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You've Been Told You Have PCOS. Now What?

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a blog by Eric Levens, M.D., Shady Grove Fertility Center, June 8, 2010

Almost daily in my clinical practice (and on my Facebook page) I get questions about polycystic ovary syndrome (PCOS) and what the diagnosis means for fertility and overall health. PCOS remains the most common endocrine disorder in women of reproductive age. It affects approximately 5 -10 percent of the population and consists of a group of symptoms.

In order to be diagnosed with PCOS, a woman must have two out of three findings:

    1) Enlarged ovaries with multiple resting follicles
    2) Increased male hormones in the blood, balding, acne, or excess hair growth
    3) Absent or irregular menstrual cycles.

It’s important to remember that no single criteria is sufficient to make the diagnosis.

There are several important facets of PCOS to consider. The first has to deal with immediate fertility concerns. Other concerns include the long-term health consequences of PCOS and their impact on the health of a pregnancy. Today, I’ll discuss the fertility aspects. In a future blog, we'll discuss some of the other important health issues.

Because the ovaries are not producing a follicle containing an egg each month (and sometimes no follicle is produced at all), without assistance, achieving a pregnancy can be very difficult, if not impossible. Oral fertility medications like clomiphene, which have been available for more than 50 years, continue to be widely used to produce an ovarian follicle containing an egg. Clomiphene acts by blocking the action of estrogen in the brain (the hypothalamus and pituitary -- see my first blog “What Happens in Your First Visit to a Fertility Doctor?” for further details). As a result, there is an increased production of follicle stimulating hormone (FSH) causing the development of one or more follicles.

Timed intercourse or intrauterine insemination (IUI) can then be scheduled around the development of the follicle(s), provided that the Fallopian tubes are open and the sperm counts are normal. The typical chances for success are about 15 - 25 percent per cycle with higher chances among younger women and lower chances for older women. In the end, several treatment cycles may be required to achieve a pregnancy and, if this process is not successful, then moving on to another treatment such as injectable medications or IVF may be necessary.

I hope that this information helps you better understand PCOS and what's required, for many women with this condition, to achieve pregnancy.

I wish you the best in the pursuit of a fertile future.

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Comments (4)

Dr. Leven,.

Enjoyed your webinar on pcos. Curious to know if I am starting a strict caloric diet and want to take bcp while losing weight then what would be the best pill to take? I have read of a study in PA that sugguests taking Lo Estrin but I reseached some and found other studies using Yasmin. Also, how long would it take on bcp to help clear up the ovaries? or to be beneficial. My diet is being supervised under a Dr. for the next 3-4 months.

If testosterone levels are a high normal value then would you still prescibe some sort of med to help lower it? What kind of med? Anything over the counter?

Thank you,

Thank you for joining in the webinar. I generally recommend a birth control pill that has the same dosage each day (a monophasic pill). Lo-estrin,Yasmin, ortho-novum or desogen are some examples. Generally, there is not a lot of differences among these choices. In terms of regulating your cycle, it may take a couple of months for the pills to work. As for the elevated testosterone, because it is produced by the ovary, the birth control pills would be expected to reduce the levels which is in part why the pills help with acne and hair growth. There are other causes of increased testosterone that is not related to PCOS, so it's important for your doctor to exclude those causes.

i have been put on birth control to regulate my cycle. how long does it normally take to regulate. once i regulate how long does it take to conceive? i know each body is different, but speaking from your experience.

It may take a couple of months of taking the birth control pills to regulate your cycle. Fertility will largely depend on whether you are able to have regular menstrual cycles after stopping the birth control pills. If you do not have regular cycles following the pills then you may need to take fertility medications to help you ovulate.

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