The Doctor's Column - Dr. Ellen Greenblatt (Fall 2011)

The Doctor’s Column

Q: I am 20 years old and I have just been diagnosed with polycystic ovarian syndrome (PCOS). What are my chances of becoming pregnant, naturally or through assisted reproduction technologies, and is there anything I can do to help it happen?

A: Dr. Ellen Greenblatt: Women with PCOS can have different symptoms, from infrequent or no periods at all to frequent and heavy periods. Acne and excess facial hair growth are common, as is difficulty in conceiving. PCOS is associated with higher than normal levels of male hormones. In all cases, the failure to conceive is due to the absence of ovulation.

If fertility is not an immediate concern, as you are only 20 years old and may not be ready to start a family yet, the usual approach is to prescribe a low dose oral contraceptive, which will make your cycles regular and lower the levels of male hormones responsible for acne, among other symptoms.

If a woman with PCOS wants to become pregnant and is overweight, lifestyle changes such as a healthy diet and an exercise program are usually very helpful, as even a modest weight loss can improve her hormonal profile and increase her chances of ovulating. Note that lifestyle changes may increase likelihood of ovulation and improvement of symptoms right now – she should not wait until she wants to conceive.

PCOS is often associated with conditions such as pre-diabetes, high cholesterol and other cardiovascular risk factors such as hypertension, and therefore physicians will address these concerns before an attempt to conceive is recommended.

If ovulation still does not occur, oral fertility drugs, to induce ovulation are used, in the hope that a single egg will be released and mature, however all fertility medications are associated with a small risk of a multiple pregnancy. In some cases, the addition of insulin-lowering medications such as metformin may be useful to enhance a woman’s chances of ovulating with oral medications. If the woman does not respond to oral medications, her doctor will likely resort to injectable drugs which are associated with a higher risk of multiple pregnancy.

Depending on the situation, your doctor may suggest the addition of intrauterine insemination (IUI) to the course of ovulation induction, to enhance the chance of conception each cycle. If there are other fertility concerns (such as sperm problems or a blocked or damaged fallopian tube), or if ovulation induction with timed intercourse or IUI are not successful, then in vitro fertilization (IVF) would be the next step.

An older woman, or a woman with an additional medical concern, or whose partner has been diagnosed with male-factor infertility, might consider moving to IVF more quickly.

You should remain optimistic, because the majority of women with PCOS will achieve pregnancy through ovulation induction and intercourse or IUI.

Dear reader:

This page belongs to you! Send your question/s to: info@iaac.ca on IAAC’s website (www.iaac.ca) and one of our specialists will answer. Of course, this column cannot replace a medical consultation and doctors may not be able to answer questions which are too complex or specific, but you are sure to find valuable advice here. We have asked Dr. Ellen Greenblatt to host this edition of The Doctor’s Column. Dr. Greenblatt is Medical Director of the Centre for Fertility and Reproductive Health and Head of the Division of Reproductive Endocrinology and Infertility at Mount Sinai Hospital, in Toronto. An Associate Professor in the Department of Obstetrics and Gynaecology at the University of Toronto, she is on the Board of the Infertility Awareness Association of Canada (IAAC). Her research interests focus on polycystic ovary syndrome, fertility preservation, and optimizing ART treatments.