PCOS affects an estimated 5-10 percent of women of childbearing age and it is a leading cause of infertility.
PCOS is generally considered a syndrome rather than a disease (though it is sometimes called Polycystic Ovary Disease) because it manifests itself through a group of signs and symptoms that can occur in any combination, rather than having one known cause or presentation.
The exact cause of PCOS is unknown. There are studies being conducted to see if there may be a genetic link — that PCOS is passed along in families. Just as one might have a genetic predisposition to diabetes, one might also have a disposition to PCOS. The above analogy to diabetes seems appropriate as many current studies into PCOS are focusing on the body’s ability to process insulin. A growing collection of data suggests that elevated insulin levels are unhealthy and contribute to increased androgen production, worsening PCOS symptoms from cosmetic issues to infertility, and eventually increasing the risk of certain cancers, diabetes and heart disease. It is also possible that PCOS may be caused or worsened by valproate, a medication used to treat seizures.
PCOS should be diagnosed based on physical exam, ultrasound of the ovaries, and the results of various blood tests.
About 15-20 percent of normal women can have the appearance of polycystic ovaries. Diagnosis of PCOS is based on signs and symptoms as already mentioned along with corroborative laboratory results. It may be best to consider the finding of polycystic ovaries as a possible sign of PCOS, but not to rely on this as the sole criterion in making a diagnosis.
Even though PCOS is one of the leading causes of female infertility, infertility related to PCOS is treatable in the majority of cases. Women with PCOS can and do still get pregnant—sometimes naturally, sometimes with help. Lifestyle changes, such as losing weight, can trigger body changes that improve pregnancy rates. For many women with PCOS who want to get pregnant, health care providers will recommend weight loss and other lifestyle changes before adding medications to see if fertility returns and pregnancy occurs naturally.
Sometimes PCOS is not the cause of the infertility. Instead, it results from other factors, such as fallopian tube blockage or a low concentration of sperm in male partners. Women with PCOS and their partners may be screened for non-PCOS infertility factors before starting treatment.
There does appear to be a higher miscarriage rate in women with PCOS, but the exact reason is still under investigation. One possibility is that PCOS may be associated with poor follicle development and decreased egg quality.
The primary way to reduce miscarriage associated with PCOS is to normalize hormone levels. For women with low progesterone levels in the luteal phase, improving ovulation through the use of clomiphene citrate, or injectable FSH or FSH/LH may help the problem. Addressing ovulation issues is more useful than progesterone supplementation as low progesterone is usually a symptom of a problem, such a weak ovulation, rather than the actual cause of miscarriage. Normalizing blood sugar and glucose levels may help, and lead to lower androgen levels, so use of metformin during pregnancy is increasing.
Metformin was originally prescribed to diabetes patients, but is widely used to treat PCOS. PCOS patients commonly have insulin resistance. Lowering of insulin resistance by metformin provides symptomatic benefits in PCOS . There is some evidence that women who continue metformin throughout pregnancy have lower rates of miscarriage.
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