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Houston Fertility Journal

Fertility Treatments for PCOS: What You Need to Know

[fa icon="calendar"] Nov 29, 2016 9:00:00 AM / by Center of Reproductive Medicine   

Center of Reproductive Medicine

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Polycystic ovarian syndrome (PCOS) is one of the most common reproductive health conditions, afflicting between 8-10% of women of childbearing age. Despite its name, PCOS is not caused by ovarian cysts, but instead by a hormonal imbalance. This imbalance of estrogen and progesterone can cause an overproduction in androgenic hormones -- so-called male hormones like testosterone. This changes the functioning of the ovaries and diminishes fertility.

It's still possible to get pregnant with PCOS, particularly if symptoms are promptly identified and treated. Our expert team works with you to understand and treat your symptoms. We aim to get you pregnant as quickly and economically as possible. We offer a range of treatment options for PCOS.

Lifestyle Remedies

PCOS can cause insulin resistance, and may even trigger diabetes. Diabetes is itself a risk factor for infertility. Likewise, weight gain can impede fertility by causing hormonal imbalances. It may also cause health problems, such as cardiovascular disease or high blood pressure, that reduce fertility and increase the likelihood of pregnancy complications.

Unfortunately, many women with PCOS find themselves trapped in a vicious cycle: PCOS causes weight gain, which further diminishes fertility. You can stop this cycle before it starts by embracing a healthy lifestyle. This includes:

      • A healthy sleep schedule, since inadequate sleep has been linked to excess weight gain.
      • Regular exercise. Exercise helps you maintain a healthy body weight, improves fertility, and can reduce the risk of the depression that sometimes coincides with PCOS.
      • A balanced diet. Your doctor will discuss whether certain foods might increase or reduce your fertility. Many women with PCOS opt to eat a reduced sugar diet.

Hormonal Treatments

Women with PCOS may not ovulate, or may only ovulate irregularly. You can't get pregnant if you don't ovulate, and if you ovulate infrequently, the total number of chances you have to get pregnant is reduced. Anovulatory cycles -- cycles during which you do not ovulate -- may still produce what appears to be a period, though the bleeding is often irregular and lasts a shorter period of time.

Another indication of anovulatory cycles is several positive ovulation tests that are not accompanied by other signs of ovulation, such as a spike in basal body temperature or fertile cervical fluid. This happens because your body releases luteinizing hormone, the hormone associated with ovulation, but does not successfully ovulate.

Hormonal treatments can correct PCOS related hormonal imbalances, helping you ovulate. Clomid is the first choice for most women with PCOS. Clomid is generally well-tolerated, though it can trigger mild side effects such as weight gain and mood swings. If treatment with Clomid fails, your doctor might recommend follicle-stimulating hormone (FSH) injections, or other hormonal treatments.

Fertility Monitoring

Fertility monitoring will not “cure” infertility. But it can increase your chances of getting pregnant if you only rarely ovulate. The reason for this is simple: by helping you identify your fertile window, fertility monitoring helps you correctly time intercourse. Your doctor may educate you about fertility monitoring techniques such as basal body temperature monitoring, ovulation tests, and tracking cervical fluid. Alternatively, your doctor might use blood tests or ovarian scans to assess whether and when you are ovulating.

Intrauterine Insemination (IUI)

Intrauterine insemination facilitates pregnancy by placing sperm directly in the uterus. This strategy won't work if you do not ovulate. But if you ovulate infrequently, IUI increases the chances of a successful pregnancy. IUI is an especially potent combination for women with PCOS whose partners have a low sperm count or decreased sperm motility.

In Vitro Fertilization (IVF)

When you have PCOS, there are two issues: hormonal imbalances decrease ovulation frequency, and these same hormonal imbalances can then interfere with your body's ability to support a developing embryo. IVF addresses both issues.

In vitro fertilization fertilizes an egg outside of your body, then implants that egg several days later when it grows into an embryo. Before the procedure, you'll take a number of fertility drugs designed to induce ovulation. In most cases, you'll produce multiple eggs, thereby increasing the chances of a successful pregnancy. By fertilizing the egg with sperm outside your body, the doctor circumvents the many variables -- implantation, hormone balance, genetic defects, sperm motility and quality -- that can reduce the chances of a successful fertilization.

IVF has a success rate of about 25%, which is significantly higher than the success rate you can expect from trying to conceive without help. Depending upon your health and hormone profile, you may need to undergo hormone treatments to support your pregnancy.

Fertility Surgery

PCOS can cause the outer shell of your ovaries to harden. This makes ovulation more difficult, and can also undermine egg quality. If hormone treatments fail to induce ovulation, or if IUI and IVF fail, your doctor may recommend fertility surgery. During surgery, your doctor drills into your ovaries to allow you to ovulate.

Surgery is a treatment of last resort, so your doctor might require you to try hormone treatments or to undertake lifestyle remedies before attempting surgery. The results typically last only 6-8 months, so your provider may recommend additional treatments, including IUI or IVF, to increase the odds of a successful pregnancy during this brief window.

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Topics: Treatment, Fertility Tracking Apps, Reproductive Specialist

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