Polycystic Ovarian Syndrome (PCOS)

PCOS, also known as polycystic ovarian syndrome, is a common cause of infertility.

PCOS is a common cause of female infertility, being a key factor in up to 20 percent of women with difficulty conceiving. PCOS is a clinical syndrome consisting of ovulatory dysfunction, increased androgen levels, and the presence of multiple small follicles/cysts on the ovaries.

One finding from fertility tests in PCOS patients is elevated levels of androgens, or male hormones like testosterone. This can be manifested by excess body hair and acne. Although many PCOS patients are overweight, thin women can also have the syndrome.

PCOS is frequently associated with increased levels of insulin, a condition known as hyperinsulinemia. Elevated insulin levels can be associated with the overproduction of androgens by the ovary, which ultimately leads to impaired follicular growth and ovulatory dysfunction. In some overweight patients with PCOS, the hyperinsulinemia may signify a predisposition to diabetes or impaired glucose tolerance.

Current medical treatment of PCOS reduces the levels of insulin with diet and exercise, as well as use of fertility drugs such as metformin, an insulin-sensitizing agent. As insulin levels decline, the production of androgens by the ovaries also decreases and normal ovulation is often established. Many specialists prescribe long-term treatment with metformin to reduce the health risks associated with the condition. Health consequences may include type II diabetes, cardiovascular disease, and increased risk for some types of cancer.

Clomid is also sometimes used as a first-line treatment for ovulation induction and it may be used in conjunction with metformin. Follicle-stimulating hormone (FSH) may be used as well to induce ovulation, either in combination with IUI or with IVF. PCOS patients often have an exaggerated response to FSH, and the drug should only be administered by a reproductive endocrinologist/infertility specialist thoroughly trained in its use.

Surgical treatment (ovarian diathermy or ovarian drilling) is sometimes performed, essentially removing portions of the ovary in order to reduce androgen production. Surgery is rarely performed today due to the effectiveness of medical therapies.