 |
 |
What can we help you find today? |
| This site has over 200 educational pages on fertility issues and IVF Call our specialists today! (847) 662-1818 |
 |
 |
Infertility with PCOS, Polycystic Ovaries
Advanced Fertility Center of Chicago
Diagnosis, testing and treatments for polycystic ovaries
We are PCOS Doctors
Background
PCOS, short for polycystic ovarian syndrome, is a common cause of anovulation and female infertility. What are the chances that you have PCOS? It is estimated that PCOS affects about 8-10% of women of reproductive age.
Women with polycystic ovaries and infertility do not release an egg (ovulate) regularly and have ovaries with multiple small cystic structures, about 2-9 mm in diameter. In a normal menstrual cycle with ovulation, a mature follicle, which is also a cystic structure, develops. A mature follicle that is ready to ovulate is usually 18-28mm in diameter.
In a polycystic ovary, the numerous small cystic structures, also called antral follicles, give the ovaries a characteristic "polycystic" (many cysts) appearance on ultrasound. Laparoscopic surgery and ultrasound pictures of polycystic ovaries are shown below.
PCOS is also referred to as PCO, or PCOD - polycystic ovarian disease. Women with PCOS and infertility usually have very irregular menstrual cycles (oligomenorrhea), and sometimes a total lack of periods, referred to by doctors as amenorrhea.
Surgery photo of an enlarged PCOS ovary at laparoscopy
A typical, enlarged polycystic ovary
The numerous small
cysts (antral follicles) are just under the thick outer capsule
Ultrasound picture of a typical polycystic ovary
Ultrasound picture of a polycystic ovary with many antral follicles
Ultrasound photo of an ovary with a mature follicle (17mm diameter) close to ovulation
Yellow cursors are measuring the follicle. Fluid in the follicle is black on ultrasound
The wall of the follicle contains a microscopic egg (not visible with ultrasound)
Ovulation Problems and Hormone Levels With Polycystic Ovarian Syndrome
The basic problem is that although the polycystic ovaries contain many follicles with eggs, the follicles do not develop and mature properly so that they do not ovulate. Women without polycystic ovaries normally develop one mature follicle each month which ovulates (releases) one egg.
The FSH and LH levels in PCOS are often not in the proper balance. FSH (follicle stimulating hormone) and LH (luteinizing hormone) each need to be present at certain levels at specific times during the normal menstrual cycle in order for proper follicle and egg development to proceed. Many (but not all) women with PCOS have an abnormal FSH to LH ratio. Normally this ratio is about 1:1 - meaning the FSH and LH levels in the blood are similar. In women with polycystic ovaries the LH to FSH ratio is often higher - for example 2:1, or even 3:1.
FSH and LH are often both in the range of about 4-8 in young fertile women. With PCOS we often see the FSH in that same range - but with LH levels of 10-20. Testing FSH and LH hormone levels is not all that helpful when trying to make a diagnosis of PCOS because it is also common for women that clearly fit the syndrome in other ways to have normal FSH and LH levels and a normal FSH to LH ratio.
Women with polycystic ovaries are often hyperandrogenic as well. This means that PCOS ovaries produce an excess amount of the male hormones testosterone and androstenedione resulting in high testosterone levels in the blood. PCOS with high testosterone can cause increased hair growth, called hirsutism, and sometimes other problems as well. A common scenario in women with polycystic ovaries is irregular menstrual cycles, onset of excess hair growth in the teens or early 20s, and gradually worsening excess hair growth over the years.
Infertility Treatments With Polycystic Ovaries, and Pregnancy Success Rate Statistics with PCOS
Can I conceive with PCOS? When they try to get pregnant, women with polycystic ovaries usually will have difficulty. Some PCO women will ovulate (release a mature egg) occasionally, others do not ever ovulate. In order to conceive, sperm must find and fertilize a mature egg. Therefore, women with polycystic ovaries will usually need to undergo induction of ovulation to be able to get pregnant.
