PCOS is a common medical problem faced by women. It is usually caused by an imbalance in reproductive hormones. This imbalance can lead to problems in the ovaries. In a normal state, the ovaries make the egg and release it every month as part of a healthy menstrual cycle, however, for those with PCOS, the egg may not completely develop as it should or, in some cases, it is not released during the ovulation process. Women suffering from PCOS have multiple cysts on their ovaries, hence the name polycystic ovary syndrome. These cysts are usually not harmful, but they can lead to an imbalance in hormones.
PCOS is characterized by the enlargement of the ovaries. These enlarged ovaries contain a collection of fluids in small amounts, called follicles. Women suffering from PCOS experience an irregular menstrual cycle or a missed period and, due to the irregularity in periods, it can lead to an inability to get pregnant, or infertility, and the development of cysts in the body.
The symptoms in PCOS are usually mild in the initial phase and gradually worsen if not diagnosed or treated in a timely manner. Also, a woman would not experience all of the symptoms at first; initially, there would be just a few symptoms. The common symptoms are:
- Hair thinning on the scalp. This is a common occurrence, but can also lead to other medical conditions, hence, proper diagnosis is required. This pattern of thinning is also related to male pattern baldness.
- Increase in weight
- Increase in acne on the face, chest, and upper back
- Delay in menstrual period or irregular periods, wherein there are less than nine periods in a given year. In some cases, the woman would have periods alternately once every three months and, in some cases, they would not have periods at all. Others would experience heavy menstrual bleeding.
- Due to the persisting symptoms and imbalance in hormones, the woman would undergo mental changes, which could lead to depression.
- Issues relating to fertility, wherein women diagnosed with PCOS have trouble getting pregnant or, if they are pregnant, it can lead to complications that need to be dealt with properly.
- Excess hair growth on the face and other parts of the body. Similar to men, women would get thicker, darker hair on the face, such as below the chin and on the sides of the cheek. There would also be thicker hair on the belly, back, and chest. This problem is also medically termed hirsutism, and it tends to affect at least 70% of women with PCOS.
- Skin turning dark or pale, mostly at the creases around the neck, underneath the breast, and the groin.
- Excess formation of skin flaps in the area around the armpits or neck
According to a study conducted by the National Institutes of Health, infertility treatment for PCOS with the hormone progestin decreases the chances of conception and giving birth. PCOS is a disorder in which the ovaries, and sometimes the adrenal glands, produce excess amounts of androgens. The syndrome is characterized by menstrual irregularities, and women with this condition often have difficulty conceiving.
In order to induce a period and regulate the menstrual cycle in women, those suffering from PCOS were given progestin. Progestin is a chemical that mimics the action of the hormone progesterone. Progestin, or synthetic progestin, was developed during the same time as birth control pills. The natural progesterone’s half-life was very short, and researchers were looking for an agent to introduce into the body that would increase the half-life and still imitate the same effects as actual progesterone. Note that progestin and progesterone are not the same; progestin is ten to one hundred times more potent and also has a longer life in the body compared to progesterone. Progestin was chosen along with the synthetic form of estrogen for use in birth control pills. The common progestin names are Provera, Amen, Curretab, Cycrin, and Aygestin.
In certain women with PCOS, the estrogen levels are not sufficient for progestin to take effect, so, in order for the synthetic progestin to be effective, the uterus should first be primed with estrogen. If the progestin alone cannot induce bleeding, a program may be tried using estrogen to cause the endometrial lining of the uterus to proliferate, after which it would allow the progestin to mature the lining. In some women, this estrogen procedure is not required because their bodies are already estrogen dominant.
In certain cases, progestin can be used to partially suppress the ovary and regulate bleeding before the use of fertility medicines.
The scientific study conducted in the National Institutes of Health research network found that infertility treatment of polycystic ovarian syndrome with progestin could decrease the chances of pregnancy. It does reduce the chances of conception and the possibility of giving birth. PCOS is a disorder that relates to the ovaries and the adrenal glands, which produce excess amounts of androgens. It is characterized by menstrual irregularities, and women with such difficulties often find it difficult to conceive.
Induction of ovulation is the most common method for treating infertility associated with this disorder. Before ovulation induction, a single course of progestin is often administered; this helps thicken the uterine lining. As progestin is not continued, the uterine lining is sloughed off in the beginning of a monthly menstrual cycle.
According to a new study, women who did not have progestin before receiving the fertility treatment had four times more chances of getting pregnant compared to those who had the progestin treatment. The results showed that 20% of women who did not have the progestin treatment gave birth, compared to 5% of women who did receive the progestin treatment.
Esther Eisenberg, MD, of the Reproductive Sciences Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), one of the study’s authors, commented that the results clearly show progestin treatment is counterproductive in helping women with PCOS to conceive. The study published in the journal Obstetrics and Gynecology, was conducted by Michael P. Diamond, MD, of Wayne State University in Detroit, Richard S. Legro, MD, of the Penn State College of Medicine in Hershey, and researchers at 16 institutions in the NICHD Cooperative Reproductive Medicine Network (RMN).
