PCOS - Polycystic Ovary Syndrome

Welcome to our course for those who have polycystic ovary syndrome (PCOS) and for those who believe they should seek out a diagnosis. PCOS is an immensely complex condition and in the coming lessons, we’ll cover many of its most salient aspects.

For the purposes of this course, we’ll focus much of our attention on trying to conceive with a PCOS diagnosis. We’ll also touch on other aspects and symptoms of PCOS, and as always, it’s critical that you consult with your doctor on diagnosing and treating all of the underlying disease manifestations and your symptoms.

To get started and to keep life simple, let’s summarize a few of the more important concepts before we step through the nuances of diagnosis and treatment.

First, polycystic ovary syndrome (PCOS) is a complex syndrome primarily hormonal in nature. Symptoms begin at puberty and continue throughout life with a wide range of impacts on health that may include psychological, metabolic, and reproductive consequences.

PCOS is the most common hormonal syndrome in reproductive-aged women, affecting up to 20% of this demographic. It is the leading cause of anovulatory infertility which is infertility caused by the inability to develop a mature egg.

In order for a woman to be diagnosed with PCOS, she must demonstrate at least two of the following three characteristics: clinical and/or biochemical signs of hyperandrogenism (acne, excess hair growth, male-pattern hair loss), menstrual irregularities or complete lack of menses, and ovaries that appear “polycystic” upon observation by ultrasound.

PCOS is a syndrome of exclusion because several endocrine disorders can mimic the symptoms of PCOS and they must be ruled out before a PCOS diagnosis can be made. Among these are hypothyroidism, hyperprolactinemia, nonclassical congenital adrenal hyperplasia, hypothalamic amenorrhea or adrenal tumors, and anabolic steroid use.

Treatment for PCOS is individualized and depends on the goals of the woman and her symptoms. A PCOS diagnosis comes along with a broad range of consequences which differ from one individual to another and may be prioritized differently for different people.

For many women with PCOS accompanied by excess body weight, addressing diet and lifestyle is critical to long-term health and wellbeing. For PCOS patients with a high body mass index (BMI), losing weight can improve general health, reduce depression, improve fertility, and more.

Women with PCOS have an increased risk of developing insulin resistance, so taking corrective steps is often pivotal to the patient’s long-term health and likely that of any offspring.

Women with PCOS are also more likely to encounter challenges from a mental health standpoint, depending upon the symptoms of their condition. Challenges related to body image and infertility are common, and seeking the help of mental health professionals is often warranted.

Women with PCOS pursuing fertility treatment should be seen at facilities that are able to perform regular transvaginal ultrasound monitoring of the patient’s ovarian follicles to mitigate the risks of high-order multiple gestation pregnancies and ovarian hyperstimulation syndrome.

From a fertility perspective, diet and lifestyle changes can sometimes restore ovulation and lead to a live birth; however, if these do not work, oral medication to induce ovulation is often the next step. Physicians often begin with metformin, followed by letrozole and then clomiphene citrate, and in some cases, a combination of metformin and one of the other drugs may be used.

If none of these leads to a pregnancy, injectable drugs called gonadotropins should be considered. The need for regular monitoring is raised when PCOS patients are placed on gonadotropins to mitigate the risk of a high order pregnancy or hyperstimulation. Options like ovarian drilling may also be considered when other approaches have not worked.

As long as a severe male factor fertility concern does not exist, ovulation induction may be coupled with either timed intercourse or intrauterine insemination (IUI), but if either of these methods are unable to bring about a pregnancy, in vitro fertilization (IVF) is a viable option and can be optimized for women with PCOS to minimize risks.

IVF outcomes for women with PCOS are generally very good, and approaches like deploying an GnRH antagonist during ovarian stimulation and use of frozen embryo transfers have resulted in comparable high rates of success, while mitigating many of the risks associated with PCOS patients.

With the right medical intervention, women with PCOS can live normal, healthy lives and raise families like anyone else.