PCOS

Polycystic ovarian syndrome, PCOS is a relatively common hormonal disorder and it is estimated that 20% of infertile women suffer from the disease. The term "polycystic ovary" describes the appearance of the ovaries of women who have this disease. Typically, their ovaries are covered with numerous small cysts that are actually follicles that did not develop properly (residual follicles).

PCOS patients typically have elevated androgens (male hormones, testosterone) which leads to several of the classic symptoms of the syndrome including excess body hair, a classic pear shaped body appearance, obesity in some women, lack of regular ovulation, and an increased miscarriage rate. PCOS patients are often overweight, however the syndrome can occur in women with ideal body weights. Some PCOS patients who are able to loose weight frequently begin spontaneous ovulation.

Women with PCOS often have chronically elevated insulin levels, which leads to overproduction of androgens by the ovaries. This "insulin resistance" means that they do not respond normally to a given amount of insulin and have chronically elevated insulin levels. They are also at increased risk for cardiovascular disease and diabetes later in life.

In the past, surgery was a common treatment for PCOS and involved "ovarian drilling" or removing a portion of the ovary (wedge resection). This tissue destruction leads to a reduction in androgen production and often resumption of normal ovulation. Ovarian drilling is usually reserved for patients who do not respond to medical treatment and the benefits are temporary.

Glucophage (metformin) is sometimes used as a first line treatment for PCOS. Metformin is an "insulin sensitizing" drug meaning that it increases the cells sensitivity to insulin. Once the PCOS patient's response to insulin is normalized, androgen levels decrease and ovulation will often begin. The main side effect associated with metformin is nausea and diarrhea. Clomid is also used as an ovulation induction agent and it is sometimes prescribed with metformin.

PCOS management can be complex and these patients should be managed by a reproductive endocrinologist. They are prone to exaggerated stimulation responses to follicle stimulating hormone administration (Gonal- F, Follistim) and are at increased risk for hyperstimulation syndrome.

Dr. Webster has extensive experience treating PCOS patients.

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