Women under 35 with PCOS will have about a 10-15% chance of pregnancy per month with Clomid treatment (for at least 3 months) - if they are ovulating with the Clomid.For PCO women that try to conceive using injectable gonadotropins, pregnancy rate success statistics of about 15% per cycle can be expected (beware of multiple birth risks with this treatment option). Details about the use of injectable fertility drugs
In our in vitro fertilization program we see PCOS pregnancy statistics of about 60% for a live birth rate. Our IVF Pregnancy Success Rate Statistics
Clomid pills as treatment for PCOS and infertility
Many women with PCOS can get pregnant using treatment with Clomid pills or tablets to induce ovulation. Clomiphene citrate, or Clomid, is given by general gynecologists, or by infertility specialists. Learn more about Clomid treatment for PCOS and anovulation
Clomid and metformin or Glucophage for PCOS
A newer method of trying to induce ovulation in women with polycystic ovarian syndrome is with oral medications such as metformin (brand name Glucophage) in conjunction with Clomid. Metformin is an "insulin sensitizing agent" primarily used to control diabetes. In recent years, it has been found to help stimulate ovulation in some women with PCOS. Unfortunately, metformin has unpleasant gastrointestinal side effects such as diarrhea in about 25% of patients.
Femara or letrozole for PCOS
Femara (generic name is letrozole) is an oral drug which can be effective in stimulating ovulation in some women with anovulation. Learn more about letrozole for infertility treatment
PCOS and metformin for infertility with clomiphene resistant polycystic ovaries
Fertility drugs after Clomid or Femara - Injectable Gonadotropin Treatment for PCOS
There are other fertility drugs that can be used after Clomid. If Clomid fails after about 6-9 ovulatory cycles, the next step used to be to give injectable gonadotropins (injectable FSH hormone). About 90% of women with infertility with PCOS will be able to develop mature follicles and ovulate with this medication. Most of them would be likely to get pregnant as well. However, this step has often been skipped in recent years because of the high risk for multiple births, particularly the risk of triplets and higher.
Although we can get almost all women to develop mature follicles and eggs with injectable FSH drugs, the problem is that there will quite often be several mature follicles, not just one. Proceeding with intercourse or intrauterine insemination with these multiple mature follicles has a significant risk of ending up with triplets, or more. Such high-order multiple pregnancies are very high risk for the babies because of premature birth related deaths and disabilities. Because of these risks, many couples and infertility specialists move directly to IVF if clomiphene treatment is not successful.
If the injectable FSH drugs are used for ovulation induction with timed intercourse or insemination, they should be used cautiously and in the lowest possible effective dosage by an experienced specialist in order to minimize the number of mature follicles that develop. In this way the risk for twins, triplets, and higher order pregnancies can be minimized.
More about multiple birth risks with ovarian stimulation drug treatments
IVF Treatment for PCOS - In Vitro Fertilization
The large majority of women with PCOS that have not gotten pregnant with other treatments will have a baby with IVF if they are under 40 years of age and have IVF at a high quality clinic. IVF clinics are not all the same - learn more about IVF pregnancy rates. Recent advances in IVF technologies have resulted in the ability to maintain high pregnancy rates while controlling multiple pregnancy risk. Blastocyst embryo transfer is a variant of the standard IVF treatment that is useful in controlling multiple birth rates. In general, IVF success rates are excellent in cases with infertility caused by PCOS. We specialize in treating women with PCOS and use an IVF protocol for PCOS that combines metformin, oral contraceptive pills, and the Lupron down-regulation ovarian stimulation protocol. We have been involved in many IVF PCOS success stories.
See our IVF live birth success rates
Other Health Issues Related to Polycystic Ovarian Syndrome
Women with PCOS are known to be at increased risks for developing certain other medical problems. The insulin resistance seen in PCOS is believed to be at least partially responsible for the increased risk for developing these conditions which are mainly cardiac and metabolic in nature. The chances of developing diabetes, or hypertension, or of having a heart attack or a stroke are higher in women with a history of having polycystic ovaries as compared to women that never had PCOS.
There is also evidence that mothers and sisters of women with PCOS are more likely than the general population to have PCOS as well. Fathers and brothers of women with polycystic ovaries appear to be at increased risk for developing insulin resistance and type 2 diabetes. It has been suggested that family members of women with PCOS should be screened for insulin resistance, hypertension and diabetes. Research is continuing in this area so that guidelines for early screening for these conditions can be developed.
PCO Laparoscopy
| Babies who had our help |
Quick Links
|
IVF Live Birth Success Rates |
 |
