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Treating PCOS and Infertility

Women who have polycystic ovarian syndrome (PCOS) typically have ovaries that contain many small follicles, which are often called "cysts." The eggs in these follicles don't grow normally, which is why women with PCOS ovulate less frequently and have trouble getting pregnant. The many small follicles in the ovaries produce androgens, male hormones that not only lead to an imbalance that affects a woman's ability to conceive, but can also lead to conditions such as high blood pressure and diabetes.

Patients with PCOS who are trying to get conceive should have a complete fertility work-up in order to determine if there are factors other than PCOS that may be contributing to infertility, according to Anuja Dokras, MD, PhD, a reproductive endocrinologist with Penn Fertility Care, and director of the Penn Polycystic Ovary Syndrome Center. "If they have PCOS only, then the focus is to help them ovulate," she says. "But I would make sure there are no other factors, such as male factor or tubal factor., etc."

Weight Loss

If the fertility doctor finds the only cause of the infertility is PCOS, the first-line treatment is to educate the patient about weight loss. "If you are able to lose weight, your periods may come more regularly," Dr.Dokras says. "You may not need any fertility medications, or you may need a low dose medication, and your pregnancy will be safer if you're lower in weight. So the discussion about weight loss is always the first thing when you're trying to get pregnant."

In women with PCOS, the underlying problem is insulin resistance. Losing weight helps drop the insulin levels and help you ovulate more regularly. A patient may also be given Metformin, a diabetes medication used to control blood sugar and insulin levels. Metformin can also help reduce androgen levels and make ovulation normal.

Fertility Drugs

If periods are still irregular even with weight loss, fertility drugs are the next step. "Usually tablets by mouth that will help them ovulate each month," Dr. Dokras says. "Clomid or Letrozole. We are part of a multi-center study funded through the National Institutes of Health comparing these two drugs head to head."

Dr. Dokras says that for the percentage who don't respond to the oral fertility drugs, they go on to injections with gonadotropins (FSH injections). "It's the same jormone that is secreted by the brain; it's just a higher dose to help form the eggs and release them," she says.


When the less invasive treatments do not succeed, ovarian drilling is a laparoscopic procedure that is sometimes used to treat PCOS and infertility. Patients with PCOS typically have ovaries with a thick outer surface. Ovarian drilling breaks through the thick outer surface and reduces the amount of testosterone the ovaries make.

"With laparoscopy, one could look at both the ovaries and with a very low dose current, one can cauterize small areas of the ovary on both sides or one side, the idea being the ovaries have these excessive follicles, and that is where the male hormone is coming from," says Dr. Dokras. "So if you burnt off little areas, maybe you drop the levels, and the woman would start ovulating. The studies show that that can happen, and it does happen in fair proportion, but for a short time. Once the areas heal over again, the majority of the women go back to their original menstrual pattern."

Women who are experiencing infertility because of PCOS and no other reason typically do not need in vitro fertilization, Dr. Dokras says. "If the only reason [they are not getting pregnant] is they are not able to ovulate, then the great majority will be pregnant either with weight loss or with Clomid or with injections."


Comments (4)

I found out about 2 years ago that I have PCOS. I placed on Metformin 500mg and Yasmine contraceptive. Went to Gyno and she took me off Yasmine and I went for Ovarian drilling on her request. She did not however after the operation send me for any blood tests. I then moved to another province where I was placed on PostOval for 3 months and GlucoPhase 1000mg and a low GI diet. I then changed to a female dr again who took me of the PostOval and placed me on Androcur 50mg ( Day 5 to day 14 2 tablets). She then took bloods and the result came back that my Testostorone levels are high and my Insulin levels also high. My question is do you think that I need to go back on the contraceptive with the Androcur and the Glucophage? Or do you maybe suggest a different treatment. You can contact me on I am living in South Africa and have to dr's in three provinces and no one can help me. I was also on Dianne from 2000 to 2006. And from 2007 to 2010 I was on Yasmin. I have forgooten to add that I am currently 25 with no children at present

i have pcos and hirsutism i have been on various medication but nothing has work. i no longer wish to take birth control pill . i have never had a period with out birth control. i had various symptoms that are arising like hair lost , bone density problem . i have lost weight visit doctor various years i would like to know if surgery would do the best for me . please contact me at thank you so much for your time

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