Infertility diagnosis / PCOS, An Overview

PCOS, An Overview

We are highly committed to helping patients with polycystic ovarian syndrome (PCOS). We strive to increase awareness by providing educational and emotional support to patients who suffer from PCOS.

Before an initial visit to discuss PCOS, patients should bring a list of questions and concerns and all previous medical records including nutritional therapy.

Polycystic Ovary Syndrome (PCOS) is a leading cause of infertility and it affects an estimated 10 percent of women of childbearing age. In infertile women, the prevalence of PCOS is much higher.

There is no one specific set of lab values that we can use to definitively give the diagnosis of PCOS. This has posed a dilemma for many physicians.

pcos-overview

In a 2003 consensus for PCOS, the following conclusions were reached.

At least two of the three symptoms below are required for the diagnosis of PCOS: 1. Oligomenorrhea (menstrual interval greater than 35 days or 8 or less menstrual cycles per year); 2. Clinical or laboratory exam consistent with androgen excess (excess body hair, acne, scalp hair loss, or elevated blood levels of testosterone, DHEAS, low sex hormone binding globulin); 3. Ultrasound evidence of polycystic ovaries (12 or more follicles at 2-8 mm or increased ovarian volume)

Polycystic ovarian syndrome is a term used for a “syndrome” that has many different manifestations in different women. PCOS symptoms vary in presentation and severity but the common clinical features usually include irregular and unpredictable menstrual bleeding, elevated insulin levels (hyperinsulinemia) and excess androgen (male hormones) production.

PCOS produces many symptoms affecting different body systems that include:

Amenorrhea (no menstrual cycles), Oligomenorrhea (irregular menstrual cycles)
Hirsutism and/or acne is seen in up to 70%of cases
Hyperandrogenism- elevated androgens (male hormones)
Infertility seen in 55-75%
Polycystic ovaries -enlarged ovaries with multiple small follicles
Chronic pelvic pain
Obesity or weight gain. 70% of PCOS patients are obese and 30% are thin
Insulin resistance is estimated to be present in 80% of patients and obesity increases the incidence of insulin resistance.
Dyslipidemia, which includes elevation of cholesterol/triglycerides seen in 70% of women
Hypertension
Acanthosis nigricans

Health risks associated with PCOS

Elevated cholesterol/triglycerides
Increased risks of type 2 diabetes which is estimated to be at 65% by the age of 50
Increased risk of uterine cancer by 3 fold
Increased risk of miscarriages
A fourfold increased risk of diabetes associated with pregnancy
Increased risk of hypertension associated with pregnancy
Increased risk of heart attacks and strokes up to 10 fold
Increased risk of cancellation of IVF cycles, poor egg quality, lower fertilization, poor embryo quality, and higher risk of exaggerated ovarian response (known as ovarian hyperstimulation syndrome)

Investigation of PCOS

A laboratory exam may include:

* Estradiol
* FSH
* A two hour glucose tolerance test

* Testosterone total and free
* Sex hormone binding globulin
* DHEAS

* Follicular phase 17-hydroxyprogesterone
* LH
* Lipid profile

* Prolactin
* Thyroid function test
* A complete physical exam will be conducted.

The exact etiology of PCOS is unknown. A genetic component can be identified in many patients.

Many of the symptoms of PCOS are due to increased production of ovarian testosterone and chronically elevated levels of insulin(hyperinsulinemia). In PCOS patients, the body’s cells do not respond normally to a “given amount” of glucose and they “over produce” insulin to compensate. This excess insulin drives the ovaries to increase androgen (testosterone) production and decrease serum sex hormone-binding globulin. The elevated testosterone impedes the growth of ovarian follicles and leads to lack of ovulation. Lack of ovulation will cause amenorrhea and increases the risk of endometrial hyperplasia. Metformin has been shown effective in lowering insulin levels.

An OB/GYN physician can diagnose PCOS; however, women with PCOS who are attempting to become pregnant, should seek care from a reproductive endocrinologist/fertility specialist. PCOS can be very difficult to manage especially if fertility drugs are used.

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