Polycystic Ovarian Syndrome (PCOS) is a condition caused by an imbalance in female sex hormones which can disrupt the normal functioning of the female reproductive system, cause hirsutism, acne, obesity, diabetes, and can even lead to heart disease. PCOS, also known as Stein-Leventhal syndrome, is the most common cause of female infertility.
In PCOS too much of the sex hormones, called androgens or male hormones, are made in relationship to the “female” hormones which are estrogen and progesterone. During a normal menstrual cycle estrogen and progesterone work together to mature an egg in a woman’s ovaries. Once they are mature they are then released into the fallopian tubes to be fertilized by sperm, a process known as ovulation. However, in PCOS, this egg never becomes mature enough to be released and instead turns into a cyst in the ovaries. This makes it nearly impossible for a woman to become pregnant without proper PCOS treatment.
PCOS Treatment Options Defined
The first line of polcystic ovarian hormone treatment is medication. There is no known cure for this disease so therefore infertility treatment for PCOS focuses on stimulating ovulation. In the event that these medication are not effective, doctors may try other treatments such as surgical procedures or in vitro fertilization (IVF).
Clomid (Clomipherine)
Typically, Clomid is the first line of treatment in women who wish to get pregnant with PCOS. It is in a class of medications known to stimulate ovulation. This medication works very similarly to estrogen in the body. Women typically take Clomid between days 3-7 of their menstrual cycle or 5-9. Pregnancy success rates vary with Clomid depending on the reporting fertility clinic, however, typically it runs around 15 percent per month for women under the age of 35. Approximately 50 percent of women ovulate with Clomid treatment only.
Femera (Letrozole)
Femera is an an aromatase inhibitor, which acts as a suppressant for estrogen. When estrogen production is suppressed in women the brain signals the production of follicle stimulating hormone, which is necessary to mature a woman egg for ovulation. Women who are unsuccessful with ovulating or conceiving on Clomid may have a better chance with Femera. The chance for pregnancy is the same as Clomid, 15 percent per month.
Glucophage (Metformin)
Metformin is a a part of a class of medications called thiazolidinediones, which are used to control blood sugar in patients with Type 2 diabetes. However, recent studies have found that this medication, especially in combination with Clomid, can be very effective in stimulating ovulation. Metformin can also be beneficial when combined with gonadotropins and IVF. The method of action is still unknown, however several well controlled clinical trials have shown very positive results.
Injectable Gonadotropins
This broad term refers to the injectable form of follicle stimulating hormones(FSH) and lutenizing hormones (LH). These medications are typically given when oral therapies have failed. Women are given daily injections of these medications in order to fully mature eggs for ovulation. Then when the eggs are ready, another injection of human chorionic gonadotropin (hCG) is administered to stimulate the release of the eggs. The risk for a multiple pregnancy with this treatment is around 16-18 percent and the pregnancy success rate is around 20 percent per month.
Alternative Treatments
In some cases, women may choose to try alternative therapies before undergoing medication treatment. These may include wight loss, diet change, Chinese medicine or acupuncture. Weight loss has been shown in studies to help improve a woman’s chances of pregnancy, but other alternative therapies have not been well researched and their safety and effectiveness is unknown.
In the case that a woman is unresponsive to all natural and medication treatments in vitro fertilization or laparoscopic laser drilling of the ovaries may be indicated.
Treatment type may depend on individual circumstances, health and age and therefore all treatment options should be discussed with a qualified fertility specialist.
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