FertilityAnswers
Home | About FWHC | Clinicians | Staff | Locations | Appointments | Forms | Pre-Op Info | Financial Info | News & Events
The Miracle of Birth
Read this uplifting story of one couple's journey from the frustrations of infertility to the miracle of birth. 
 
Take a peek at our Newest Arrivals!
 
Special Pricing for Tubal Ligation Reversal Surgery
Tubal Ligation Reversal Surgery, now just $5,800. Click HERE for more information.
 
Discover why you should trust your infertility treatment to the doctors at Fertility & Women's Health Center. Read our Patient Success Stories HERE.
cover OBGynNews
Dr. William Pelletier on the cover of Ob.Gyn. News! Read his article here.

PCOS and Infertility

Infertility and PCOS

The inability of some women with polycystic ovary syndrome to produce and release an egg is due to a complex web of multiple hormone imbalances. The hormones involved include insulin, androgens, estrogens, progesterone, luteinizing hormone, follicle stimulating hormone, adrenal hormones, thyroid hormones, prolactin, and others. All of these hormones influence each other in some way. Therefore, if you can optimize any one of them, you are taking a step towards optimizing the others and increasing your chances of becoming fertile.  

In addition, some women have other factors that contribute to infertility (like a husband with a low sperm count or a uterus scarred by a previous infection), which have nothing to do with PCOS. If you have PCOS, it's difficult to estimate your chances of having a baby. Nevertheless, there's plenty you can do to improve your odds.  

Back to top

 

Lifestyle Modifications

Up to 70% of patients with PCOS are overweight. A loss of just 10% of the total body weight (that’s only 20 pounds for patients that weigh 200 pounds) can improve the chance of ovulation by 50%. This is sometimes MORE successful than with fertility medications. In addition, the weight loss improves the health of the pregnancy and decreases the chance of miscarriage.  

WEIGHT LOSS IS ESSENTIAL for optimal outcome.  

Exercise (even without weight loss) can lower the insulin levels and improve ovulation. But exercise must consist of at least 30 – 60 minutes of aerobic activity – that is, getting your heart rate up and staying up. Although walking is a favorite form of exercise of many overweigh patients, it is only effective if you are increasing the heart rate. A common rule is – if you’re moving slow enough to talk to your exercise partner, you’re not moving fast enough! Exercise should be done at least 4 times per week (and preferably EVERY DAY).  

Back to top

 

Conventional Infertility Treatment - Drugs to Induce Ovulation

Many women with PCOS don't ovulate and thus cannot become pregnant. So the first treatment option for infertility is usually the administration of drugs to induce ovulation.  

  • Clomiphene citrate (Brand names: "Clomid" or "Serophene"). Clomid is taken for 5 days early in your cycle to stimulate ovulation. Clomid may not be effective if taken for more than four to six menstrual cycles. There is some evidence to suggest it may increase your risk of ovarian cancer if taken for 12 or more cycles. Clomid also has a number of side effects including bowel problems, headache, dizziness, blurred vision, depression, and more. After taking Clomid for up to four to six cycles, it is reported that you have a 30% chance of becoming pregnant.  
  • Letrozole (Femara®) Letrozole can be taken for 5 days early in your cycle to stimulate ovulation. It works similar to clomiphene citrate, but may not cause the thinning of the lining that clomiphene sometimes does. In some studies, it has a higher chance of pregnancy than does clomiphene. It can also be used in conjunction with hMG or FSH. (see below)
  • Metformin (Brand name: Glucophage). Metformin is an insulin-sensitizing agent that is sometimes used in conjunction with Clomid. Metformin may increase your fertility to the extent that it reduces insulin resistance, and thus helps to normalize insulin. Too much insulin reduces your fertility.
  • hCG (human chorionic gonadotrophin). (Brand names: Profasi, Pregnyl). hCG may be used in conjunction with Clomid. hCG has the same effect on the follicle as LH (luteinizing hormone). It stimulates the dominant follicle to release its egg. hCG is given by injection, and has to be carefully timed. If given too soon, ovulation may be blocked. Too much hCG may cause ovarian hyperstimulation and cyst formation.
  • hMG (human menopausal gonadotrophin) (Brand names: Pergonal, Humegon, Repronex). hMG is a combination of LH (luteinizing hormone) and FSH (follicle stimulating hormone) that is derived from the urine of menopausal women. Both LH and FSH are required for follicle development. It is given by injection. There's a narrow range between giving too little vs. too much. Too much hMG may cause ovarian hyperstimulation and cyst formation. hMG is also expensive and may result in a multiple pregnancy.
  • FSH (follicle stimulating hormone). (Brand names: Metrodin, Fertinex, Follistim, Gonal-F). This injectable drug is intended for women who already have enough LH. Since many women with PCOS have excessive LH, FSH can be helpful in some cases.
  • GnRHa (GnRH analogs). (Brand names: Lupron, Synarel, Zoladex, Antagon). GnRH analogs are synthetic hormones that have a continuous effect, unlike the normal 90-minute pulsations of GnRH. This blocks production of both LH and FSH. These analogs are commonly used along with gonadotrophin injections in IVF (in vitro fertilization) clinics. Since LH may cause release of eggs from the follicles before they are ready, GnRH analogs are used to prevent that from happening. Reported side effects include headaches, insomnia, and mood swings.
  • Prolactin inhibition drugs. Bromocriptine ("Parlodel"), or cabergoline ("Dostinex") may be used to reduce prolactin levels if they are too high. Excessive levels of prolactin inhibit ovulation. Side effects vary, according to which drug you are using.  

Back to top

Back to Home Page