Polycystic ovaries are larger than normal and with almost double number of oocytes. The polycystic ovaries DO NOT contain cysts but small ovarian follicles with a specific distribution inside the ovary like a “pearl necklace”. The follicles contain oocytes that cannot grow properly due to hormonal disturbance.
What is the polycystic ovarian syndrome?
The polycystic ovarian syndrome (PCOS) is a common endocrine and metabolic disorder that affects 1 in 10 women of reproductive age. The syndrome causes menstrual disorders and affects fertility, appearance and even the emotional status of a woman.
How is PCOS diagnosed?
For diagnosing PCOS at least 2 of the following criteria need to be fulfilled:
- Menstrual disturbances, areomenorrhoea or amenorrhoea
- Hirsutism and increased levels of testosterone in the blood
- Polycystic ovaries on ultrasound examination
Polycystic ovaries and fertility
The mere presence of polycystic ovaries on scan, in women with regular cycle and normal androgen levels, is not always related to infertility.
However, the PCOS can affect fertility. Menstrual cycle irregularities such as amenorrhoea, indicate that ovulation does not occur regularly or if it occurs is delayed and usually associated with low-quality oocytes.
Can you conceive without treatment?
Yes, you could conceive without treatment. However, this depends on your age, your history and the severity of the syndrome.
When should you have treatment?
A woman, who has PCOS associated with irregular menstrual cycle and wishes to conceive, is recommended to visit her gynaecologist. She does not necessarily need to have medical treatment. In some cases, lifestyle changes might be the only intervention needed.
Management of infertility in women with PCOS
- Life style modification
The first step against PCOS is loss of weight and exercise. Women are encouraged to exercise even for 30 minutes per day for 3 days per week.
- Medications for ovarian stimulation
Medications such as clomiphene citrate or hormonal injections aim to stimulate the ovaries in order to produce more than one follicle per month. Clomiphene citrate use is contraindicated for more than 6 cycles.
In some cases the change of lifestyle and use of medications are not enough for conception to occur. Women with PCOS who do not respond to clomiphene citrate might need to consider IVF.