IVF

Polycystic Ovary Syndrome (PCOS), was first described by Irving Stein and Michael Leventhal (1955) as a triad of amenorrhea (no menstruation), obesity and hirsutism (abnormal growth of hair in women′s face and body), and was named as Stein-Leventhal-Syndrome.

It is the most common endocrine disorder in women of reproductive age; it affects about 5%-10% of women. Like all syndromes, PCOS is a collection of problems that are found together. Not all women with PCOS have the same symptoms. According to the Rotterdam-criteria′s, to be diagnosed with PCOS, a woman must have 2 of 3 possible issues:

  • Chronic lack of ovulation (anovulation)
  • Chronic high testosterone (hormone) levels (hyperandrogenism)
  • Ovaries that have multiple small cysts containing eggs (polycystic). The ultrasound image is of multiple small follicles between 2-8 mm on the outer side of the ovary. It is often called a “string of pearls”, and the number of follicles must be more than 12 on each side

Additional features may include:

  • Excessive hair growth (hirsutism), especially in regions that are not typical for females like the chin, upper lip, thighs, lower abdominal wall, and back side
  • Abnormal bleeding
  • Obesity (especially the more male obesity, so called “apple shape obesity” with a waist circumference of more than 88 cm (35 inches) in females
  • Acne
  • Infertility

What are polycystic ovaries?

The small follicles, wrongly being defined as cysts, do contain immature eggs. Often in PCOS, the ovaries are unable to grow and release the eggs, meaning ovulation doesn’t take place at all and / or on a regular basis.

Why does it happen?

The cause of PCOS is unknown. The condition appears to be genetically linked, this means the chance of having the condition is higher if one of your close family members is affected.

PCOS is also related to abnormal hormonal imbalance including high levels of androgens and in some patients – especially in the insulin resistance, overweight and obese.

Insulin is a hormone that controls the sugar levels in the body. If you have insulin resistance, your body doesn’t use insulin well. Excess insulin might also affect the ovaries by increasing androgen production, which may affect the ovaries’ ability to release eggs. Moreover patient with insulin resistance do have a higher risk of developing diabetes at an older age or during the pregnancy.

How is PCOS diagnosed?

A combination of results of physical exam, ultrasound of the ovaries and blood tests, including an account of family history is used, to diagnose PCOS.

What risks do women have with PCOS?

PCOS has certain risks linked to it, one being irregular ovulation. When ovulation doesn’t happen, it interrupts the regular hormone cycle and causes a disturbance in levels of estrogen. Thus causes the uterus lining to thicken, causing abnormal bleeding.

Over time, these can even lead to pre-cancerous changes or uterine cancer. Most importantly, lack of regular ovulation makes conception difficult.

PCOS patients are at risk of having a metabolic syndrome. Besides the already mentioned symptoms like extra weight around the middle and insulin resistance or even diabetes, there is also high cholesterol and high blood pressure. Each of these symptoms raises the risk of heart disease.

Lifestyle and Prevention:

One of the best treatments for PCOS is a healthy lifestyle. A combination of eating lower amounts of calories, combined with moderate exercise is important, as this can help regulate your blood sugar level and keep excess weight off. Losing weight is a challenge with PCOS, but doing so can help to normalise the endocrine hormone levels and may restore natural ovulation. It has been shown, that already a mild to moderate loss of weight – around 5% of your body weight – improves the situation.

How is infertility in women with PCOS treated?

In a patient who has PCOS the lack of ovulation is often the only cause of infertility. So one way to treat infertility is to use medicine that supports the growth and the release of an egg.

Usually, Clomiphene citrate is tried first. Another alternate is Letrozole, which is also an oral medicine. If both of these are unsuccessful, fertility medicines called gonadotropins are injected to stimulate egg growth.

It is essential that women with PCOS taking these medicines are monitored carefully to make sure that they are not responding too much to them, as this increases the risk of multiple births.

It has been proven that insulin impacts ovulation. So, Metaformin is an insulinsensitising medicine that helps the body use insulin more effectively. This improves ovulation in some patients with PCOS.

This also helps reduce the risk of developing diabetes or other metabolic disorders. If other treatments and medication do not help, then In vitro fertilization (IVF) may help women with PCOS get pregnant.

Many treatment options are possible. However, it is crucial that a patient-tailored treatment is recommended for PCOS patients. Your clinician will evaluate your situation and will provide you personal treatment according to your personal requirement.

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