Polycystic ovarian syndrome (PCOS) is a fairly common condition. The main symptoms include irregular or absent menstrual periods, reduced ability to get pregnant, acne and bodily hair growth. Some women will experience weight gain and find it difficult to maintain a normal body mass index (BMI).
The cause of PCOS is not known, but sometimes runs in families. The symptoms are related to abnormal hormone production (hormone imbalance). A person is diagnosed to have PCOS when they have the above typical symptoms and through hormone testing and ultrasound imaging of the ovaries. The ovaries will usually be enlarged with multiple follicles (small cysts), hence the description of polycystic ovaries. However, some women may have a polycystic appearance of the ovaries for other reasons but not be diagnosed to have PCOS.
Failure to ovulate regularly is the main cause for delay in conceiving in women with PCOS. Young women with PCOS who are below 35 years of age and who occasionally have periods, may try for about six months for natural conception. Those who are overweight should aim to optimize their BMI to between 19 and 25. This can be achieved by increased physical activity combined with a healthier diet. Losing at least five percent of your weight may lead to natural ovulation and conception.
If attaining a normal BMI does not lead to natural conception within a few months, fertility treatment usually becomes necessary. The initial recommended treatment is the use of ovulation tablets. Injectable hormones can also be used, but this is reserved only for those who don’t ovulate even while using tablets. You should only get ovulation medications prescribed by your gynaecologist, following an initial appropriate assessment. You will also require monitoring to ensure that you are responding appropriately on the prescribed medications. One should not have such medications without consultation with a gynaecologist. Conception is usually expected within 3 to 6 months following correction of ovulation.
If the initial simple treatment fails, it will lead to an additional fertility assessment and consideration of second line treatment options. At this point, consulting a fertility specialist is advisable. If not initially done, tests to confirm normality of sperm and fallopian tubes should be done. Surgical treatment referred to as ovarian drilling, may also be considered to promote return to normal periods and ovulation. Once again, time should be given after this surgery for there to be success in conception.
Advanced assisted conception through in vitro fertilisation (IVF) becomes the main option for treatment when the above solutions fail, or if additional causes of infertility are diagnosed. Success rates tend to be good, although there can be associated additional risks with IVF treatments, mainly due to excessive ovarian response to hormonal stimulation. The IVF team will normally put in place various strategies to ensure the safety of your treatment.
