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PCOS and Fertility Positive Steps Forward Fertility SA

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PCOS and Fertility Positive Steps Forward Fertility SA Powered By Docstoc
					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            Ultrasound
                    PCOS
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   the
population
- Up to 70% remains undiagnosed
• Long and short term consequences
Short term            Long term

• Irregular periods   • Type 2 Diabetes
• Hair growth         • Increased risk of
• Acne                  cardiovascular disease eg.
• Infertility           strokes, heart 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?
  GENETICS                         LIFESTYLE



                Hormonal Changes




  ↑ Androgens                      ↑ Insulin



                    OVARIES         CARDIO-
  Hair Growth
                   Anovulation     VASCULAR
     Acne
                    Irregular         RISK
                     Periods
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, anti-
  androgenic
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   Day 9 stop   Day 11-13                  Day 21
                     clomiphene    clomiphene   scan                    Progesterone

                                                       If no response
                                                       increase dose



 Progesterone
    10 days
                    Period                          Ovulation + intercourse
 or blood test                                            +/- 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
                                                            hCG
Starting     Scan     Scan             Scan      Follicle   5000u
dose         d7       d14              d21       =16mm




                                          Increase dose
                       Increase dose
                                           by 50%
                        by 50%
      25-50iu/day
Laparoscopic Ovarian Drilling (LOD)
• Day surgery procedure via
  keyhole surgery
• Can restore ovulation in 60-
  80% 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

				
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posted:11/13/2011
language:English
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