PCOS and Infertility

Polycystic Ovarian Syndrome (PCOS) is one of the main reasons for infertility problems in women. It is believed that due to excessive insulin production in some women their bodies respond by producing high levels of male hormones or androgens. Women with PCOC are insulin resistant which leads to diabetes.

During a women’s normal menstrual cycle, several follicles develop within the ovaries. Each follicle contains an egg. As the menstrual cycle continues, only one follicle will remain which will produce the egg during ovulation. After the egg has matured, LH levels will surge causing the egg to burst from the follicle thus causing ovulation. Because women with PCOS do not normally produce enough female hormones necessary for ovulation, these follicles do not mature to become eggs. Some follicles may develop into cysts. PCOS may show up on an ultra sound as a “string of pearls” within the ovary. This “string of pearls” are the follicles that have not developed. The ovaries will typically have several small cysts covering the outside. Because ovulation does not occur, progesterone is not produced which is what causes the lining of the uterus to thicken.

Some symptoms of Polycystic Ovarian Syndrome include the absence or an irregular period. As a woman gets older, PCOS can become worse. Some women may ovulate irregularly as well as not at all. Five to ten percent of women of childbearing age have PCOS. Most women are unaware that they have it. In fact, less the twenty-five percent of women with PCOS have been diagnosed. Some women are lucky enough to conceive during an irregular ovulation cycle. Other symptoms include increased hair growth on back, chest or face, thinning hair, obesity, high insulin levels or type two diabetes, acne or pelvic pain. Symptoms for PCOS vary with each woman. Some women only have an irregular period as a symptom.

Obviously PCOS affects a woman’s ability to conceive because of a lack of ovulation. But, there are several steps that can be taken to correct the problem. Some women can simply treat their PCOS by losing weight. Weight loss can sometimes help to improve hormone imbalances. Metformin is a drug that improves the body’s ability to absorb insulin. It is considered safe to use on women who do not have diabetes because it affects insulin levels and does not actually lower blood sugar directly. Clomid or other fertility drugs are often used in the treatment of infertility relating to PCOS. Clomid blocks estrogen receptors in the brain. With these receptors blocked, the brain thinks there are low estrogen levels. Low estrogen levels trigger the body to produce more FSH and LH which signal the body to ovulate. Even though Clomid is often successful at bringing about ovulation, only thirty to forty percent of the women who do ovulate from Clomid will actually become pregnant. In vitro Maturation (IVM) or in vitro fertilization (IVF) is also options for women with PCOS. In vitro maturation is a procedure where immature eggs are harvested early in a woman’s cycle. The eggs are then matured in a laboratory and afterwards can be used for fertilization. In vitro fertilization harvests the eggs after they are already mature. The eggs are then fertilized and implanted in the woman’s uterus. IVF treatments also include medications that help the eggs develop. IVM is helpful for women who do not respond to drug therapy.

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