Polycystic Ovarian Syndrome or PCOS is a very common cause of female sub-fertility or infertility, affecting 5-10% of women
PCOS is a syndrome in which ovarian follicles (the fluid filled sacs in which eggs grow) mature to only a certain degree and no further. Ovulation does not occur or occurs infrequently, so women with this condition usually have absent or irregular periods and difficulty becoming pregnant . This syndrome has been studied for many years and is thought to be related to insulin resistance which in turn increases male hormone levels that prevent full maturation of the follicle and ovulation.
The maturation of ovarian follicles without ovulation give the ovaries a specific look on ultrasound called “polycystic”. That is, multiple small ovarian follicles are seen just beneath the surface of the ovary. Usually 10-15 can be counted on each ovary. These follicles do not cause the syndrome but are the result of it. Other results of insulin resistance and elevated male hormone levels may include excess hair growth, acne and difficulty losing weight. Although PCOS is often seen in thin women, it is more commonly diagnosed in women who are obese since obesity increases insulin resistance and causes more pronounced symptoms.
The diagnosis of PCOS usually includes the following:
- irregular on absent ovulation that presents as absent or irregular periods
- excess male hormone activity that may result in excess hair growth and acne, or just irregular menses
- polycystic ovaries by gynecologic ultrasound
For many overweight women with PCOS, weight loss can lead to a resumption of normal ovulation and even fertility. If not, treatment focuses initially on ovulation induction, usually with Clomid, but gonadotropins or IVF may be recommended based on the individual circumstances. For example, women with PCOS may produce many more than one or two follicles in response to fertility medicine, and IVF may be the safest way to attempt pregnancy without risking a multiple pregnancy.