If you have a history of irregular menstrual cycles or if you never have a menstrual period, you may have Polycystic Ovarian Syndrome (PCOS), the most common hormonal abnormality in reproductive age women. In addition to irregular menstrual periods women with PCOS may also have unwanted hair growth (face, chest, abdomen), acne and difficulty controlling their weight. For many women there is no obvious cause of PCOS; however, a large percentage will have what's termed "insulin resistance" which results in higher than normal production of insulin hormone which initiates hormonal abnormalities in the ovaries that lead to PCOS. To diagnose PCOS, a pelvic ultrasound is performed which reveals a large number of small egg sacs (cysts) that line up along the periphery of the ovary. Blood tests are also taken to determine if you have hormonal irregularities such as higher levels of male hormones. Women with PCOS who don't want to get pregnant are usually treated with birth control pills or medication, to help to induce a period each month. This is important because when a woman does not get her period each month, the lining of her uterus can build up, leading to irregular and heavy vaginal bleeding. If left untreated, the lining can develop pre-cancerous or cancerous cells.

For women who would like to conceive, PCOS can have an adverse effect on the ability to become pregnant because it can prevent ovulation. If a woman with PCOS desires to conceive, she is treated with fertility medications that induce ovulation. Clomiphene citrate, or Clomid®, is an oral medication and is the most common drug used for PCOS to induce ovulation. Letrazole is another oral medication that is occasionally substituted for Clomid. Another option is injectable medications called gonadotropins. Insulin sensitizing medication such as Metformin (Glucophage) can also be used in women who are insulin resistant. If these treatments fail, In Vitro Fertilization (IVF) is recommended.

To learn more about PCOS and infertility treatments such as IVF that can help patients in Bucks County, New Jersey, and beyond, contact IVF New Jersey.

What are the side effects of ovulation induction?

When undergoing ovulation induction, PCOS patients are at increased risk of multiple pregnancy and severe ovarian hyperstimulation (painful enlargement of the ovaries)as compared to women without PCOS. We try to minimize the risk of multiple pregnancies by using the smallest amount of medication possible in PCOS patients. Hyperstimulation is a side effect of fertility medications, associated with abdominal bloating, nausea, and discomfort. It is usually treated with hydration and rest. There is also an increased risk of multiple pregnancies, most often twins. Because of these risks, it is very important that PCOS patients have their treatment cycles monitored with blood tests and ovarian ultrasounds when taking fertility medications.

What does it mean if I am found to be insulin resistant?

Many PCOS patients are also found to have insulin resistance. This is diagnosed by drawing a fasting glucose and/or insulin level. Elevated insulin levels can make weight loss very difficult It is often associated with acne, excessive hair growth on the face, chest, abdomen and thighs; and thinning of scalp hair. The possible long-term consequences of untreated high insulin levels include an increased risk of diabetes and heart disease. For this reason, additional medication and a modified diet may be prescribed. Finally, insulin resistance has also been shown to increase the "bad" cholesterol (LDL) levels and decrease the "good" cholesterol (HDL) levels. Your doctor may order a fasting lipid profile if this is suspected.

What medications are given for insulin resistance?

Metformin, or Glucophage, is an oral medication that can both facilitate weight loss and allow some patients to ovulate in response to Clomid® treatment, where they previously have been "clomiphene resistant." It is usually given two or three times per day. About half of all patients will initially experience diarrhea, bloating, or gas pain when first starting metformin. These symptoms can be minimized by beginning with a smaller dose, taking the pills with meals, and avoiding meals high in carbohydrates. Usually, periodic liver function tests are done due to reports of extremely rare cases of liver inflammation.

Why should I follow a special diet?

A diet relatively low in carbohydrate and high in protein usually helps insulin-resistant patients to lose weight and become more responsive to medication. As little as 5% weight loss can restore ovulatory function. We recommend a diet lower in carbohydrates (30 to 40 of total calories) and high in protein such as "The Zone," "Sugar Busters," or "The Carbohydrate Addict's Diet." Diets very low in carbohydrates can be dangerous and should be avoided. A diet high in fiber (20 to 30 grams per day) will also help to stabilize blood sugar levels and decrease insulin secretion. Finally, exercise is helpful in losing weight and weight training has been shown to increase muscle mass and decrease insulin resistance. As little as 30 minutes twice a week can significantly increase muscle mass and lower insulin levels.

How long will I have to take medication or follow a diet?

It depends. Some women with PCOS and insulin resistance will return to normal hormonal function if they lose weight. Others may need to be treated for long periods of time. The lifetime risk of developing diabetes is higher for women with PCOS as compared to "normal" women, so it is advisable to have laboratory testing repeated at least every few years.

How is excessive hair growth treated?

Unwanted dark, thick body hair can be treated medically and/or with various procedures that remove hair. Medications including spironolactone in combination with birth control pills lighten the color and decrease thickness of the hair shaft, and help suppress development of new hair growth. Eflornithine (Vaniqa) is a drug which is applied to the skin in cream form, and acts directly on the hair follicles to inhibit hair growth. It is usually applied to the face. These medications may take up to six months to produce noticeable results. For immediate improvement, laser hair removal can be performed. The latest technology provides for painless removal that, depending on the extent of hair removal necessary, is completed in three to six sittings and results in permanent removal of the hair shafts treated in this manner.

More Information About PCOS

If you want to learn more about PCOS and infertility, we suggested the following website:

The Polycystic Ovarian Syndrome Association

If you are interested in PCOS infertility treatment, contact IVF New Jersey, serving Bucks County and beyond.