PCOS and Fertility
Positive Steps Forward
Dr Michelle Wellman
MBBS FRANZCOG
Questions
• What is Polycystic Ovary Syndrome (PCOS)?
• Why is PCOS important?
• What causes PCOS?
• Can PCOS be cured?
• Will I be able to have children?
What is PCOS?
• Involves more than just the ovaries
• Syndrome = Group of Symptoms or signs
• 2 out of 3
PCOS Types
Menstrual
Irregularities
PCOS
PCOS
PCOS
Androgens
PCOS
Ultrasound
Irregular periods
• Cycles consistently
more than 35 days
• Less than 10
periods per year
Hypothalamus
GnRH
Pituitary
FSH
LH
Ovaries
Oestrogen
Progesterone
Uterus
Ovulation
PCOS
No ovulation
Infrequent ovulation
Progesterone
Increased androgens
• Androgens
= ‘male-type’ hormone
• Sometimes increased hair growth on face,
chest, back (hirsutism)
• Sometimes loss of hair on the scalp (alopecia)
• Sometimes acne
• Can be seen on a blood test
Ultrasound
appearance
• Transvaginal
(internal)ultrasoun
d is best
What is not PCOS?
Single cysts on ultrasound or follicles
Loss of periods due to stress, rapid weight
loss or excessive exercise
Loss of periods due to premature menopause
Why is PCOS important?
• Common
- Estimated to affect between 12 and 21% of
population
- Up to 70% remains undiagnosed
• Long and short term consequences
the
Short term
Long term
• Irregular periods
• Type 2 Diabetes
• Hair growth
• Increased risk of cardiovascular
• Acne
disease eg. strokes, heart
• Infertility
attacks
• Psychological
Weight and PCOS
• Not all women with PCOS are
overweight
• Being overweight increases the
signs and symptoms of PCOS
• Weight loss has been shown to
reduce the signs and symptoms
of PCOS and reduce the risk of
long-term consequences
If you think you may have PCOS
• Speak with your GP
• They may organise appropriate tests if required
• May require input from other specialists
• Gynaecologist
• Fertility Specialist
• Endocrinologist
• Dermatologist
• May refer to other allied health professionals
• Dietician
What causes PCOS?
LIFESTYLE
GENETICS
Hormonal Changes
↑ Androgens
Hair Growth
Acne
↑ Insulin
OVARIES
Anovulation
Irregular
Periods
CARDIOVASCULAR
RISK
Can PCOS be cured?
• No cure
but very effective treatment options for
managing the associated problems
• Removing the ‘cysts’ does not cure the problem
• LIFESTYLE CHANGE
first line treatment for all PCOS problems
SMALL CHANGES
MAKE A BIG
DIFFERENCE
Menstrual problems
• Medication - pill, cyclical
progesterone
• Mirena® - intrauterine
contraceptive device
• Surgery
Hair growth
• Cosmetic treatment eg
laser, electrolysis
• Medication eg. pill, antiandrogenic
WILL I BE ABLE TO
HAVE CHILDREN?
• Anovulation
= ovary does not release an egg
• In most instances ovulation can be restored with
simple, inexpensive techniques
WEIGHT LOSS
• If overweight even small (5-10%) reduction in
bodyweight can reduce insulin resistance and
restore ovulation
• Other health benefits
• Benefits during pregnancy
- reduces miscarriage rate
- reduces diabetes during pregnancy
WEIGHT LOSS SURGERY
• Laparoscopic banding, gastric sleeve
operations
• Can be useful for very overweight woman who
are unable to lose weight after prolonged efforts
at lifestyle change
• General recommendation to defer conception
for 12 months or until weight-loss stabilised
Clomiphene Citrate
• Trade names Serophene® and
Clomid®
• Generally low risk and low cost
• Twins 5-7%, Triplets 0.3%
• Response rate 60-85%
• Pregnancy rate 50% after 6
ovulatory cycles
Clomiphene tracking
Allows assessment of response, intercourse timing and triggering
Day 1
Day 5 start
clomiphene
Day 9 stop
clomiphene
Day 11-13
scan
Day 21
Progesterone
If no response
increase dose
Progesterone
10 days
or blood test
Period
Ovulation + intercourse
+/- trigger
Metformin
• Medication used to reduce blood glucose levels
in diabetes
• Taken 3-4 times a day
• May be useful for women who do not respond to
maximum doses of clomiphene
• Sometimes beneficial on its own to induce
ovulation in women with lower BMI
Gonadotropins
• Use synthetic FSH to stimulate ovulation (GonalF® or
Puregon®)
• Usually used for women who do not respond to
Clomiphene
• Rare not to respond
• Additional trigger (ovulation) injection and luteal
(lining)support medication usually required
Puregon®
Gonal F®
FSH Ovulation Induction Protocol
Increase dose slowly - can be very sensitive
Starting
dose
Scan
d7
Scan
d14
Increase dose
by 50%
25-50iu/day
Scan
d21
Follicle
=16mm
Increase dose
by 50%
hCG
5000u
Laparoscopic Ovarian Drilling (LOD)
• Day surgery procedure via
keyhole surgery
• Can restore ovulation in 6080% of women in the short
term (few months)
• Lower risk of multiple
pregnancy
IVF
•Generally last option
•Increased sensitivity to medication in patients with
PCOS
•If other associated factors may be indicated, but
not always necessary i.e semen abnormality
If IVF is needed FertilitySA has
outstanding pregnancy rates!
Resources
• Jean Hailes Foundation Website
www.jeanhailes.org.au
• FertilitySA website
www.fertilitysa.com.au
• Polycystic Ovary Syndrome Association of Australia
(POSAA)
www.main.posaa.asn.au
• Brochures
Any Questions?
Consulting Clinic
345 Carrington Street
Adelaide SA 5000
Phone 8100 2900
e info@fertilitysa.com.au
w www.fertilitysa.com.au