Uploaded on August 10, 2014
Polycystic Ovary Syndrome (PCOS)
My name is Amr Azim I am a reproductive endocrinologist at New York City IVF. If you were diagnosed with polycystic ovarian disease (PCOS) or polycystic ovarian syndrome and interested in getting pregnant, there are a few things to consider. Polycystic ovary mean higher concentration or density of small follicles in the ovary. This is a good thing, it means you have many eggs. But sometimes for unknown reasons this will interfere with ovulation so that you do not mature one of the big number of eggs that you have into an egg that can ovulate. And because of that estrogen does not increase and build the lining and because of that sometimes the period is delayed and you might miss your period for a few months. The male hormone is also at a higher concentration because it is produced from the large number of follicles and sometimes you would have manifestations of increased male hormone. Sometimes women with polycystic ovaries are overweight and that also interferes with ovulation. In the absence of other fertility factors such as a tubal factor or a male factor, usually many women with polycystic ovaries can be helped with simple treatments. The mainstay of treatment is to use oral medications. There is clomiphene citrate a medicine that has been used for a very long time and more recently another group of medications called aromatase inhibitors, notably letrozole can be alternatively for that purpose and yields a very good success rate. These medications enable you to mature your eggs and ovulate. They work with different mechanisms, they are generally safe, and they have been used for quite a long time in the case of both clomiphene citrate and letrozole, and there is no evidence that they are associated with increased risk of anomalies, they are oral, usually produce one egg, so the risk of multiple pregnancy from these medications is not that high, its about 8% per cycle. The majority of multiple pregnancies are twins. It should though be monitored to avoid and further minimize the risk of multiple pregnancy because some women are sensitive to these medications. It should be monitored by a person that is well versed in monitoring ovulation using ultrasound and bloodwork. In some women clomiphene citrate and letrozole does not lead to ovulation, about 10-20% of women are resistant to these medications.
In this case, one option would be to use injection medications like gonadotropins that are usually successful in affecting ovulation. The issue is that women with polycystic ovaries are sensitive to these medications so they might produce many eggs after an injection of gonadotropins. Certainly these medications should be monitored by a reproductive endocrinologist to minimize the risk of multiple pregnancy. The risk of multiple pregnancies in using injection medications and insemination, although it is a simple treatment, is about 30% for twins and about 1-3% for triplets and because of that they have to be used with extreme caution in women with polycystic ovaries.
Another alternative treatment is to stimulate the ovaries, retrieve all the eggs out, fertilize them in the lab, and transfer only one embryo so that the risk of multiple pregnancy is minimized to less than 1%. This treatment appears to be safer for the long term baby outcomes when compared to gonadotropins or injectable medications and intrauterine insemination. It also has a much higher success rate and it also carries the that the excess embryos are frozen and can be used for subsequent cycles or subsequent babies.