Polycystic Ovarian Syndrome, PCOS
PCOS is present in up to 20% of infertile women. Women with PCOS have irregular ovulation, elevated male hormones (androgens such as testosterone or DHEAS), and more than twelve small follicles seen on ultrasound. They may also have acne, excessive facial or body hair, and thinning scalp hair. Many women with PCOS are obese and have a difficult time losing weight; however, PCOS can occur in thin women or those with “ideal body weights”.
PCOS patients often have chronically elevated insulin levels (hyperinsulinemic), especially if there is a family history of diabetes. Elevated insulin levels cause the over production of male hormones by the ovary, leading to the symptoms of PCOS. Chronically elevated insulin levels can also lead to long term health consequences including an increased incidence of cardiovascular disease, Type II diabetes (non-insulin dependent), and other conditions.
PCOS is sometimes treated with Clomid but most infertility specialists use metformin (Glucophage) as the “first line” treatment. Metformin is sometimes prescribed in combination with Clomid, FSH, or letrozole (Femara). Metformin is an “insulin sensitizing drug” which lowers insulin levels by increasing the pancreatic cells sensitivity to insulin. This increased sensitivity leads to lower insulin levels thus reducing androgen production and allowing normal ovulation to resume. Fertility specialists will sometimes prescribe metformin for “long term” treatment of PCOS hoping to avoid the health consequences of the disease.
Surgery was once a common treatment for PCOS where sections of the ovary were removed in an attempt to lower the production of male hormones (ovarian drilling). Surgery is rarely performed today due to the effectiveness of medications.
An infertility specialist, or an experienced gynecologist, should manage PCOS patients trying to become pregnant. FSH for ovulation induction should only be administered to PCOS patients by an infertility specialist as these patients can have an exaggerated, unpredictable response to this drug.
You can find additional information on the PCOS Awareness Association Website.