Polycystic ovarian syndrome, also short PCOS, is the most prevalent ovulatory disorder in women with fertility problems. Up to 10 percent of women suffer from this condition in their most fertile years. Before we go into detail about fertility treatment options for PCOS, let’s first shed some light on what PCOS.

What is Polycystic Ovarian Syndrome (PCOS)?

Polycystic ovarian syndrome is a medical condition that affects hormonal levels in women. Women living with this dreaded condition produce a large amount of male reproductive hormones. This creates a hormonal imbalance that can make women miss their menstrual periods, hence making it difficult for them to conceive. PCOS can also cause hair to grow on a woman’s face and body, and in extremely rare cases, baldness, due to the presence of these male hormones.

Among other effects, PCOS directly interferes with egg maturation and ovulation in the body. The 3 main symptoms of PCOS include irregular menstrual cycles, excessive androgen (the cause of facial hair growth and acne), and multiple cysts in the ovaries, which can be seen using ultrasound. Women with PCOS find it difficult to get pregnant as their ovaries do not produce a mature oocyte (egg) monthly. This medical condition also associates with diabetes, heart disease, and high rates of miscarriage. 

Many women with PCOS don’t even know that they have the condition.  According to a study, more than 60 percent of women with PCOS are yet to be diagnosed. 

The worst part? The cause of PCOS is unknown which makes the related fertility problems & treatment options diverse. Weight can play a factor in the severity of the condition. It is a fact that the symptoms get worse with obesity. PCOS may also have a genetic basis and may be hereditary as well. If your mom or sister has the condition, you also have a higher chance of developing it. 

What tests can diagnose PCOS?

There are various reasons a woman may find it difficult to get pregnant. It is best to consult a doctor for a proper diagnosis. Knowing what can come up during your appointment will make it less stressful. Below are some of the things that may happen:

• Questions about your menstrual period and overall health
• Questions about your family members with similar symptoms
• A physical examination that is going to include measuring your waist size and BMI (body mass index)
• Examination of various parts of your female reproductive system
• A blood test to determine your hormonal and blood sugar levels

PCOS-related Fertility Treatment Options

Lifestyle Modification

For overweight women with Polycystic Ovarian Syndrome (PCOS), the first line of treatment is changing their lifestyle to promote weight loss. This often has to do with exercise and diet. Losing just 5 percent of your weight can normalize your menstrual cycle and allow you to ovulate on your own. Additionally, losing weight minimizes the possibility of having a miscarriage and improves your body response to fertility drugs. Studies have shown that losing just a few pounds improves a woman’s menstrual function and fertility.

Ovulation Induction

Your fertility expert may suggest a process called Ovulation Induction if lifestyle changes fail to yield the desired results after 3-6 months. This is one of the fertility treatment options for PCOS. It helps to stimulate the ovaries and boost egg production.  However, Ovulation induction treatment is not advisable for women with a BMI higher than 35. Your fertility expert may suggest treatment using a wide range of fertility medications. 

Use of Clomiphene

The most common medication used for inducing ovulation is Clomiphene (Clomid). The American College of Obstetricians and Gynecologists (ACOG) recommends Clomiphene as the primary medication for women with PCOS-related infertility. It inhibits estrogen activity in the brain, which raises the level of FSH (follicle stimulating hormone), causing the ovarian follicles to become mature so that ovulation can take place. In the case of insulin resistance, metformin may also be prescribed. Since clomiphene citrate is only effective within 3-6 cycles, it is not usable for a long period of time. Doing so may raise the odds of developing ovarian cancer. However, treating patients using clomiphene increases the chance of having multiple births. Some women may need monitoring via ultrasound during treatment. Patients sometimes receive a trigger shot to induce ovulation when the eggs are mature.

Letrozole Medication

Another medication that works in a similar fashion is Letrozole. It reduces estrogen production, causing the body to synthesize more follicle stimulating hormone, which is needful for ovulation. In recent studies comparing the effectiveness of the two fertility medications, more live births, and higher ovulation rates were recorded with letrozole than with clomiphene citrate.  For this reason, letrozole may be the preferred choice in the treatment options of PCOS-related infertility. It can also be an option in place of clomiphene citrate in case of an adverse reaction to the medication. Both Letrozole and clomiphene are for short-term use only. This is because they are only effective within 3 to 6 cycles. 

Gonadotropin Deployment

Gonadotropins (Follistim or Gonal F) is also applicable as one of the options for PCOS fertility treatment. Patients usually need to take daily hormone injections for 5 to 12 days. These hormones encourage eggs in the follicles (oocytes) to become mature. The right dosage is going to vary from one patient to the other to reduce the risk of OHSS and maximize the chance of getting pregnant. Once the patient starts receiving hormone injections, she is going under careful monitoring to prevent overstimulation. After the injections of Gonadotropins are complete, ovulation induction takes place through an HCG injection and Intrauterine Insemination (IUI).

If you achieve pregnancy, the probability of having twins is around 15 percent, triplets are 5 percent while the chance of giving birth to 4 or more babies is 1 percent. Gonadotropins are the go-to option when a woman’s body does not respond or responds poorly to Clomiphene or letrozole.

Other Fertility Treatment Options For PCOS

Other options such as IVF may be considered if all the fertility medications fail to result in ovulation. It is recommended that a patient get a comprehensive fertility workup if she suspects that she’s suffering from PCOS.  This is because other factors, such as age, blocked Fallopian tubes, or male infertility may also be contributing to her inability to conceive. Your fertility expert is going to create a suitable treatment plan that will put you on the path to motherhood. Having PCOS does not mean you won’t be able to have your own children.  With the right lifestyle changes and fertility treatment, you can get pregnant sooner than you think.

Coastal Fertility, a fertility clinic in Orange County, has helped thousands of patients start the family of their dreams. For more information about PCOS and other fertility treatment options, you can visit us at coastalfertility.com or call (949) 726-0600.