PCOS – Polycystic Ovarian Syndrome
How is PCOS diagnosed?
There are a few different classifications, NIH classification which is the least specific, Androgen Excess and PCOS Society classification which is the most stringent, and the most commonly used Rotterdam Criteria.
We use the Rotterdam Criteria where you need to meet 2 out of the 3 categories
- Oligoovulation/anovulation (not ovulating/having irregular periods –periods usually occur every 21 to 35 days so if you get a period every 45days that is considered irregular. Some patients have no periods at all)
- Polycystic ovaries on ultrasound (ovaries have a distinct appearance, young patients with lots of eggs can be tricky to diagnose)
- Clinical and/or biochemical signs of hyperandrogenism (male hormones)
Why is it important to make a correct diagnosis of PCOS?
Making the correct diagnosis of PCOS is essential as there are multiple syndromes with similar signs and symptoms which can mimic the disorder but require different treatments. So PCOS can only be made, after a comprehensive workup and the more serious endocrine disorders are ruled out.
PCOS is also associated with risks of developing future systemic illnesses like diabetes and heart disease so these should also be monitored by your physician.
What should I do if I think I have PCOS?
First thing is to make an appointment with your obstetrician/gynecologist. Family doctors are great for routine pap smears and such, but for a full evaluation see your gynecologist.
They will order bloodwork and an ultrasound to start. For patients not seeking to conceive, various treatments are available which may alleviate symptoms and regulate your periods.
What if I want to get pregnant and I have PCOS and irregular periods?
Once the diagnosis is established and fertility is desired most patients will undergo ovulation induction. Your ob/gyn can start you on an oral medications (Letrozole and/or Clomid and with certain indications metformin). These medications are meant to help you ovulate an egg so that you can try to conceive.
When should I see a reproductive endocrinologist and infertility specialist (REI) for my PCOS?
If you are trying to conceive and have tried 3-4 cycles of ovulation induction with your ob/gyn and still have not achieved pregnancy then you should consider seeing an REI. You may need further evaluation of your fertility. REI’s are also trained to perform more advanced reproductive techniques such as hormone injections and in vitro fertilization, or IVF.
Feel free to reach out to our clinic if you have more questions or want to set up an appointment to review your case.
FAQ
Reproductive endocrinology and Infertility is a sub-specialty of Obstetrics and Gynecology. In addition to managing medical and surgical treatment of disorders of the female reproductive tract, reproductive endocrinologist and infertility (REI) specialists undergo additional years of training to provide fertility treatments using assisted reproductive technology (ART) such as in vitro fertilization.
Reproductive endocrinologists receive board certification by the American Board of Obstetrics and Gynecology in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.
In general, patients should consider consulting with an REI specialist after one year of trying unsuccessfully to achieve pregnancy. The chance of conceiving every month is around 20%, therefore after a full year of trying approximately 15% of couples will still not have achieved a pregnancy.
However, if a woman is over the age of 35 it would be reasonable to see a fertility specialist earlier, typically after 6 months of trying.
Other candidates to seek earlier treatment are women who have irregular menses, endometriosis, fibroids, polycystic ovary syndrome (PCOS), women who have had 2 or more miscarriages, or problems with the fallopian tubes (prior ectopic pregnancy).
Approximately 1/3 of the time cause for infertility is a female factor, 1/3 of the time a male factor, and the remaining 1/3 a couples’ factor.
At CCRH, we emphasize the importance of establishing a correct diagnosis. Both partners undergo a comprehensive evaluation including a medical history and physical exam.
Furthremore, the woman’s ovarian reserve is assessed with a pelvic ultrasound and a hormonal profile. A hysterosalpingogram (HSG) will confirm fallopian tube patency and the uterine cavity is free of intracavitary lesions. A semen analysis is also obtained to evaluate for concentration, motility, and morphology of the sperm.
Additional work up is then individualized to direct the best possible treatment option for each couple.
In vitro fertilization (IVF) is the process that involves fertilization of an egg outside of a woman’s body.
The process starts with fertility drugs prescribed to help stimulate egg development. In your natural cycle, your body is only able to grow one dominant egg, but with stimulation medication we can recruit multiple eggs to continue to grow. After about 8-10 days of stimulation, the eggs are surgically retrieved and then fertilized with sperm in a specialized laboratory. Fertilized eggs are then cultured under a strictly controlled environment within specialized incubators in the IVF laboratory for 3-5 days while they develop as embryos. Finally, embryos (or an embryo) are transferred into the uterine cavity for implantation.
Before deciding if IVF is the right choice, it’s important to sit down with an REI specialist to discuss available treatment options. For some people, other methods such as fertility drugs, intrauterine insemination (IUI) may be the best first choice treatment. At CCRH, we believe each individual couple is unique and not everyone needs IVF.
While not painful, the fertility medications may some side effects including headaches, hot flashes, mood swings, and bloating. The injection sites may also bruise.
Unfortunately, no. Many people think once they start IVF it’s a matter of time that they will be pregnant and have a baby. But according to national statistics per the Society of Assisted Reproduction (SART), on average 40% of assisted reproduction cycles achieve live births in women under age 35. The chances of success then continue to decrease with advancing age.
At CCRH, we employ only evidence-based interventions to ensure patient safety and optimal outcome. While we cannot guarantee a baby, we guarantee that you will receive the best, most advanced, personalized care to help you maximize your chance of a baby.
The average IVF success rate (success measured in live birth rate) using one’s own eggs begins to drop around age 35 and then rapidly after age 40. This is due to the decline in egg quantity and egg quality as a woman ages.
Our clinic’s success rate consistently beats the national average year after year.
Individual insurance plans often do not have any coverage for infertility treatments. If you have a group plan, you can call members services to see if they have coverage for infertility (including consultation/workup and IVF).
After your consultation with our REI specialist, one of our dedicated account managers with sit with you to go over the cost of treatment.