Polycystic Ovarian Syndrome

Fertility Treatment Options for Women with Polycystic Ovarian Syndrome, PCOS

There are various options for women with polycystic ovarian syndrome wishing to conceive. Since patients with polycystic ovarian syndrome have insulin resistance, it has been found that weight loss may decrease insulin resistance and then allow the patient to spontaneously ovulate.

Simply losing 10-15% of total body weight can make a difference.

Another one of the first steps involved in helping patients ovulate is the administration of medical treatment. Insulin-sensitizing medications can be used to decrease insulin levels, which can help restore normal ovarian hormone profile, allowing spontaneous ovulation to occur.

The most commonly used medication is metformin (Glucophage). Generally, this is initiated in the form of 500 mg of Glucophage a day for a week, increasing to 500 mg twice a day with meals the second week, and 1 tablet 3 times a day with meals the third week. This medication is increased slowly to decrease some of the side effects. Common side effects with metformin are gastrointestinal disturbance and weight loss.

Glucophage is generally continued through the first trimester of pregnancy to decrease the risk of miscarriages, which may be increased to approximately 40% in patients with polycystic ovarian syndrome. There are newer insulin-sensitizing medications available including rosiglitazone maleate (Avandia) or pioglitazone (Actos).

If a patient is anovulatory after taking an insulin-sensitizing agent, clomiphene citrate is administered. If clomiphene citrate does not induce ovulation, injectable medications (gonadotropins) may be utilized. When using injectable medications, we must be careful to use enough medication to have 1 or 2 eggs grow, but not so much medication that many eggs grow. We use a strategy of using low dose medications with slow incremental increase of the dosage. Occasionally, in vitro fertilization is necessary because of difficulty in obtaining a controlled response of ovaries in patients with polycystic ovarian syndrome.