Infertility: Cause and Management

Polycystic Ovarian Syndrome & Infertility

PCOS, is a common cause of anovulation and female infertility. Anovulation occurs when the ovaries do not release an egg during menstruation.

PCOS Infertility Causes: Why do Women with polycystic ovaries have fertility problems?

    • Do not release an egg (ovulate) regularly
    • Have ovaries that contain many small cystic structures, about 2-9 mm in diameter

High levels of androgens (‘male’ hormones such as testosterone) and high insulin levels can affect the menstrual cycle and prevent ovulation (the release of an egg from the ovary).

When an egg is not released on a regular basis, this is called anovulation. Ovulation can stop completely or it can occur irregularly. This can make it more difficult for women with PCOS to conceive naturally, and some women may also have a greater risk of miscarriage. However, this does not mean all women with PCOS are infertile.

The infertility rate with polycystic ovaries is very high. Women with PCOS usually will have difficulty getting pregnant – and require treatment to improve chances for pregnancy. Some women with polycystic ovary syndrome will ovulate (release a mature egg) occasionally – others do not ever ovulate. In order to conceive, sperm must find and fertilize a mature egg – so we need to ovulate.

Polycystic Ovarian Syndrome Infertility Treatment

The good news is that the chance of getting pregnant with polycystic ovarian syndrome using fertility treatments is very good. The great majority of women with polycystic ovarian syndrome will be able to have a baby with fertility treatment.

PCOS Infertility Management

Weight management

Small reductions in weight can assist with fertility, so if you are above a healthy weight, weight management and physical activity is the first treatment option. Even a five to ten per cent loss of weight has been shown to greatly improve the chances of becoming pregnant. Current international recommendations are to either achieve a healthy weight or modest weight loss before pregnancy. This will reduce the risk of complications during pregnancy.

Estimate your ovulation time

As PCOS can affect the regularity of periods it can be tricky to estimate your ovulation time. An ovulation calculator and an ovulation predictor kit may help you work out when you may be ovulating.

Ovulation induction

If lifestyle and weight loss have not helped improve your fertility after three to six months, then your doctor may recommend medication to encourage ovulation.

Called ovulation induction, the treatment is designed to stimulate the ovary to increase egg production. Ovulation induction uses tablets or injections over a period of time. Ultrasounds and blood tests are performed to determine the best time to trigger ovulation using a hormone called HCG. Once ovulation has been triggered, semen is introduced either by sexual intercourse or inter-uterine insemination when collected semen is placed directly into the uterus through the cervix. Ovulation induction is not recommended for women with PCOS who have a BMI greater than 35.

Clomiphene Citrate, Metformin and Gonadotrophins are typically used during Ovulation Induction. Each of these have their own side effects and is to be used only under medical advice and supervision.

Ovarian Drilling for improving fertility in PCOS

Ovarian drilling is a surgical procedure that can increase ovulation. This is performed using a laparoscope. It is a minimally invasive procedure where an incision is made in the abdomen under a general anaesthetic. Small holes are drilled in the surface of the ovary to remove tissue that produces excessive amounts of androgens (male hormones such as testosterone). Following ovarian drilling, ovulation is often restored for up to 6-12 months.

As surgery is a more intensive treatment than taking medication or lifestyle treatment, ovarian drilling is not commonly used and is primarily used after other lifestyle or medical treatment has proved ineffective.

Assisted reproductive technology

For women who have not been able to conceive naturally or by using medications or lifestyle treatment to improve their fertility, another option is assisted reproductive technology. This includes treatments such as IVF (in vitro fertilisation). Referral to a fertility specialist is necessary for these treatments.

Assisted reproductive technology is best tried after other less intensive treatments have proved unsuccessful, as it is often costly and demanding. This technology is also more successful in women who have instituted lifestyle change effectively first, even if these changes have not improved fertility by themselves.

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