What
is PCOS?
PCOS,
or Polycystic Ovarian Syndrome, is a medical condition that
affects women’s menstrual cycles, fertility, hormone
levels, and physical appearance. Women with PCOS produce high
levels of insulin. Researchers believe that excessive insulin
production causes their bodies to respond by producing high
levels of male hormones or androgens.
During
the first half of a normal menstrual cycle, several follicles
will develop. Each follicle contains an egg. As the menstrual
cycle continues, only one follicle will remain. This follicle
will produce the egg during ovulation. Once the egg has matured,
LH levels will surge causing the egg to burst from the follicle.
This is when ovulation occurs.
Excess
male hormones produced with PCOS affect the production of
female hormones necessary for ovulation. A woman with PCOS
does not produce enough hormones to cause any of the follicles
to mature. They may grow and collect fluid but none become
large enough for ovulation. Some of these follicles may develop
into cysts. Because ovulation does not occur, progesterone
is not produced. Progesterone
is what causes the lining of the uterus to thicken. A woman’s
cycle will be irregular or absent without progesterone.
Symptoms
of PCOS
-
Irregular or infrequent menstrual cycles
- Infertility
- Increased
hair growth on face, back or chest
- Multiple
cysts on the ovaries
-
Thinning hair
- Obesity
- Elevated
insulin levels or Type II Diabetes
- Acne
- PMS
or pelvic pain
PCOS
and Ovulation Prediction
Because
hormone levels are affected with PCOS, predicting ovulation
can be difficult. Women with PCOS usually have an anovulatory
BBT chart. If they do ovulate, it may be very difficult to
interpret their BBT
chart. PCOS may also affect the results of ovulation prediction
kits. Ovulation
prediction kits work by detecting LH surges.
Some women with PCOS have elevated LH hormones making it difficult
to use an ovulation prediction kit. The Clear Plan Fertility
monitor also informs customers that PCOS adversely affects
the performance of the monitor.
PCOS
Infertility Treatments
- Weight
Loss –
Weight loss can sometimes help to improve hormone imbalances
and restore normal menses.
- Metformin
(or Glucophage)
– Metformin improves the body’s sensitivity
to insulin. It helps your body to use insulin better so
that you do not produce as much insulin to control blood
sugar. High insulin levels appear to be what creates the
high levels of male hormones. By reducing insulin levels,
male hormones also decrease. If Metformin is successful,
male hormones will be lower, and ovulation will resume.
Metformin 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. There are also
a few other insulin reducing medications that are used
in the treatment of PCOS. You will want to discuss your
options with your doctor.
- Clomid
(or other fertility drugs) – Fertility
drugs, such as Clomid, are often used in the treatment
of PCOS related infertility. Clomid works by blocking
estrogen receptors in the brain. With estrogen receptors
blocked the brain is tricked into thinking there are low
estrogen levels. Low estrogen levels trigger the body
to produce more FSH and LH. FSH and LH are what signal
the body to ovulate. Clomid is often successful at bringing
about ovulation but only thirty to forty percent of the
women who do ovulate from Clomid will actually become
pregnant. Metformin may also be prescribed in conjunction
with Clomid.
Other fertility drugs work more directly. Injections of
gonadotropins (FSH and LH) work directly to stimulate
follicle production and ovulation. These injections require
more monitoring than Clomid and are generally used only
after other options are tried first.
- Ovarian
drilling
– Ovarian drilling is a procedure where a small
needle is used to puncture tiny holes in the ovary with
an electrosurgical needle. The electric current destroys
a small portion of the ovary. This may result in lowering
androgen levels and restoring ovulation.
- IVM
(in vitro maturation) or IVF or (in vitro fertilization)
– In vitro Maturation is a procedure where immature
eggs are harvested early in a woman’s cycle. The
eggs are matured in a laboratory and can then be used
for fertilization. In vitro fertilization is procedure
where mature eggs are collected from the woman’s
ovary. The eggs are then fertilized and implanted in the
woman’s uterus. The difference between the two is
that with IVF medications are used to produce mature eggs
and with IVM the eggs are matured in a laboratory. IVM
may be helpful for women who do not respond to drug therapy.
Consult
your doctor to discuss the best treatment options for you.
Sources:
www.4woman.gov/faq/pcos.htm
www.resolve.org
www.inciid.org
