Fertility Management and PCOS

PCOS is a leading cause of subfertility and nearly half of the woman trying to get pregnant have PCOS. With PCOS it may take longer for women to conceive and may also need further medical assistance to achieve a pregnancy. Fertility management in PCOS with the assistance of a specialist is doable and over 90% of the women become pregnant.

In PCOS, the menstrual cycle is adversely impacted due to high levels of blood sugar or insulin in the body along with high levels of male hormones such as testosterone. These hormonal imbalances, while impacting the menstrual cycle also prevent ovulation (release of an egg from the ovary). When an egg is not released on a regular basis, it causes ‘anovulation’ making it difficult for a woman to conceive naturally, sometimes increasing the risk of miscarriage

Anovulation can occur recurrently making it difficult for women with PCOS to conceive naturally, and while it may impact fertility, it can also be managed by taking measures methodically to fight PCOS impact on fertility.

Weight management:

Around 70% of PCOS women are overweight or obese. Hence one of the key issues in the management of PCOS women is weight management, particularly if trying to get pregnant. Sometimes even a 5-10% reduction in weight can improve the chances of regularising cycles and increase the chances of becoming pregnant.

Treatments:

Weight management is the first step in the treatment and then specific treatment can be initiated. It is important to seek out a fertility specialist early enough to plan this better. As all the doctors repeatedly mention age is a really big factor in pregnancy, it is prudent to seek out a fertility specialist early to monitor and recommend the necessary treatments. 

Ovulation induction: This is a treatment designed to facilitate egg growth and ovulation to increase the chances of getting pregnant. Prior to initiating treatment, hormone blood tests including the male hormone levels are requested and also a test called GTT-to see if there is a tendency to develop diabetes and if there are abnormal hormone levels or GTT abnormalities they are corrected prior to starting ovulation induction treatment.

• While on these  ovulation induction treatment, monitoring happens mainly by performing ultrasound scans and occasionally blood tests. Once the egg reaches a mature size, trigger medication for ovulation to happen is given. Once this is a triggered, a couple is advised to either have intercourse or IUI (intra-uterine insemination).

Some of the medications  used for ovulation induction are:

• Clomid or Clomiphene citrate is one the most common medication for ovulation induction. It is used early in the menstrual cycle to increase the chances of an egg being released by the ovary, which can then be fertilised naturally. It may be used in combination with some insulin medicines for maximum effect in certain women.

The side effects one needs to be aware of with the intake of this drug are

1. It is associated with the increase in multiple births (twins and in some case triplets), as the inducing ovulation increase chances development of more than one egg.
2. There may be some physical and emotional side effects associated with the use of clomiphene citrate including headaches, blurred vision, and mood swings and if this happens get in touch with your doctor.

• LETROZOLE is another medication used for ovulation induction and gives excellent results in term of ovulation and subsequent achievement of pregnancy.
• Metformin or Glucophage is a treatment medication for type 2 diabetes and used in some women with polycystic ovary syndrome (PCOS). It improves the function of circulating insulin, reduces the androgen levels while improving the ovulation rate in some women and hence it is often given in combination with Clomid or letrozole.
• Use of metformin is not without some side effects, it is known to cause nausea, abdominal bloating, vomiting, and loss of appetite in some individuals.. It is usually recommended that slow release of the medication can curtail the side effects, for this reason, it is usually ingested at night to start with.

Continued use of this medication depends on a Doctors counsel, it is normally stopped when the pregnancy is achieved.

• Hormone injections such as FSH(Follicle Stimulating Hormone) can be used as treatments to stimulate growth and release of eggs. As mentioned previously in this article, the hormone is introduced in the system after careful monitoring to induce better ovulation. This is usually given when other treatments do not result in pregnancy. Human chorionic gonadotrophin (hCG) is normally used to induce ovulation. Women using gonadotrophins are more likely to have multiple pregnancies – and hence dosage is carefully regulated to reduce the risk.

Pregnancy is an easy possibility with the help of a good specialist. While it is must to visit a fertility specialist when women with PCOS are planning a baby, it is also advisable to have routine check-ups if one has PCOS, as certain measures such as weight management and lifestyle changes can be initiated much earlier even if pregnancy is not desired.

A vast majority of women do conceive with ovulation induction and IUI treatment as the second step and a very few who are not successful are suggested to have IVF which also has very high success rates in this group of women.

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