For many women attempting to get pregnant, the diagnosis of polycystic ovary syndrome, better known as PCOS, is devastating. PCOS is the most common type of infertility issue in women, affecting nearly five million women, and many women with PCOS incorrectly assume they will never be able to have children. Women with PCOS have hope, however. While PCOS is complex and not completely understood, doctors can treat it to allow a couple to conceive, explains Dr. Ron Thompson.
Even though PCOS is treatable, it is also a progressively worsening condition. Symptoms include weight gain, acne, thinning scalp hair, excessive facial hair, amenorrhea, infertility, and ovarian cysts, and it elevates risk for insulin resistance. Obesity exacerbates PCOS symptoms.
Nearly 10 percent of infertile women have PCOS, which essentially is a signaling problem between the ovary and pituitary gland in the brain and from the pituitary gland back to the ovary to stimulate ovulation. “The signaling problem between the pituitary gland and the ovary is like a cell phone reception problem between a cell phone tower and a cell phone,” said Dr. Thompson. “Basically, the ovary is saying, ‘Can you hear me now?’”
Normally, each month the ovary develops a single ovum in an enlarging, clear and fluid-filled sac called the ovarian follicle. The follicle develops because the pituitary gland in the brain produces a Follicle Stimulating Hormone (FSH) that starts stimulating the follicle. The pituitary gland also sends a second signal to the ovary in the form of the luteinizing hormone (LH) that stimulates the grape-sized ovarian follicle to rupture.
“This rupture of the ovarian follicle releases the mature ovum into the fallopian tube and equally importantly, releases and drains the follicular fluid from the ovary,” said Dr. Thompson. “The ovum is then ready for fertilization.” If sperm do not fertilize the ovum in the 14 days after ovulation, the woman will start her next menstrual cycle.
PCOS occurs when the ovarian follicle does not rupture and the ovum inside the un-ruptured follicle dies, leaving a cyst. If this process occurs for several months in a row, the woman will develop early and mild PCOS with irregular menstrual periods. If the syndrome continues to go untreated, it will worsen to a moderate to severe case of PCOS and the woman will cease to have any menstrual periods.
A doctor will make the diagnosis of PCOS when a patient reports irregular or absent monthly menstrual periods. “An ultrasound of the ovaries confirms the diagnosis of PCOS by documenting eight to ten large, grape-sized cysts in each ovary,” states Dr. Thompson. “The ovaries at this stage are about ten times the size of a normal ovary, and the hormone signal from the pituitary gland that stimulates ovulation is ineffective.”
Treatment for PCOS involves decreasing the size of the ovary through a procedure called Laparoscopic Ovarian Cyst Decompression. “This drains the cysts by laser or hot-needle drilling and decreases the volume of each ovary by about 70 percent,” said Dr. Thompson. “These laparoscopic procedures are also very effective to resume regular monthly ovulations.”
Woman with PCOS also benefit from medications that amplify the hormone signals sent between the pituitary gland and the ovary. Medications like oral Clomid, injectable Follicule Stimulating Hormone (FSH) and injectable Leutinizing Hormone (LH) are also effective treatments for PCOS. Insulin sensitizing oral medications like Metformin also help treat PCOS, either alone or in combination with Clomid.
Women faced with a PCOS diagnosis can take hope in the fact that while complex and progressively worsening, PCOS is easy to diagnose and successfully treat. Fixing the signal problem between the pituitary gland and the ovaries leads to conception and a baby in over 90 percent of women within 12 to 24 months.