What causes PCOS?
The exact cause of PCOS is unknown. The common consensus is that PCOS is multifactorial (involving many factors) and as common as 20 % in adolescent and young females.
It was previously called PCOD (Polycystic Ovarian Disease) and is often wrongly referred to as PCO (Polycystic Ovaries).
The consensus is that PCOS is because of a combination of familial, environmental and nutritional factors.
The underlying problem is thought to be that women with PCOS have resistance to the action of insulin. This leads to an increase in the circulating levels of insulin in the body. High levels of insulin cause the ovary to release more male hormones (Androgens) and this leads to all the symptoms and sequelae of PCOS.
What are symptoms of PCOS and how is PCOS diagnosed?
The excessive male hormones (Androgens) in PCOS lead to following effects:
- Delayed, irregular, scanty menstrual cycles
- Increase in weight
- Skin disturbances such as acne and Hyperpigmentation
- Excessive unwanted hair growth
Apart from these symptoms, doctor may ask about family history of diabetes as there is a positive correlation between family history of diabetes and PCOS (Familial / Genetic).
The doctor may ask for blood tests to check the hormone levels and confirm the diagnosis.
You may also be asked to undergo a pelvic ultrasound to check for polycystic appearance of ovaries which is characteristic in PCOS and is known as “string of pearls” appearance.
HOW DOES PCOS AFFECT YOUR FERTILITY?
The main problem with PCOS is that the ovary does not get the required levels of hormones it needs for ovulation. Therefore, ovulation does not occur as it normally should, which causes the menstrual cycle to be irregular and also causes infertility. This is the key as to why PCOS leads to infertility.
In a normal cycle, one egg matures and gets released every month. This is called normal ovulation.
In PCOS, all the follicles remain small throughout the cycle and egg release or ovulation does not occur. This is called anovulation or ovulatory dysfunction. This lack of ovulation in PCOS causes infertility and menstrual irregularities.
What are the Treatment Options for Infertility in patients who have PCOS?
- Lifestyle and Behavioural Changes:
Dieting, Exercise and Weight loss are all very important components of treatment. A 5 % loss of weight is known to have a beneficial effect on ovulation rates and chances of pregnancy.
- Induction of ovulation or Ovarian Stimulation with Tablets:
If ovulation does not occur on its own, it can be made to occur by giving tablets like clomiphene citrate or letrozole. These are usually given from second day of menstrual cycle.
- Induction of ovulation with Injections:
In some cases where tablets are not effective, Injection HMG and FSH is given in varying doses to induce ovulation.
- Laparoscopy & Ovarian Drilling : Laparoscopic Ovarian Drilling corrects the hormonal imbalance to a certain extent but drawbacks are that it is an invasive surgical procedure performed under anaesthesia, may be associated with premature ovarian insufficiency, effect is limited to a time period of 6 months and the fact that inspite of laparoscopic ovarian drilling, ovulation induction with medicines may be required.
IUI in PCOS:
Usually when ovulation is induced with medicines, IUI or Intra Uterine Insemination is recommended as it increases the chances of pregnancy.
IVF in PCOS
Women with PCOS respond well to IVF or In Vitro Fertilization treatment. At Indore Infertility Clinic most PCOS patients are treated with Mild Stimulation protocols. We usually recommend antagonist protocol with Freeze all IVF and Elective Single Blastocyst Transfer to all our PCOS patients undergoing IVF.
Women with PCOS respond well to IVF treatment. At Indore Infertility Clinic most PCOS patients are treated with Mild Stimulation protocols. We usually recommend Antagonist protocol with Freeze All IVF and Elective Single Blastocyst Transfer to all our PCOS patients undergoing IVF