By Dr Suzan Elharmeel, City Fertility Centre Gold Coast.
Polycystic Ovary Syndrome (PCOS) can significantly affect fertility but with proper diagnosis and medical care, women living with the condition can achieve successful pregnancies.
Women with PCOS can usually be treated with methods that do not require them to progress to IVF.
As the most common endocrine disorder in females of reproductive age, PCOS affects between 12 and 21 per cent of women; however, it is estimated that 70 per cent of Australian women with the condition remain undiagnosed.
The concern in being undiagnosed is that the PCOS goes untreated and can result in a range of health issues, including fertility problems and potentially major conditions or illnesses such as obesity, type 2 diabetes, metabolic syndrome and cardiovascular disease. It can also affect psychological health.
When I am diagnosing a patient with PCOS, using an ultrasound, the three key features I look for are: infrequent or irregular periods; evidence of excessive blood levels of androgens, often causing symptoms such as excessive hair; and the presence of a large ovarian volume or polycystic ovaries.
In women with PCOS, estrogen is usually produced in normal amounts, testosterone appears in excessive amounts and progesterone may be generated irregularly or not at all.
Treatment for PCOS varies depending on the presenting problem. However, the first line of treatment would be to improve lifestyle and diet. If fertility is the main priority, treatment with medication to assist in ovulation can be given. Ovulation can be induced with clomiphene citrate (Clomid or Serophene), and Metformin may be used in conjunction with Clomid to improve results. Women using clomiphene will have success in ovulating, resulting in pregnancy rates comparable to those of the general population.
It should be noted that clomiphene is only prescribed by a fertility specialist for up to six menstrual cycles. If the woman does not become pregnant, injectable fertility drugs, administered at low doses (follicle stimulation hormone, or FSH), may be used to induce ovulation.
IVF is usually offered to PCOS patients when other treatments have failed.
Obesity is common in women with PCOS, so a healthy diet and exercise are recommended for weight loss, which can in turn help improve the frequency of ovulation and spontaneous conception with better pregnancy outcomes.
If infertility is not the immediate concern, the combined oral contraceptive pill (OCP) can be prescribed to reduce acne and hirsutism (hairiness) and maintain regular menstrual periods. Most importantly, the OCP provides constant progesterone to protect the endometrium and lower the risk of uterine cancer from the unopposed estrogen that is a common feature of PCOS.
Women with PCOS also need biennial glucose tolerance tests (GTT) and regular metabolic screening, such as cholesterol checks.
While infertility can be a challenging experience for you and your partner, the good news is that it can usually be treated.
To find out more on female infertility, visit our page: Female Infertility Diagnosis.
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