Polycystic Ovary Syndrome Polycystic Ovary

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					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
subfertility
                                                              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
syndrome.
                                                              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
fertility.
                                                                                      East Sussex TN40 1JA
How is the diagnosis made?                                                        Telephone: 08701 188088
                                                                      Email: admin@infertilitynetworkuk.com
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

				
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