PCOS and Fertility Positive Steps Forward Dr Michelle Wellman MBBS FRANZCOG
PCOS and FertilityPositive Steps Forward
Dr Michelle Wellman
MBBS FRANZCOG
• What is Polycystic Ovary Syndrome (PCOS)?
• Why is PCOS important?
• What causes PCOS?• Can PCOS be cured?• Will I be able to have children?
Questions
• Involves more than just the ovaries
• Syndrome = Group of Symptoms or signs
• 2 out of 3
What is PCOS?
MenstrualIrregularities
Androgens Ultrasound
PCOS
PCOS PCOS
PCOS
PCOS Types
• Cycles consistently
more than 35 days
• Less than 10
periods per year
Irregular periods
Hypothalamus
Pituitary
Ovaries
Uterus
GnRH
FSHLH
OestrogenProgesterone
Ovulation PCOSNo ovulation
Infrequent ovulation
Progesterone
• Androgens
= ‘male-type’ hormone• Sometimes increased hair growth on face,
chest, back (hirsutism)• Sometimes loss of hair on the scalp (alopecia)• Sometimes acne• Can be seen on a blood test
Increased androgens
• Transvaginal
(internal)ultrasoun
d is best
Ultrasound
appearance
Single cysts on ultrasound or follicles
Loss of periods due to stress, rapid weight
loss or excessive exercise
Loss of periods due to premature menopause
What is not PCOS?
• Common
- Estimated to affect between 12 and 21% of the
population
- Up to 70% remains undiagnosed• Long and short term consequences
Why is PCOS important?
Short term Long term
• Irregular periods
• Hair growth
• Acne
• Infertility
• Psychological
• Type 2 Diabetes
• Increased risk of
cardiovascular disease eg.
strokes, heart attacks
• Not all women with PCOS are
overweight• Being overweight increases the
signs and symptoms of PCOS• Weight loss has been shown to
reduce the signs and symptoms
of PCOS and reduce the risk of
long-term consequences
Weight and PCOS
• Speak with your GP• They may organise appropriate tests if required
• May require input from other specialists• Gynaecologist• Fertility Specialist• Endocrinologist• Dermatologist• May refer to other allied health professionals• Dietician
If you think you may have PCOS
What causes PCOS?GENETICS LIFESTYLE
Hormonal Changes
↑ Insulin
OVARIESAnovulation
Irregular Periods
CARDIO- VASCULAR
RISK
↑ Androgens
Hair GrowthAcne
• No cure
but very effective treatment options for
managing the associated problems• Removing the ‘cysts’ does not cure the problem• LIFESTYLE CHANGE
first line treatment for all PCOS problems
Can PCOS be cured?
SMALL CHANGES
MAKE A BIG
DIFFERENCE
• Medication - pill, cyclical
progesterone• Mirena® - intrauterine
contraceptive device• Surgery
Menstrual problems
• Cosmetic treatment eg
laser, electrolysis• Medication eg. pill, anti-
androgenic
Hair growth
WILL I BE ABLE TO
HAVE CHILDREN?
• Anovulation
= ovary does not release an egg• In most instances ovulation can be restored with
simple, inexpensive techniques
• If overweight even small (5-10%) reduction in
bodyweight can reduce insulin resistance and
restore ovulation• Other health benefits• Benefits during pregnancy
- reduces miscarriage rate
- reduces diabetes during pregnancy
WEIGHT LOSS
• Laparoscopic banding, gastric sleeve operations• Can be useful for very overweight woman who
are unable to lose weight after prolonged efforts
at lifestyle change• General recommendation to defer conception
for 12 months or until weight-loss stabilised
WEIGHT LOSS SURGERY
• Trade names Serophene® and
Clomid®• Generally low risk and low cost• Twins 5-7%, Triplets 0.3%• Response rate 60-85%• Pregnancy rate 50% after 6
ovulatory cycles
Clomiphene Citrate
Clomiphene trackingAllows assessment of response, intercourse timing and triggering
Progesterone10 days
or blood test
Period
Day 1 Day 9 stop clomiphene
Day 11-13scan
Day 5 start clomiphene
Ovulation + intercourse+/- trigger
Day 21Progesterone
If no responseincrease dose
• Medication used to reduce blood glucose levels
in diabetes• Taken 3-4 times a day• May be useful for women who do not respond to
maximum doses of clomiphene • Sometimes beneficial on its own to induce
ovulation in women with lower BMI
Metformin
• Use synthetic FSH to stimulate ovulation (GonalF® or
Puregon®) • Usually used for women who do not respond to
Clomiphene • Rare not to respond • Additional trigger (ovulation) injection and luteal
(lining)support medication usually required
Gonadotropins
Puregon® Gonal F®
FSH Ovulation Induction ProtocolIncrease dose slowly - can be very sensitive
25-50iu/day
Increase dose by 50%
Increase dose by 50%
Startingdose
Scan d14
Scan d7
Scand21
hCG 5000uFollicle
=16mm
• Day surgery procedure via
keyhole surgery• Can restore ovulation in 60-
80% of women in the short
term (few months)• Lower risk of multiple
pregnancy
Laparoscopic Ovarian Drilling (LOD)
•Generally last option•Increased sensitivity to medication in patients with
PCOS •If other associated factors may be indicated, but
not always necessary i.e semen abnormality
IVF
If IVF is needed FertilitySA has
outstanding pregnancy rates!
• Jean Hailes Foundation Website
www.jeanhailes.org.au• FertilitySA website
www.fertilitysa.com.au• Polycystic Ovary Syndrome Association of Australia
(POSAA)
www.main.posaa.asn.au• Brochures
Resources
Any Questions?
Consulting Clinic345 Carrington Street
Adelaide SA 5000
Phone 8100 2900
w www.fertilitysa.com.au