Polycystic ovary syndrome (PCOS) is the most common known cause of infertility in women, affecting five to 10 percent of women of childbearing age. PCOS causes the ovaries to produce excessive levels of androgens (male hormones), and insufficient progesterone. The extra androgens cause symptoms such as excess hair growth (hirsutism) on the face and chest. High androgen levels also cause thinning hair reminiscent of male pattern baldness. PCOS symptoms are quite distressing for sufferers.
PCOS Infertility Causes Multiple Symptoms
In addition to abnormal hormone levels, PCOS also leads to insulin resistance, high blood sugar levels, and extra body weight that concentrates around the waist. Multiple ovarian cysts result in irregular, anovulatory, or absent menstrual cycles. These ovarian follicles expand, but rarely rupture, so ovulation seldom occurs. When ovulation and conception do occur, the low progesterone levels released by polycystic ovaries increase the risk of miscarriage.
Diagnosis Criteria for PCOS
While there is no single definitive test for PCOS, women with this disorder are diagnosed through several criteria. The doctor collects a medical history, asking about symptoms such as irregular periods and weight gain. A physical exam is performed, with special attention to abnormal hair growth patterns, acne, and darkened skin patches on the back of the neck or thighs, which may signal high blood sugar levels. In some cases, pelvic pain and sleep apnea also point to PCOS. Blood may be drawn to check hormone and blood glucose levels. Another diagnostic tool is a vaginal ultrasound, which is used to examine the ovaries for abnormal cysts.
Infertility Treatment is Often Needed for PCOS
Although some women with PCOS conceive without difficulty, many need infertility medications to induce ovulation. Two common medications prescribed for PCOS infertility are metformin (Glucophage) and clomiphene (Clomid). Both medications have risks and benefits, so concerns should be addressed with the prescribing physician.
Metformin (Glucophage) for PCOS Infertility
When starting PCOS infertility treatment, metformin is usually the first oral medication prescribed. Glucophage is a blood sugar medication, labeled for use in type 2 diabetics, that reduces the liver's release of glycogen (sugar) stores. Glucophage also stimulates the body's muscle cells to increase their uptake of glucose, thus reducing blood sugar levels. Reduction in blood sugar and insulin levels results in reduced androgen production.
While prescribing metformin for PCOS is an off-label use, meaning that it has not yet been studied by the FDA, 45 percent of PCOS sufferers ovulate while taking this medication. Side effects of metformin include nausea, diarrhea, loss of appetite, and bloating. Lactic acidosis is a rare but serious side effect, in which the kidneys are unable to remove the metformin from the blood, causing a potentially dangerous buildup of acid levels. While metformin may initially be prescribed alone, the doctor may prescribe clomid along with metformin to induce ovulation.
Clomiphene (Clomid) for PCOS Treatment
Clomiphene (Clomid) is another oral medication prescribed as infertility treatment for anovulatory women who wish to conceive. Clomid is in the drug class "ovulatory stimulants." Clomid is typically prescribed to be taken once a day for five days, beginning on day five of the menstrual cycle. Use is usually limited to six cycles.
One side effect of clomiphene is blurred vision, so patients must avoid driving until they know how the medication affects them. Risks of Clomid include an increased chance of conceiving multiple babies, which results in a higher risk pregnancy. Women taking Clomid should notify their doctor immediately if they suspect they are pregnant, as this medication is not compatible with pregnancy or breastfeeding.
Further Infertility Treatments
When metformin and clomiphene do not assist a couple in conceiving a baby, the next steps are often more expensive treatments, such as injectable fertility drugs, in vitro fertilization and intrauterine insemination. See Treating Infertility for further information on these more complex infertility treatments. Also, see What Causes Polycystic Ovary Syndrome? for further reading.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
References:
Mayo Clinic: Polycystic Ovary Syndrome. Accessed January 20, 2010.
WebMD: Metformin (Glucophage) for Polycystic Ovary Syndrome. Accessed January 20, 2010.
WomensHealth.gov: Polycystic Ovarian Syndrome. Accessed January 20, 2010.
National Institutes of Health: Clomiphene. Accessed January 20, 2010.
Kay Majors - Kay graduated college with a bachelor of science degree in nursing. She has experience in the areas of women's health, newborn care, and ...
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