How Does PCOS Affect Fertility?
From Dr. Paul Gindoff of Chelsea Fertility NYC
PCOS is polycystic ovarian syndrome or disease. It is a nebulous diagnosis mysteriously avoiding clear definition since Stein and Leventhal published their original findings as the classic case.
It is really a heterogeneous group of woman suffering from conception delay due to ovulation disorders. Typically having irregular cycles which is the sine qua non for not ovulating. This leads to simple inefficiency in reproduction. Not knowing when to time intercourse or have insemination leads to very low pregnancy rates either on your own or under medical care.
Lab tests can support the diagnosis such as high AMH, low FSH to LH ratio, and sonogram showing multiple studding of ovary with small primordial follicles. Some patients have metabolic syndrome with higher BMI and high triglycerides or abnormal hemoglobin A1C. Thyroid imbalance and prolactin disorders must be ruled out as well.
So what can be done?
Logically, getting ovulation accomplished in a reliable sustainable manner is the mainstay. This can be best accomplished with medications: oral in the form of clomiphene citrate, or letrozole; or injectable such as FSH gonoadotrophin. Fundamentally, once a patient is on fertility medications, she needs to be monitored with serial ultrasounds and estrogen blood levels for safety and timing of trigger with HCG. The trigger shot is critical for timing to be precise and the program to succeed. This is where your fertility doctor makes the difference in management. Experience does matter.
This approach helps almost half the patients the other half have significant egg quality issues and will need further diagnosis and treatment within the IVF level of care. Egg retrieval and culture of embryos will allow clear understanding of the extent of the egg quality issues and lead to several successful strategies in embryo selection. Further enhancement of hormone supplementation for endometrial lining before returning the embryos to the uterus will also augment the pregnancy rates.
If you have PCOS and are interested in trying for a pregnancy, or if you have experienced recurring miscarriages, please contact the fertility specialists at Chelsea Fertility of New York City.