Polycystic Ovarian Syndrome & Infertility

What is Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder and one of the common causes of infertility among women.

PCOS is characterised by an ovulation dysfunction or impedance to the ovaries' normal growth and release of eggs. It is commonly seen in women of childbearing age and is rare after menopause. The hormonal imbalance results in enlarged ovaries containing several small cysts (fluid-filled sacs). 8 MM OR LESS IN SIZE

Causes of Polycystic Ovarian Syndrome (PCOS)

The exact cause of polycystic ovarian syndrome is unknown. However, several factors, including genetics, have been implicated in playing a role in PCOS development.

Women with either weight and lifestyle issues or a family history of polycystic ovarian syndrome are more likely to develop this condition.

Researchers have found an association between excessive insulin production and PCOS development. High insulin can be related to lifestyle and weight issues or a pre diabetic or diabetic disorders.

Insulin hormone regulates blood sugar levels, and any disorder affecting the insulin mechanism may result in excessive insulin secretion, which triggers androgen secretion from the ovaries. In response to ingestion of certain foods, Low-grade inflammation may lead to the release of substances that can cause insulin resistance and cholesterol accumulation in the blood vessels or atherosclerosis.

Clinical studies have demonstrated the presence of low-grade inflammation in women with PCOS. Excessive exposure to the male hormone during the fetal period may disrupt the function of normal genes and increase the risk of insulin resistance and low-grade inflammation in the offspring.

Symptoms of Polycystic Ovarian Syndrome

The symptoms of polycystic ovarian syndrome vary from person to person and depend upon the nature and severity of the condition.

Some symptoms of PCOS include

• infertility,
• absent or irregular menstrual cycle,
• obesity or accumulation of fat, usually around the waist.
• abnormal facial and body hair,
• adult acne
• male pattern baldness or hair thinning may develop due to excessive androgen secretion.
• In some patients, black or dark brown patches are seen around the skin of the neck, arm, breasts or thighs.
• Recently it has been recognised that depression and anxiety is more common in women with PCOS.

Diagnosis of Polycystic Ovarian Syndrome (PCOS)

The diagnosis of polycystic ovarian syndrome is based on the medical history and a physical and pelvic examination to evaluate the patient's condition and help identify the underlying cause. Test conducted could include:

• Blood tests are conducted to determine the level of various hormones.
• Glucose tolerance test
• Evaluation of blood cholesterol
• Pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining.

PCOS is a diagnosis of exclusion and is considered when looking at possible causes for fertility problems.

Treatments for Polycystic Ovarian Syndrome?

The treatment of polycystic ovarian syndrome is based on the symptoms and individual concerns such as infertility, irregular menstrual cycle, acne or obesity.

Both medications and surgical treatment can be used for the management of PCOS. Infertility may be treated by fertility therapy with ovulation-inducing drugs.

Drug Therapy

An oral drug Letrozole, 2.5-5 mg, is taken from D2-D6 of the menstrual cycle as the first-line treatment, adding metformin if no success. Dr Turner will do an ultrasound to check the growth of follicles and determine the time of ovulation.

Another oral medication, Clomiphene citrate may be prescribed for patients not responding toLetrozole. Dr Turner may also add metformin or enhance the stimulation with a follicle-stimulating hormone (FSH) administered by injection.

Lifestyle Modifications

Lifestyle and anti-diabetic medications may be prescribed to manage or prevent obesity and diabetes mellitus.

Surgery

Surgery may be recommended in patients who do not respond to medications. Laparoscopic ovarian drilling, a surgical procedure, may be used to treat the condition and induce ovulation.

What if PCOS is not Treated?

Patients with polycystic ovarian syndrome frequently develop other serious medical conditions such as

• diabetes mellitus,
• cardiovascular diseases,
• pregnancy-induced high blood pressure,
• miscarriage or premature delivery.

These patients are also at risk of uterine cancer, anxiety or depression.