Polycystic Ovary Syndrome (POCS)

The polycystic ovary syndrome (PCOS) is a condition in which the ovaries accumulate tiny "cysts" (actually little follicles, two to five millimeters in diameter, each of which contains an egg) instead of the follicles growing and going on to ovulate they stall and secrete male hormone into the blood. Ovulation can be rare without the help of medications. In some women, there will be a long history of irregular periods and, perhaps, an increase in facial and body hair caused by more than the normal amount of male hormone in the blood. There are estimates that about 20 percent of all women have mild polycystic ovaries (PCO). It's probably genetic - often coming down the male side of the family.

One problem physicians have had in making the diagnosis of PCOS is that there is no universally accepted definition for this disease. Most reproductive endocrinologists, however, require the presence of hyperandrogenism (excessive "male" hormones) and chronic anovulation (infrequent or absent ovulation resulting in irregular menstrual cycles) to make the diagnosis. Others require the appearance of polycystic ovaries on vaginal ultrasound examination.

Because other disorders of the ovary, pituitary gland and adrenal gland can mimic the symptoms and appearance of PCOS, these disorders should be excluded before an accurate diagnosis of PCOS can be made. When a woman is not trying to get pregnant, oral contraceptive pills are good treatments: they stop follicles and male-hormone-producing tissue from accumulating, stops complications such as abnormal hair growth from taking place, gives regular periods, provides contraception, and protects future fertility.

When attempting pregnancy, the drug Clomiphene citrate (Clomid or Serophene) is often the first choice to induce ovulation. If Clomiphene doesn't work then physicians often use injectable medications such as Pergonal, Humegon, Gonal-F, Follistim, and Repronex. Using the injectable medications to induce ovulation patients with PCOS is often complicated, since in some cases, up to 10 or 20 follicles will respond and try to ovulate. It is important that if this happens, the cycle be cancelled, and the next month be started with lower doses of medications.

Finally, there has recently been a strong association uncovered between PCOS and Insulin resistance (part of a spectrum that includes Diabetes Mellitus). Weight reduction will greatly improve not only insulin resistance, but also help regulate menstrual cycles, improve fertility and reduce male hormone levels. In addition, weight loss will lower the risks of coronary artery disease and uterine cancer. Recently, two medications, Metformin and Troglitazone, have been shown to effectively improve insulin sensitivity in women with PCOS and help regulate menstrual cycles. They can be considered as an adjunct to weight loss and exercise in some patients, and may improve a patient's response to fertility medications.

It is important to remember that PCOS is a complicated disease with many different presentations. In most patients, however, it can be managed safely and effectively to help patients improve their fertility and lead healthier lifestyles.