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Jefferson Health

Home of Sidney Kimmel Medical College

Women with Polycystic Ovarian Syndrome Have Fertility Treatment Options

Ovulation-inducing medications and other treatments have proven overwhelmingly successful in overriding the fertility challenge posed by PCOS.

If you’ve been diagnosed with polycystic ovarian syndrome (PCOS), you’re not alone. PCOS is among the most common hormonal and reproductive problems affecting women of childbearing age.

“Women with PCOS typically don’t ovulate consistently,” says gynecologist Dr. Rebecca Jackson. “Some women ovulate infrequently, and some don’t ovulate at all, which can make it more challenging for them to become pregnant.”

Challenging – but far from impossible.

“The overwhelming majority of women with PCOS who come to us for treatment are then able to successfully achieve a pregnancy,” reports Dr. Jacqueline N. Gutmann, a specialist in reproductive endocrinology and infertility at RMA of Philadelphia at Jefferson. “In general, infrequent or lack of ovulation is something that we’re actually able to treat quite well.”

Symptoms and Diagnosis

Not ovulating, or having irregular periods, is just one of three primary symptoms of PCOS. A second indicator is evidence of too many male hormones, revealed either through blood work or such clinical signs as increased hair growth or acne. The third is the presence of polycystic ovaries, as shown by an ultrasound. In order to have PCOS, a woman must have two of these three symptoms.

However, Dr. Guttman cautions, a diagnosis of PCOS doesn’t automatically make that the cause of infertility: “Before assuming PCOS to be the cause of her irregular periods, it’s vitally important that a woman see her doctor as soon as possible in order to rule out other possible causes, such as a thyroid gland problem or too much prolactin, the hormone responsible for milk production.”

Facilitating Weight Loss

PCOS is more common in somebody who is overweight or obese. In such cases, treatment may focus initially on facilitating weight loss, with the help of physical a nutritionist as well as physical activity.

“There are good data that suggest that for somebody who is significantly overweight, losing as little as five percent of her weight will actually get her to ovulate regularly,” says Dr. Gutmann. “It will also decrease the likelihood of complications during pregnancy, including miscarriage, which are much more related to metabolic issues, including diabetes and high blood pressure that are common in overweight women with PCOS.”

“In addition to practicing good nutrition and having regular physical activity, anybody with PCOS should also take folic acid supplements,” recommends Dr. Jackson. “Research has shown them to be helpful in inducing ovulation in these women,”

Ovulation-Inducing Medications

Another treatment approach is the use of oral ovulation-inducing medications. The most effective of these is letrozole, which is typically used for breast cancer treatment. It can help induce ovulation by blocking the conversion of testosterone to estrogen, thereby causing the brain to drive the ovaries somewhat harder.

“Letrozole use for ovulation induction in people with PCOS has been shown to be an even more successful treatment than clomiphene, another often-used medication, However, it is important to note that despite much safe and effective usage for this purpose, letrozole is not FDA-approved,” cautions Dr. Jackson.

The slight possible risk of letrozole use is of having a multiple pregnancy – typically, twins; this happens with less than 10% of patients. Among potential side effects are headaches, hot flashes, mood changes and irritability. Patients typically take letrozole for only five days, and side effects, if any, will disappear after that.

Timed Intercourse

Another fertility treatment – sometimes combined with ovulation-inducing medication for patients with PCOS – is timed intercourse, which involves the timing of sex within the fertility window or the period where a woman has the best chances of becoming pregnant – about five days before ovulation until a day after. Timed intercourse has a great chance of being successful if done correctly. A fertility specialist utilizes ultrasound and blood work monitoring to help women properly identify their fertility window.

In Vitro Fertilization

“The likelihood of getting pregnant in any single one cycle is actually quite small for the most fertile persons,” Dr. Gutmann cautions patients. “They really need to not think that once medication gets them to ovulate, they will quickly become pregnant. It may perhaps take a few cycles before they successfully become pregnant. They should certainly feel disappointed when it doesn’t work, but they should not feel discouraged.”

“However, there are challenging patients who don’t ovulate following weight loss and medication. In such cases, we need to become more aggressive and try in vitro fertilization [i.e., fertilizing an egg by sperm in a test tube or elsewhere outside the body]. In fact, we’ve become increasingly successful using in vitro fertilization over the last few years. But it is still rarely necessary.”

Making Sure Sperm Are Present

Dr. Gutmann also stresses that even if a woman has PCOS, she shouldn’t automatically assume that to be the cause of her being unable to become pregnant without complete testing of both her and her partner.

“On a handful of occasions,” recalls Dr. Gutmann, “after giving a patient either letrozole or clomiphene, and her then having regular periods, she still was not becoming pregnant. We then did a semen analysis and determined that her partner had no or very few sperm. That, rather than PCOS, turned out to be the reason behind the woman not becoming pregnant. The couple wound up doing in vitro fertilization and had a beautiful baby.”

Don’t Put Off Treatment

Normally the definition of infertility is not achieving a pregnancy within a year of attempting if somebody is under 35, or six months after attempting if they are 35 or over or have had a prior child. But if somebody is not having regular periods, they shouldn’t wait that year or six months. They should see an infertility specialist for an evaluation sooner rather than later so that the underlying problem may be identified and appropriate treatment can be instituted promptly.

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