Polycystic Ovarian Syndrome (PCOS)

PCOS is a common condition affecting about 15% of reproductive age women and can usually be diagnosed by your medical provider if you have 2 of the following 3 present: increased bodily hair growth or increased blood testosterone levels, absent or infrequent periods, and/or the appearance of polycystic appearing ovaries on ultrasound. Women with PCOS have a higher risk than normal to develop diabetes, heart disease, and uterine cancer. Furthermore, overweight PCOS women who get pregnant run the risk of developing gestational diabetes, fetal demise, and many other pregnancy related complications. It is therefore recommended that all overweight women with PCOS undergo weight loss prior to planning their pregnancy. For some of these PCOS women who wish to undertake these pregnancy risks, there are several ways to help them get pregnant.

There are several oral medications that can be given to promote ovulation in women with PCOS. Most experts agree that an excess amount of bodily insulin can deter ovulation; as such, diabetic drugs such as Metformin or Rosiglitazone are commonly used to help increase the probability of ovulation in insulin resistant PCOS patients. Another class of medications, ovulatory induction agents such as Clomid and Letrozole, can be used to help PCOS patients. Most studies that have evaluated the combined use of an insulin drug such as Metformin with an ovulatory agent like Clomid have repeatedly shown a higher pregnancy rate than when individual drugs are used alone.

The majority of people who get pregnant using Clomid do so within the first 3 cycles, with no further benefit noted after 6 failed cycles. If a pregnancy isn’t attained with Clomid, then injectable medications with human Menopausal Gonadotropins (hMG) or Follicle Stimulating Hormone (FSH) should be given. However, risks of multiple gestations and ovarian hyperstimulation (OHSS) should be considered since multiple eggs can be created following a treatment plan. To help avoid these complications, patients require proper ultrasonographic monitoring from their medical provider. Intrauterine Inseminations (IUI) should be considered to be performed in conjunction with the oral and/or injectable medications listed above to help increase pregnancy rates.

In Vitro Fertilization (IVF) provides the highest pregnancy rates out of all available procedures. PCOS patients, however, have slightly decreased pregnancy rates because their egg quality tends to be poorer and they encounter higher rates of OHSS. Obese patients with or without PCOS have also been shown to have diminished pregnancy rates, contributing to this overall finding. If possible, it is always recommended that overweight patients lose weight not only to increase their probability of pregnancy, but to also live a healthier, longer life.