Polycystic Ovary Syndrome
A disorder of ovulation (e.g. release) is one of the most the ovaries. Blood tests are also taken for hormone
common causes of subfertility, affecting some 25-30% of measurements as most women with PCOS have evidence
couples. It has been estimated that three quarters of the of a hormone imbalance which may be an important
women with this problem have polycystic ovary syndrome factor in causing the problem with ovulation.
which makes it one of the most common causes of
Fortunately, most women who are subfertile because of
PCOS are able to get pregnant as a result of treatment to
What is a polycystic ovary? stimulate ovulation. The key to treatment lies in
increasing the levels of "follicle-stimulating hormone"
The term polycystic literally means "many cysts", but this
(FSH) in the blood. The first line treatment is the use of
description is misleading and, for many women, worrying clomiphene.
because of the word "cyst". It conjures up the vision of
diseased ovaries and, understandably, even raises the How can it be treated?
question of cancer. It is important to emphasise that all
Clomid or other similar "anti-oestrogens". It works by
ovaries, if they are functioning formally, contain "cysts".
stimulating the body's own supply of FSH from the
These cysts are more correctly called "follicles" and are
pituitary gland. Clomiphene is given in tablet form and is
vital to the reproductive process because they contain
usually prescribed for five days shortly afte r the start of
the eggs. The only differences between "polycystic" and
the period. This is successful in about three quarters of
"normal" ovaries are that polycystic ovaries are usually
patients with PCOS.
somewhat larger than average and contain about twice
as many, but normal, follicles - hence "polycystic". Treatment is more complicated in the 25% of women
Polycystic ovaries are not, in themselves, abnormal. who do not respond to clomiphene and should be given
About 1 in 5 of the general female population have and supervised at a specialist infertility centre. In such
polycystic ovaries and only a small proportion of these cases it may be necessary to give FSH by injection, but
women will have fertility problems. We do not yet fully care must be taken to avoid over stimulating the ovary
understand what other factors must be present in a as this can lead to severe swelling of the ovaries
woman with polycystic ovaries for her to go on to develop ("hyperstimulation syndrome") and increases the risk of
polycystic ovary syndrome and subfertility. multiple pregnancy. For this reason some centres
(including our own) have adopted a "low dose" scheme
What is Polycystic Ovary Syndrome? for the use of FSH and have been able to reduce the
The typical features of polycystic ovary syndrome (PCOS) incidence of these worrying side effects.
include a disturbance of the pattern of menstrual periods
Also available are surgical methods of treatment -
(sometimes no periods at all, but, more commonly,
ovarian wedge resection or (more recently) "drilling" of
irregular and infrequent menstruation) together with
the surface of the ovary through laparoscope. However,
some degree of unwanted body hair. However, it is
many experts think that these treatments should be
important to point out that whilst growth of unwanted
reserved for those women who do not respond to, or are
hair may be very troublesome for some women with
thought unsuitable for, medical treatment. As mentioned
polycystic ovaries, it is only moderate in most (and easily
earlier, a calorie-controlled diet is an important part of
managed by simple cosmetic measures) and does not
treatment in overweight women with PCOS. The response
occur at all in a substantial number (4 out of 10) with the
to clomiphene or to FSH is much better in women of
normal weight compared with those who are overweight.
There is also an association between PCOS and body fat.
Professor S Franks
About one third of women with this disorder are
overweight and it appears that women with PCOS may St. Mary’s Hospital, London
have a slightly different metabolism from women without Infertility Network UK
the syndrome which makes them more prone to gain Charter House
weight. However, the important point is that weight 43 St. Leonards Road
reduction in overweight women with PCOS improves
Bexhill on Sea
East Sussex TN40 1JA
How is the diagnosis made? Telephone: 08701 188088
The diagnosis of PCOS is obviously suspected in a woman
with infertility who is having irregular, infrequent or no www.infertilitynetworkuk.com
periods, particularly if she also has unwanted body hair.
It can be confirmed by performing an ultrasound scan of Registered Charity Number 1099960