Polycystic Ovary Syndrome (PCOS)

PCOS is caused by a hormonal imbalance and is one of the most common causes of female infertility. This imbalance interferes with the hormone signals that trigger ovulation and allows an excess of male hormones (androgens). Typical symptoms are irregular menstrual periods, obesity, and abnormal hair growth on the face, chest, and abdomen. Symptoms often appear soon after puberty.

Polycystic ovaries are often twice normal size. They are covered with a tough white membrane. The condition causes follicles (egg-containing sacs) in the ovary to stop developing. The under-developed follicles form cysts 2 to 5 mm in size.

PCOS affects 5% to 10% of women of childbearing age. No one knows exactly what causes the condition but it often affects several women in the same family.

PCOS Treatment

There is no cure for PCOS but the condition can by managed in several ways.

If a woman does not want to become pregnant, PCOS is treated by stopping the function of the ovary with medications such as oral contraceptives, spironolactone, and flutamide. These medications help regulate periods and control hair growth and acne, but they do not cure PCOS. Weight management through healthy diet and exercise is also important in the treatment of PCOS.

For women who want to become pregnant, PCOS can be treated with fertility drugs that stimulate ovulation. These drugs include clomiphene citrate, an oral medication, and injectable fertility drugs such as follicle stimulating hormone (FSH) and combination follicle stimulating hormone/lutienizing hormone (FSH/LH). About 80% of patients who take clomiphine citrate will ovulate.The rate of multiple births is about 10%. The rate of multiple births with injectable drugs is 20-40%.

Medicines for type 2 diabetes, such as Metformin (also called Glucophage), can also be used. Metformin reduces production of male hormones, and ovulation sometimes returns after several months of treatment. Metformin can be taken with lower doses of fertility drugs to help reduce the risk of multiple births.

Women with PCOS can also be treated by in vitro fertilization.

A surgical technique called ovarian drilling can induce ovulation in women with PCOS. Ovarian drilling is a laparoscopic technique in which an electrical current is used to destroy a small section of the ovary. This technique can cause scar tissue to form on the ovary and should only be used if other treatments have failed.