In this study, data was analyzed from a 2007 RMN study in which two fertility treatments for women with PCOS were compared — the standard drug therapy clomiphene, which stimulates ovulation, and the diabetes treatment drug metformin. PCOS often results in insulin resistance, a condition in which the body is unable to use insulin properly. Studies have shown that drugs like metformin, which makes the body more sensitive to insulin, can increase ovulation rates in women with PCOS. The 2007 study showed that women who took metformin had lower chances of getting pregnant compared to women who took clomiphene or a combination of clomiphene and metformin.
The present data analysis compared the effectiveness of ovulation induction with that of ovulation induction combined with advanced progestin treatment. The study results showed that about 5% of women with spontaneous ovulation were able to conceive. Many women who took the fertility treatment failed to ovulate the following month. Nearly 30% of women who received a dose of progestin treatment, followed by ovulation induction, ovulated. Out of this, 7% of women conceived.
Fertility Treatment and Progestin
The medical study shows that the women who did not have progestin before the fertility treatment had greater chances of getting pregnant than the women who had the progestin treatment. According to the survey, 20% of women who did not receive the progestin treatment successfully gave birth to a child, while only 5% of women delivered a baby after having the progestin treatment.
According to the experts from the Reproductive Sciences Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), progestin treatment is not suitable to help women with PCOS conceive. The results published in the journal Obstetrics and Gynecology were based on the survey conducted at Wayne State University in Detroit with the help of Penn State College of Medicine in Hershey, and many researchers from different institutions under NICHD Cooperative Reproductive Medicine Network (RMN).
Standard Medicinal Therapy
The studies show that the standard medicinal therapy clomiphene can stimulate ovulation, along with the diabetes treatment drug metformin. PCOS results in insulin resistance, a condition in which the body is unable to use insulin properly. The studies also show that medicines such as metformin make the body sensitive to insulin. It also increases ovulation rates in women with PCOS. According to the study conducted in 2007, women who took metformin had fewer chances of getting pregnant, while the women who took clomiphene or a combination of clomiphene and metformin had greater chances of getting pregnant.
The available data analysis shows that the effectiveness of ovulation induction along with the ovulation induction combines advanced progestin treatment. The results show that about 5% of women with spontaneous ovulation successfully conceived a child. The women who failed in the test took the fertility treatment again the following month. The results show about 30% of women who received a dose of the progestin treatment, and when combined with ovulation induction, about 7% of women conceived.
According to the research, polycystic ovary syndrome is one of the most common causes of infertility in women. As many as 10% of women experience this disorder. PCOS is a hormonal problem that causes a variety of symptoms, including irregular or no menstrual periods, acne, obesity, and excess hair growth. Symptoms may start to appear in your teenage years as menstrual irregularity, or you may not notice anything until you start trying to get pregnant, and can’t.
Most women with the condition have small cysts on their ovaries, which is where the name for the syndrome comes from. Women with PCOS suffer from an excess of androgen, the male hormone, and often have difficulty ovulating and conceiving. They’re also at a higher risk of obesity, high blood pressure, and diabetes. Fertility treatment for PCOS involves lifestyle changes as well as medication to stimulate ovulation, while recent research has shed new light on the use of progestin.
Fertility Treatment for PCOS
The first line of treatment for PCOS is often weight loss. It’s not clear if obesity causes PCOS or if PCOS causes obesity, but a weight loss of as little as five percent of your body weight may affect the symptoms.
Treatment for a lack of ovulation associated with PCOS often involves taking clomiphene to stimulate the ovaries to produce and release eggs. Many physicians will prescribe a course of progestin first before starting clomiphene. Progestin causes the lining of the uterus to thicken, the way it normally does before your period starts. When the progestin is stopped, your uterus sloughs off the lining, simulating a normal menstrual period. Then, clomiphene is taken to induce ovulation.
However, recent findings show that using progestin appears to decrease your chance of getting pregnant and giving birth. A study from a National Institutes of Health research network in 2012 examined data from a 2007 Reproductive Medicine Network study comparing women who received progestin to women who did not.
Below are certain drug treatments which can be carried out to treat infertility issues in women suffering from PCOS:
- Metformin: The doctor can prescribe metformin to reduce the high levels of insulin in the blood and also bring stability to the hormones. Once the individual is started on this medicine, the ovulation cycles would become more regular.
- Clomid: With or without taking metformin, the doctor can also prescribe a fertility drug called Clomid. It has been observed that a combination of Clomid and metformin helps women suffering from PCOS get pregnant more quickly than by just taking metformin alone. In certain cases, some women would need higher doses of Clomid to restore fertility. This high dose can sometimes lead to unpleasant side effects.
- Gonadotropins: These are naturally occurring hormones that help stimulate the ovaries so as to release one or more eggs. If a woman is not ovulating on a regular basis, this medicine will be really helpful in speeding up the ovulating process. Also, women with PCOS whose bodies do not respond to Clomid treatment can benefit from gonadotropins.
Precautions To Take
If you have PCOS and infertility issues, you may want to consult a reproductive endocrinologist who treats PCOS. It’s likely this specialist will be familiar with the latest research and will be able to bring their expertise to bear on your desire to have a family. Depending on your age, the fertility center team may advise you to have IVF treatment for the best chance of getting pregnant and controlling the risk of multiple order pregnancy.
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