Combination birth control pills (OBGYN-recommended)Combination birth control pills (OBGYN-recommended)
Polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility. It affects between 8% and 13% of reproductive-aged women.
PCOS is a complex condition that requires comprehensive gynecologic and metabolic treatment. Lifestyle changes, medications and ovarian stimulation are all used to treat fertility problems caused by PCOS.
Lifestyle Changes
Infertility is a common symptom of PCOS and is associated with an increased risk of gynaecological cancer. Currently, lifestyle management including weight and diet, behavioural modification and physical activity are considered the primary therapeutic prescription for PCOS-related infertility. However, the use of medications such as medroxyprogesterone acetate (MPA) to improve clinical features of hyperandrogenism and menstrual irregularity, is an important component of PCOS management and should be included when appropriate.
The treatment of PCOS-related infertility focuses on reducing symptoms of hyperandrogenism, improving menstrual regularity and achieving conception. Oral agents, such as clomiphene citrate and letrozole, have been shown to improve pregnancy success in women with PCOS. Assisted reproductive technology, such as intrauterine insemination and in vitro fertilization (IVF), should be used only after other less intensive treatments have failed or are not effective.
In addition to dietary modifications, exercise and weight loss, lifestyle interventions include psychological and sleep intervention strategies, as well as traditional, complementary and integrative medicine (TCIM) approaches. This holistic approach offers women greater choice and control over their health, allowing them to optimise their health status and achieve their desired reproductive goals.
Medications
Many medications are available that can help with the symptoms and fertility of PCOS. These can include birth control pills and other hormonal medications, as well as medications for ovulation induction and ovarian stimulation.
The oral contraceptive pill (OCP) is often the first treatment option for a woman with pcosco because it can reduce or prevent excessive male-type hormones that can lead to irregular menstrual periods and infertility. It can also lower a woman’s risk of endometrial cancer and correct some irregularities in menstrual bleeding, excess hair growth and acne.
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Combination birth control pills (OBGYN-recommended)
Combination birth control pills (OBGYN-recommended) are also often used because they decrease androgen levels and regulate estrogen. They can be effective for reducing or stopping irregular periods and infertility, lowering your risk of endometrial cancer and helping you lose weight.
If your ovaries don’t respond to medication, you may need surgery to thicken the ovaries and make it easier for them to ovulate. This procedure, called laparoscopic ovarian drilling, usually restores ovulation for 6 to 8 months but it doesn’t have permanent results.
Medications that have shown promise in improving fertility include anti-androgens, such as spironolactone and flutamide. They block the effects of androgen at the level of the follicles in your ovaries, making it more likely for ovulation to occur each month.
Some of these drugs are available over the counter, but you must consult with your doctor to be sure you’re taking the right medicine for your condition and to avoid any side effects. Other drugs for PCOS include sulfonylureas/biguanides and metformin, which can improve ovulation by reducing luteinizing hormone (LH) levels in the body.
Other medications that can increase the chances of conceiving include ovulation inducing medications and hormone replacement therapy. Hormones can be expensive, so it’s important to consider all options before deciding which one is best for you.
Ovulation Induction
Ovulation is the process by which a woman’s ovaries release an egg. This is part of a normal menstrual cycle and usually lasts one day. Medications that work on ovulation may improve a woman’s chance of becoming pregnant.
These medications replicate a naturally-produced hormone called follicle stimulating hormone (FSH), also known as a pituitary gonadotropin. When these drugs are given in a women’s cycle, they stimulate the ovaries to produce multiple eggs. This helps control the timing of ovulation so sexual intercourse, intrauterine insemination (IUI) and in vitro fertilization procedures can be scheduled at the most likely time to achieve pregnancy.
There are several ovulation induction medications available, including metformin, clomiphene and pioglitazone. These drugs can help regulate menstrual cycles, increase ovulation, and improve the lining of the uterus (endometrium) in some patients with PCOS.
Type of medication is an aromatase inhibitor
Another type of medication is an aromatase inhibitor. These medicines decrease the amount of estradiol in a woman’s body. This causes the pituitary gland to make more FSH, which stimulates ovulation. This is particularly effective in women who have high levels of estrogen, such as in PCOS.
Currently, letrozole is the most common drug used to induce ovulation in pcosco. This drug is a simpler tablet that you take five days into your menstrual cycle, which has been shown to produce ovulation and good pregnancy rates in women with PCOS.
The fertility specialist will prescribe the appropriate medication based on the underlying cause of the anovulation or infertility. It is also important to ensure that the fallopian tubes are open and not blocked by thickened tissue or cysts in the ovaries. Having these tests done before trying to conceive can prevent complications.
Ovarian Stimulation
Ovarian stimulation is a treatment option that helps increase the number of eggs produced in the ovaries. This is done before artificial insemination or in vitro fertilization (IVF) to help improve the chances of a pregnancy occurring.
A woman’s ovaries are home to hundreds of thousands of follicles (fluid-filled sacs) that contain an egg cell or “oocyte.” Ovarian stimulation involves the use of hormone medications, such as follicle-stimulating hormones (FSH) and luteinizing hormones (LH).
The FSH causes a follicle to grow and develop to the point where it is ready for an egg to be released into the fallopian tube. LH also causes the egg to mature and release from the ovary, increasing its size and making it more likely that it will become fertilized.
Before you start ovarian stimulation, your doctor will perform fertility testing to determine your baseline hormone levels. This will allow your doctor to prescribe the correct medication to treat your ovaries.
During ovarian stimulation, you’ll be given injections of these medications to encourage the growth and development of follicles in your ovaries. Your doctor will also monitor the follicles’ development using blood tests and ultrasound scans.
One of the most important things to remember during ovarian stimulation is to take your medications consistently and on time. Missing doses will make the process slower and reduce your chance of ovulation.
Another very important thing to remember during ovarian stimulation is to watch out for ovarian hyperstimulation syndrome, which can cause your ovaries to swell and become painful. This is most common in women who are undergoing fertility treatments with injectable drugs, but can happen with medications you take by mouth, as well.
In Vitro Fertilization (IVF)
The most effective treatment option for women with pcosco who are unable to become pregnant is in vitro fertilization (IVF). IVF involves the process of transferring eggs into the uterus with sperm. The procedure is successful for a majority of patients.
However, IVF success rates vary depending on a number of factors including age, sperm quality and egg quantity. For some patients, it may take several rounds of fertility treatment before pregnancy is achieved. In addition, it is important to note that IVF and other forms of assisted reproductive technology can lead to higher out-of-pocket costs than other treatments for infertility.
PCOS should first make lifestyle changes
Generally, women with PCOS should first make lifestyle changes to reduce their risk of developing infertility. This can include eating a healthy diet, losing weight, and taking medication to regulate their periods.
It is also helpful to talk with your doctor about medications that can help regulate your menstrual cycle and stop the side effects of PCOS. This can include hormonal therapy to stimulate the production of hormones in your body, as well as birth control to keep your menstrual cycle regular.
In addition, you might also need a semen analysis to determine the health of your sperm and fallopian tubes. This can help your doctor decide if IVF is an appropriate treatment for you and your partner.
The cost of fertility services is often high and can be out of reach for many people without insurance coverage. It is especially difficult for Black and Hispanic women to access services since they typically have lower incomes than White patients and are more likely to be uninsured.
States vary on whether they require insurers to cover infertility services. Some have “mandate to cover” laws that apply to most private insurers, while others have more limited legislation that applies to only certain insurers or specific types of services. Those with mandates usually impose a dollar limit on coverage or a maximum number of cycles they will cover.
