Treatment of Infertility in Women with Polycystic Ovary Syndrome (PCOS)

What Is PCOS?

A common cause for female infertility, PCOS, also known as the polycystic ovarian syndrome, is a common cause of female infertility. It is a condition involving hormonal imbalances and metabolism problems. While PCOS affects the ovaries, a woman with PCOS can get pregnant. However, PCOS happens to be a common cause of infertility, affecting nearly 5 to 13 percent of women of reproductive age globally.

PCOS Affect Fertility?

Women with PCOS do not ovulate regularly and have ovaries that contain many small cystic structures, about 2-9 mm in diameter. 

Women with PCOS have hormonal imbalances that lead to:

• high levels of hormones called androgens
• the formation of small, painless, fluid-filled sacs in the ovaries
• thickening of the outer shell of the ovaries
• high levels of insulin in their blood

All these factors can affect ovulation and lead to irregular and missed periods, thereby causing infertility. Women with PCOS have difficulty getting pregnant and usually need treatment to improve their chances of getting pregnant. Some women with PCOS ovulate and release a mature egg occasionally while others don’t ever ovulate. And to conceive and get pregnant, the sperm needs to find and fertilize a mature egg and women need to ovulate.

Symptoms Of PCOS

Some of the most common symptoms of PCOS include the following:

• Excessive facial and body hair since 20’s
• Irregular menstrual cycles, or sometimes a total lack of periods
• Hair loss and thin hair on the scalp
• Skin tags on the neck or armpits
• Severe acne
• Oily skin
• Weight gain and difficulty losing weight
• Insulin resistance that can lead to high levels of insulin in the blood

Treatment for PCOS

Using fertility treatments, the chances of getting pregnant with PCOS are good. A lot of women with PCOS can conceive with fertility treatment. Women with polycystic ovary syndrome usually need induction of ovulation to get pregnant.

For infertility caused by PCOS, treatment usually involves correcting any ovulation issues and tackling metabolic problems, such as insulin resistance. Maintaining a healthy weight can help regulate menstruation and keep blood glucose levels under control. So, a healthy, balanced diet and regular exercise are vital.

Some other fertility treatments for PCOS include:

1. Clomiphene citrate (Clomid) –This is an ovulatory stimulant which blocks estrogen feedback to the brain. This medication can be taken orally, once a day for five days at the beginning of the menstrual cycle. The doctor will usually start with the lowest possible dose and then increase the dosage as required. Clomiphene citrate (Clomid) is quite effective in helping women with PCOS to ovulate.
2. Letrozole – This is an aromatase inhibitor and is used to treat breast cancer. It is also for jump-starting ovulation in people with PCOS. It blocks estrogen production and increases the release of follicle-stimulating hormone (FSH) to stimulate ovulation.
3. Metformin – It boosts the body’s ability to effectively use insulin and is used to treat type-2 diabetes. It is sometimes used by doctors to encourage regular periods and ovulation. Women taking metformin who do not want to become pregnant should use birth control, as they may start ovulating.
4. Gonadotropins – These are injectable hormones that can help you ovulate. This treatment may require frequent doctor’s visits to see how your body is responding.
5. Surgery – If the patient doesn’t respond to medication, a type of surgery called laparoscopic ovarian drilling may be an option. However, it is only done with doctor’s consultation and advice. In this procedure, the doctor will make several tiny incisions as PCOS can thicken the outer shell of the ovaries and block ovulation. The patient’s internal organs will be looked at through a laparoscope which is inserted through a tiny incision. Then, a laser or fine needle will be inserted to make a few holes on the surface of the ovary. This generally restores ovulation for 6 to 8 months.
6. At times, medicines or surgery may not yield results and in such cases, the doctor may recommend in-vitro fertilization as an option. The patient must start by having fertility injections to stimulate the ovaries. The patient may probably produce multiple eggs at one time. Once the eggs are harvested, they’ll be fertilized with sperm. Some fertilized eggs can be frozen for later use. Some will be transferred to the uterus to implant and develop. IVF may increase the likelihood of a multiple birth.

Cost of PCOS Treatment

Depending on the type of treatment being recommended by the doctor, the cost of PCOS treatment may vary.

PCOS affects a lot of women and is widely a cause for infertility but is treatable as well. One should consider lifestyle changes and consult a doctor immediately if they face any symptoms.