Women with polycystic ovaries and fertility problems:
- Do not release an egg (ovulate) regularly
- Have ovaries that contain many small cystic structures, about 2-9 mm in diameter
How does normal ovulation work?
In a normal menstrual cycle with ovulation, a mature follicle – which is also a cystic structure – develops. The size of a mature follicle that is ready to ovulate is about 18 to 28mm in diameter. About 14 days after ovulation the woman would be expected to get a period if she is not pregnant. The key difference between polycystic and normal ovaries is that although the polycystic ovaries contain many small antral follicles (also referred to as resting follicles) with eggs in them, the follicles do not develop and mature properly – so there is no ovulation. This is why women with polycystic ovaries don’t ovulate regularly, hence one of the syptoms of PCOS is irregular periods.
Can women with PCOS conceive?
The good news is that the chance of getting pregnant with polycystic ovarian syndrome using fertility treatment is increasing by the year due to new treatments and drugs being discovered which can aid ovulation. The real question for women under the age of 35 with PCOS, is not so much ‘will treatment help me?’ but rather ‘which treatment will work best for me?’
- Clomid (clomiphene citrate or Serophene) is an oral medication that is commonly used for the treatment of infertility.
- Femara (generic name is letrozole) is also an oral drug which can be an effective fertility treatment for women with ovulation problems, or for those with unexplained infertility. This medication is in a class of drug called aromatase inhibitors. Femara has also been used to treat certain cases of breast cancer.
- Injectable Gonadotropins: these are the next option when oral medications, such as clomid and femara fail to result in pregnancy. However, because there’s a substantial risk for multiple births (of triplets and higher) injectables for PCOS are being used less often.
- Metaformin is a relatively new method of treating women with PCOS. Like Clomid and Femara it’s an oral medication which has, until now, been traditionally used to help control diabetes. Then, it was figured out that metformin could be very effective way of treating polycystic ovarian syndrome. If it does not work alone, it’s commonly combined with Clomid to induce ovulation.
- Lastly there’s In Vitro Fertilization (IVF) which many of us have heard of. The large majority of women with PCOS that didn’t get pregnant with other treatments will be able to get pregnant and have a baby with IVF.