Polycystic Ovarian Disease (PCOS)

The term "polycystic" means the presence of cysts on the ovary which is a diagnostic characteristic of PCOS. Polycystic ovarian disease is also usually accompanied by hirsutism (excess hair growth), elevated male hormone levels (androgens), irregular or absent menstruation, insulin resistance with a greater risk of diabetes, and being overweight. PCOS has been described in women with normal body weight.

Patients with suspected PCOS should be seen by a reproductive endocrinologist as this is a complex disease with many potential treatments. PCOS is often "missed" unless a full endocrine evaluation is performed.

Surgical treatment consists of the "ovarian wedge resection" or "laser drilling" techniques that remove a portion of the ovary. Wedge resections are associated with the highest pregnancy rates among less obese patients with lower insulin levels.

Clomiphene citrate (Clomid) is often used as a first line therapy to induce ovulation in PCOS patients. Metformin is also used to induce ovulation in PCOS patients due to the relationship between elevated insulin levels and insulin resistance. Metformin "sensitizes" cells to insulin and PCOS patients are typically hyperinsulinemic (abnormally low level of insulin in the blood),

PCOS is sometimes treated with injectable follicle stimulating hormone. When Clomid or metformin fail to induce ovulation they are sometimes administered together. FSH is also sometimes combined with metformin.

Weight reduction will sometimes restore ovulation in obese patients, however, it is very difficult for PCOS patients to loose weight. If body weight is reduced, it is also difficult to maintain due to a variety of reasons.

Many authorities postulate a genetic component related to the eggs ability to fertilize and develop into an embryo that can implant into the uterine wall and develop into a healthy fetus. There may also be an immunologic component to unexplained infertility.

Usually, one or more causes for a couple's infertility will be discovered in the infertility workup. It is absolutely essential that a complete, thorough evaluation be performed by a fellowship trained reproductive endocrinologist. These specialists are trained to recognize subtle causes that may be missed by those that do not specialize in infertility diagnosis and treatment.

Read Our Specialists Articles