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Infertility Podcast Series: Journey to the Crib: Chapter 9 Polycystic Ovarian Disease

By David Kreiner, MD

April 17th, 2013 at 10:42 pm

Welcome to the Journey to the Crib Podcast. We will have a blog discussion each week with each chapter. This podcast covers Chapter Nine: Polycystic Ovarian Disease. You, the listener, are invited to ask questions and make comments. You can access the podcast here:

Polycystic Ovarian Disease

Polycystic Ovarian Disease (PCOS) is a syndrome, not truly a disease, in which a woman’s hormones are out of balance associated with a failure to ovulate regularly, irregular cycles and sometimes elevated male sex hormones resulting in hair growth on the face, chest or abdomen as well as acne. It can also be part of a “metabolic syndrome” which may include diabetes, hyperlipidemia and hypertension.

PCOS occurs in over 7% of women and usually develops during the teen years. It may be caused by a variety of factors, is often hereditary, the most common being glucose intolerance resulting in abnormally high insulin levels. Insulin stimulates male sex hormone production in the ovaries which blocks the development and maturation of ovarian follicles preventing ovulation which leads to irregular menses and infertility. The ovaries develop numerous small follicles that look like cysts hence the name Polycystic Ovaries.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries. A glucose tolerance test is useful to determine the presence of glucose intolerance and diabetes. Typically patients have an elevated LH/FSH ratio.

Treatment starts with regular exercise and a diet including a controlled carbohydrate intake to reduce insulin production. A diabetes medicine, metformin, can help reduce insulin levels as well. Fertility medications are often needed to get a woman to ovulate and will successfully get 50% of women with PCOS to conceive. The use of gonadotropin hormones without follicular aspiration and egg removal as is performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies. However, IVF has been quite successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy as she can limit the number of embryos transferred with a single embryo transfer (SET).

Though PCOS can be annoying, aggravating and even depressing it is fortunately a very treatable condition that, with the help of a reproductive endocrinologist, patients can have their families and prevent the health problems often seen with the “metabolic syndrome”.

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Was this helpful in answering your questions about PCOS and its effects on a woman’s fertility?

Please share your thoughts about this podcast here. And ask any questions. Better yet, come to our PCOS seminar next week. See the blog or Facebook for more details.

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