- Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is the most common endocrine disease found in women in the fertile age range, and it affects an estimated 5%-10% of the population. Estimates show that approximately 105 million women worldwide between the ages of 15 and 49 have PCOS. Polycystic ovary syndrome is a disease with many causes that include genetics and environmental factors (inadequate diet, sedentary lifestyle). It is characterized by irregular menstruation, hyperandrogenism, infertility (no ovulation), obesity and insulin resistance.
1) What are the main symptoms of polycystic ovary syndrome?
It can manifest itself in various ways: menstrual and reproductive disorders, acne, hirsutism (excessive hair growth) and in the mid and long term it can include metabolic diseases and a higher risk of developing a cardiovascular disease and even cancer. Among the causes of female infertility, 35% include ovulatory disorders and of these, 80% are the consequences of polycystic ovary syndrome.
2) What are the therapeutic possibilities for treating Polycystic Ovary Syndrome?
The choice of treatment depends on the goal. Is it to treat menstrual irregularity? A metabolic disorder? Infertility? For each goal, there are a variety of options. In terms of infertility, the treatment is to basically restore ovulation. However, before the treatment, the couple must undergo minimal testing (Fallopian tube permeability and semen analysis) to exclude any other causes of infertility. An important part of treatment involves guidelines for changing life styles, especially in regards to losing weight. Studies reveal that over half the patients with PCOS are obese and obesity is related to failed fertility treatments, a higher risk for miscarriages and complications late in pregnancies (hypertensive disorders, diabetes, etc).
3) What is the treatment for Polycystic Ovary Syndrome Infertility?
When the syndrome is the only cause for a couple's infertility, the treatment consists of medically induced ovulation. The first choice for medication is clomiphene citrate (CC). However, 30% of patients with PCOS do not respond to this medication alone. In these cases we have a few options, such as including other medications (metformin, gonadotropins), the isolated use of gonadotropins or surgical treatment, cauterization of the ovarian follicles through videolaparoscopy (called ovarian drilling). These options increase the chances of success. The choice will depend on an individual evaluation of each case.
Treatment with gonadotropins in these patients must be extremely cautious, because patients with PCOS have a higher risk of developing a complication called ovarian hyperstimulation syndrome (OHSS). In short, PCOS is a complex disease, and infertility is one of the most complicated aspects of it. There are a number of possibilities for treatment which must be evaluated individually. The only treatment that should be used for the vast majority of these patients is life style changes, especially dieting for weight loss and regular physical activity. This first step will certainly facilitate complementary treatment if it is necessary. 4) Is there a technique that can be used to reduce the risk of hyperstimulation? We currently provide a new treatment alternative for these patients, which is the maturation of ova in the laboratory (IVM). To use this technique, we collect immature ova from patients with PCOS and we mature them in the laboratory. When these ova are mature, they are fertilized and then the embryos are transferred to the patient's uterus. This technique eliminates the risk of hyperstimulation.