Why can’t I conceive?

Polycystic Ovarian Syndrome (PCOS) is a common syndrome which is a hormone disorder and affects approximately 10% of women.  It is a collection of problems that are found together and doesn’t affect everyone equally.

To be diagnosed with PCOS a woman has 2 out of three issues – lack of ovulation (anovulation), chronic high testosterone hormone levels (hyper-androgenism) and ovaries that have multiple follicles (over 20)

PCOS is diagnosed by a combination of history taking, examination, pelvic ultrasound and blood tests.

SYMPTOMS OF PCOS

• Irregular or missed menstrual periods 
• Difficulty with weight (50% of women with PCOS are overweight)
• Increased hair growth (hirsutism)
• Acne
• Infertility
• Thick endometrial lining as the lining is not shed regularly which can lead to episodes of abnormal bleeding and can be a precursor to endometrial hyperplasia (stage pre cancer) and then endometrial cancer
• Metabolic syndrome – which leads to elevated blood pressure, diabetes, increased risk of heart disease, obesity with weight increasing around the abdomen mainly

INVESTIGATIONS:

• Hormone evaluation including male hormones (often elevated)
• Full blood examination with LFT (there is a increased risk of fatty liver)
• Lipid profile (often abnormal lipid profile is detected)
• Glucose testing

TREATMENT

• If pregnancy is not desired the oral contraceptive pill with an antiandrogen the best form of treatment and prevention
• If pregnancy is desired the oral therapies such as clomid or letrozole can be used (increased risk of multiple pregnancy of 10%)
• Lifestyle changes are important and a low carbohydrate diet should be followed
• Metabolic issues should be treated with metformin
• Resistance to clomid – ovarian drilling may be considered – a surgical procedure to burn the follicles – this comes with risk of scarring and damage to ovary and its function
• Low dose Gonadotropins if oral agents do not induce ovulation (there is an increased of multiple pregnancies between 20-30 %)
• IVF is generally considered if ovulation therapy fails or if the patients wish to avoid multiple pregnancy.