Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders and the most common cause of ovulatory-based infertility-- in reproductive-aged women, diagnosed in approximately 5 to 10 percent across ethnic and racial groups.

PCOS also impact many aspects of a woman’s reproductive and long-term health. Fortunately, early diagnosis and treatment can significantly improve the health and quality of life of a woman with PCOS, and significantly increase her chances of conceiving a child.

How is PCOS identified?

Polycystic ovary syndrome is defined by a combination of symptoms and physical findings that include:

• Signs of androgen (male hormone) excess or elevated circulating androgen levels in the blood
• Infrequent or absent ovulation
• Polycystic appearance of the ovaries

Women with PCOS frequently have irregular menstrual cycles and signs of androgen excess, including excessive hair growth (hirsutism), acne, and even male-pattern hair loss. Approximately 40 to 50 percent of PCOS patients are overweight or obese. However, given the significant variation in the physical expression of PCOS, a large proportion of PCOS patients are neither obese nor exhibiting hirsutism. The diagnosis of polycystic ovary syndrome can be made by the combination of physical examination, blood testing for hormone levels, and pelvic ultrasound.

Because women with PCOS can also demonstrate problems with insulin and carbohydrate metabolism, additional tests for blood sugar and insulin levels may be performed.

How is polycystic ovary syndrome treated?

Treatment of polycystic ovary syndrome is tailored to the patient’s reproductive goals. Estrogen-progestin medications including oral contraceptives pills are often used to control irregular menstrual cycles, and to improve hirsutism and acne. A number of anti-androgen medications are also effective in reducing hair growth.

Medical Therapy for Ovulation Induction

Medical therapy for ovulation induction is the first choice of treatment for PCOS patients who wish to conceive. The drug Clomid® (clomiphene citrate) is most often the first choice. Recent studies have demonstrated that insulin-sensitizing medications such as metformin may also be of benefit as additional therapies. However, medical ovulation induction in the PCOS patient who fails to ovulate or conceive after taking Clomid® can be difficult. In addition, PCOS patients can exhibit extremes in their response to gonadotropins (injectable hormonal medications). SCRC physicians can thoroughly examine the medical history of a PCOS patient and help identify the optimum treatment path.

Laparoscopic Ovary "Drilling"

Laparoscopic ovary drilling is a surgical alternative for women who fail to conceive after taking Clomid® and Metformin®, and for those who are unable or unwilling to proceed to gonadotropin treatment. In this procedure, electrical current or a laser is used to produce small holes on the surface of the ovary.

Ovary drilling can result in improved ovarian hormone production, and resumption of spontaneous ovulation and conception. Ovary drilling allows the PCOS patient to avoid the possible complications of multiple pregnancy and hyperstimulation associated with gonadotropins. However, ovary drilling entails certain surgical risks as well as possible negative long-term reproductive outcomes. Women with PCOS will be counseled by SCRC’s fertility experts regarding all of their fertility options, including risks and side effects.

Lifestyle and Dietary Modifications

Lifestyle and dietary modifications to achieve weight loss should be a primary goal for all overweight and obese patients. Loss of even 5 percent of the initial body weight can be associated with significant improvements in ovulation, androgen levels, and insulin sensitivity. Having PCOS can make conceiving difficult for a woman, but the physicians of Southern California Reproductive Center can advise you about this and other fertility issues.