Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common hormonal disorder which often causes infrequent cycles or prolonged menstrual periods. The condition is characterized by enlarged ovaries containing numerous cystic follicles, and women will often experience abnormal ovulation or even the absence of ovulation (called anovulation). Additionally, women with PCOS also frequently have high levels of male hormones and/or excess hair growth or acne.

PCOS affects approximately 15% of women overall but is more common among women with infertility. It is also more prevalent among women with obesity and insulin resistance.

While the exact causes of PCOS are not fully known, it is thought to be at least partly caused by genetics. Other issues, including lifestyle factors like weight gain or diet, can worsen the condition.

Symptoms associated with PCOS include:

• Erratic or infrequent menstrual cycles
• Irregular bleeding between periods
• Heavy menstrual flow
• Recurrent ovarian cysts
• Acne
• Hirsutism (excess hair growth)
• Infertility

Unlike many other causes of infertility, the diagnosis of PCOS is fairly straightforward. According to the Rotterdam criteria, a woman has PCOS if she meets two of the following three conditions:

• Infrequent periods (greater than 35 days between cycles)
• The appearance of polycystic ovaries on ultrasound
• Signs of high androgen levels, as evidenced by blood tests or the presence of acne and/or excess hair growth

Early diagnosis and treatment of PCOS is recommended to effectively manage symptoms and mitigate the risk of long-term complications such as heart disease and type 2 diabetes. It is also important to rule out other conditions that have similar symptoms, such as thyroid disease.

While there is no true cure for PCOS, symptoms of the disorder can be treated medically and/or surgically.

Medical treatments include hormonal birth control pills, lifestyle improvements and metformin (medication that can improve glucose metabolism). While these options can help ameliorate some of the symptoms of PCOS and create a more regular cycle, they do not directly address the underlying issue.

Women with PCOS who are trying to achieve pregnancy are commonly prescribed oral ovulation medication such as clomiphene (Clomid) or letrozole (Femara). About 80% of women with PCOS-related infertility will ovulate normally with the use of these medications. For the other 20%, another option is gonadotropins, which are hormonal injections that stimulate ovulation.

For some women, ovarian surgery can be a very effective treatment for PCOS, as it can correct the underlying problem and allow for normal ovarian function, improvement in cycle regularity and ovulation, and increased pregnancy rates.

Veritas Fertility & Surgery is dedicated to correcting the endocrine issues related to PCOS and restoring normal ovulatory function.

For women who are trying to become pregnant, we prescribe ovulation medications and monitor the ovaries’ response to medications with a series of ultrasounds called a follicle maturation study. We also recommend tracking the cycle with the Creighton Model, a standardized method of observing the function of the reproductive system. Creighton Model tracking helps women correctly identify their fertile window and helps the doctors at Veritas Fertility and Surgery assess each woman’s individual response to ovulation medications.

If ovulation medications alone prove ineffective, the doctors at Veritas Fertility and Surgery also offer laparoscopic ovarian wedge resection, an advanced reproductive surgery that helps restore normal ovarian function and corrects the hormonal disturbances associated with PCOS. Following this treatment, 90% of women will have regular monthly cycles with normal ovulation and 75% will be able to achieve pregnancy.