Polycystic Ovary Syndrome Infertility Treatment (PCOS)

This is a condition in which there are several tiny cysts in the ovaries coupled with the presence of one or more complaints such as complete cessation of the menstrual periods, irregular and/or long intervals between periods, obesity, excessive growth of body hair, greasy skin and acne. The ovaries tend to be larger than normal. These so-called cysts are not the sort of cysts that grow as ovarian tumours. Rather, they represent ovarian follicles that fail to complete their development apparently due to relatively low levels of FSH. The cause of this syndrome is unknown but it may be genetic. There seems to be a derangement in the hormonal activities of the ovaries and some other glands in the body.

For example, it is known that LH is produced in large amounts while normal or decreased quantities of FSH are produced. There is also an increase in the production of insulin which is a hormone that helps the body to control the utilization of glucose. Insulin is produced the pancreas. The need for increased insulin production arises because the patient's body tissues are not sensitive to the action of normal levels of insulin. This is called peripheral insulin resistance. Finally, the effective level of androgens such as testosterone in the body is higher than usual. Androgens are male hormones. The female normally produces a small amount of these hormones in her adrenal glands because they are needed for some of the activities that take place in her body. For example, androgens from the female adrenal glands help stimulate the growth of pubic and armpit hair. In polycystic ovary syndrome (PCOS) the ovaries also produce more androgens than normal. It is the high level of these androgens that makes some patients with PCOS have acne, greasy hair and excessive body hair. However, the level of androgens in these females is still not up to that normally found in men. Al though obesity may not necessarily cause PCOS it worsens the problem. Obese PCOS patients who succeed in losing weight have an improvement of their symptoms and may ovulate spontaneously or in response to lower drug doses than previously. It is now being recognized that the hyperinsulinaemia that is found in many women with PCOS induces changes in the body that lead to a wide range of potential problems in future.

The methods of ovulation induction usually employed in patients with PCOS include the administration of clomiphene citrate or tamoxifen tables, pulsatile Gn RH administration, Gonadotorphin injections and ovarian diathermy. The use of insulin sensitizing agents such as metformin is now being investigated as a means of treating hyperinsulinaema that is found in may of these patients.

Women who undergo treatment for PCOS but are still unable to conceive naturally often turn to assisted reproductive technologies, including IVF, and experience high pregnancy success rates.