB: 2008

What is PCOS?

Polycystic ovary syndrome (PCOS) is the most common disorder of reproductive hormones occurring in 5-10% of women. Its key feature is irregular ovulation and menstruation, typically dating from the onset of menses in adolescence. Hence PCOS frequently results in infertility. Other common problems include extra facial hair, acne and obesity but relatively few patients have all the features of the full-blown syndrome. Most women seeking help to conceive have a mild variant of PCOS manifesting itself as infertility with irregular menses.

While the diagnosis of PCOS is based on clinical assessment not laboratory tests, a number of different hormonal irregularities occur in subsets of women with PCOS. Very few women manifest all of these laboratory abnormalities which can include higher levels of LH than FSH , more male hormones (testosterone) relative to female hormones (estradiol and, especially, progesterone) and elevated fasting glucose and/or insulin. Women with more severe PCOS are at an increased lifetime risk of developing diabetes, hypertension and heart disease. Young PCOS patients who are overweight may achieve remarkable success with even modest weight loss.

When conception is the goal, oral ovulatory meds are the accepted first step. Obviously, it is important to ensure that no other factors, such as abnormal sperm or tubes, contribute to the infertility. Clomiphene pills (Clomid, Serophene are the brand names) are usually tried initially. Whereas many general Ob-Gyns prescribe clomiphene, they often fail to perform the follow-up tests necessary to monitor its effectiveness. If no regular ovulation or conception is achieved with clomiphene alone, adrenal suppression or insulin-sensitizing medication, metformin, may be added with good results. Letrazole is another option available, albeit ovulation induction is an off-label use for this medication. Once regular ovulation is established, IUIs are typically added to maximize the per cycle pregnancy rate (What is an IUI?).

Ultrasound showing multiple small follicle cysts in PCOS ovary

If oral medications do not establish pregnancy, then gonadotropin injections or IVF need to be selected. The use of injectable gonadotropins in PCOS is risky because women with such a multitude of small follicle cysts (after which the condition is named) are particularly prone to hyper-stimulate (How to avoid OHSS). Successful management of infertile women with PCOS remains a clinical challenge. At the Alta Bates IVF Program women with PCOS receive particularly close monitoring and such attention to all details of their care usually leads to a successful pregnancy. While there is no simple cure for PCOS, Dr. Chetkowski’s long experience and maximal continuity of care offered by our program have resulted in outstanding results.