Polycystic Ovary Syndrome
Edition: August 2001 - Vol 9 Number 08
Author: Mark Perloe, M.D.
Polycystic ovary syndrome (PCOS) affects an estimated five to ten million women in the United States and is currently one of the most under-diagnosed women's diseases in the country. It is the most common cause of infertility and, traditionally, one of the most difficult to treat. In addition, women with PCOS often suffer from other serious health problems including heart disease, Type II diabetes and endometrial cancer.
New medical insight into this disease has recently resulted in a new, non-invasive treatment option that is allowing many women to conceive naturally, and those undergoing fertility treatments are experiencing higher pregnancy success rates. Perhaps the greatest benefit of this new PCOS treatment will be its ability to reverse potentially long-term health risks for women diagnosed with the syndrome.
PCOS is an endocrinologic disorder characterized by irregular or absent menstrual periods and elevated male hormone levels. Women who have PCOS often have a number of presumably unrelated symptoms, including abnormal bleeding, infertility, obesity, excess hair growth, hair loss and acne. The condition appears to have a genetic component and those affected often have both male and female relatives with adult-onset diabetes, obesity, elevated blood triglycerides, high blood pressure and female relatives with infertility, excess hair growth and menstrual problems. Ultrasound reveals that polycystic appearing ovaries are another common symptom in women with PCOS, but it is believed that PCOS may be present in women who don't fit the traditional medical profile.
Physicians have yet to come to an agreement on the preferred method for diagnosing PCOS. It is estimated that only about 25 percent of women with PCOS have been diagnosed, largely due to the fact that doctors and researchers have only recently begun to understand the syndrome.
Most physicians will consider a diagnosis of PCOS after ruling out other conditions such as Cushing's disease (overactive adrenal gland), thyroid problems, congenital adrenal hyperplasia or increased prolactin production by the pituitary gland.
After reviewing the patient's medical history, the physician will determine which tests are necessary, including male hormone, fasting insulin and glucose levels along with an ultrasound scan of the ovaries. If a patient has irregular or absent menstrual periods, physical exam clues will be factored in, including height and weight, increase in facial or body hair or loss of scalp hair, acne and a discoloration of the skin under the arms, breasts and in the groin. As women with polycystic ovary syndrome may be at greater risk for other medical conditions, testing for blood lipids, diabetes and abnormal blood clotting factors often follows the initial diagnosis.
Treatments for PCOS have traditionally been difficult and expensive, and have limited success when used alone. Today, through a combination of medicinal therapy and dietary changes, approximately 65 to 85 percent of patients with PCOS achieve a regular menstruation cycle. Infertility treatments include weight loss diets, ovulation medications, ovarian drilling surgery and in vitro fertilization (IVF). Other symptoms have been managed by anti-androgen medications such as birth control pills.
During ovarian drilling, a laser fibre or electrosurgical needle is used to puncture the ovary 10 to 12 times. This treatment results in a dramatic lowering of male hormones within days. Studies have shown that up to 80 percent will benefit from such treatment. Many who failed to ovulate with clomiphene or metformin therapy will respond when these medications are reintroduced to the system after ovarian drilling. Side effects are rare, but may result in adhesion formation or ovarian failure if an inexperienced surgeon performs the procedure.
Common Cause of Infertility
For women trying to conceive, polycystic ovary syndrome is a serious, common cause of infertility because they do not ovulate regularly. In fact, PCOS may account for as many as half of all cases of infertility. Many women with PCOS are able to get pregnant as a result of a number of potential treatments including ovulation-inducing medications, in vitro fertilization and insulin sensitizing medications. Through a combination of metformin (a widely available, standard medication typically used for the treatment of adult-onset diabetes) and dietary changes, many of these patients are able to conceive. If the patient is unable to get pregnant as a result of medicinal treatment and dietary changes, in vitro fertilization becomes an option. The success rate of in vitro fertilization is higher and the risk factors lower in patients who have their PCOS under control.
There is an increasing amount of medical evidence to prove that endocrine abnormalities can be reversed and that pregnancy rates can increase through treatment with metformin. When used in conjunction with fertility treatment, the medication has been proven to have a significant impact on pregnancy rates. A recent study has shown that in a group of women who were previously resistant to fertility treatment with clomiphene citrate, an oral fertility drug, 35 percent ovulated when they were given metformin and 90 percent ovulated when a combination of metformin and clomiphene was prescribed.
Though insulin resistance is part of a metabolic condition commonly seen in men, 30 percent of women with PCOS show signs of impaired glucose tolerance, a pre-diabetic condition, while 7 percent are diabetic. The insulin sensitizing medications have been shown to reverse the endocrine abnormalities seen with polycystic ovary syndrome within two or three months. They can result in decreased hair loss, diminished facial and body hair growth, normalization of elevated blood pressure, regulation of menses, weight loss and normal fertility. By six months, more than 90 percent of women treated with insulin-lowering agents will resume a regular menstruation cycle.
PCOS is associated with increased risk of heart attack and stroke, hypertension, obesity, hyperandrogenism, hypertriglyceridemia. These are, to a large degree, resolved by therapy with the insulin sensitizing medications.
The new treatment options and increased understanding of PCOS have led to positive results. Women faced with PCOS can more easily regain a normal menstrual cycle, conceive children and live a longer, healthier life when treatment includes a combination of medicine and dietary changes.
For more information about PCOS and other infertility issues, consult your physician or visit www.ivf.com.
As medical director at Georgia Reproductive Specialists, Dr. Mark Perloe has above-average success rates in achieving pregnancies through advanced reproductive technologies, as well as expertise in treating polycystic ovary syndrome, recurrent pregnancy loss, endometriosis, menstrual disorders, fibroids, and endocrine and other reproductive health problems. He also has extensive experience using the latest microsurgical techniques for reversing tubal sterilization.
Georgia Reproductive Specialists focuses on providing individualized, innovative solutions for reproductive challenges and infertility, specializing in in vitro fertilization, intracytoplasmic sperm injection and other assisted reproductive technologies. For more information about Georgia Reproductive Specialists, visit www.ivf.com.