PCOS, also known as polycystic ovarian disease (PCOD), is a common cause of infertility in women. PCOS is characterized by a cluster of symptoms that are seen in most women who have the syndrome. However, one or more of the classic signs may be absent.

PCOS patients typically have elevated androgen levels. Androgens are male hormones, (testosterone and others) which are responsible for many of the symptoms of PCOS. These symptoms can include increased body hair (hirsutism), lowering of the voice, a classic apple shaped body appearance, obesity, irregular (or absent) ovulation, ovaries that are covered with many cysts, which are undeveloped ovarian follicles, and diabetes.

PCOS patients are usually hyperinsulinemic, meaning they have chronically elevated insulin levels. The cells within the pancreas overproduce insulin to compensate for the resistance of the cells (such as muscle and fat) to take up insulin. Chronically elevated insulin levels cause the ovaries to overproduce androgens, which leads to anovulation (lack of ovulation). Many untreated PCOS patients will eventually develop diabetes and cardiovascular disease.

“First line” treatments for PCOS are often medications such as Clomid or metformin. Second line treatment includes injectable gonadotropin therapy (FSH). Other “last resort” rarely used treatments might include laparoscopic surgery to “drill holes” in the ovaries, which sometimes induces ovulation.

Glucophage (metformin) is an insulin sensitizing agent that has recently been used with success in women with PCOS. PCOS patients are insulin resistant and metformin sensitizes their cells to insulin. This effectively lowers the levels of insulin thus slowing androgen production and establishing normal ovulation. Many specialists are prescribing long term metformin therapy to help prevent the long term consequences of hyperinsulinemia including diabetes and cardiovascular disease.

PCOS is also treated with Clomid or FSH.  PCOS patients trying to conceive should always be evaluated and treated by a reproductive endocrinologist, infertility specialist.  The condition is difficult to manage, and PCOS patients can have exaggerated responses to FSH treatment if not managed carefully.  These exaggerated responses (ovarian hyperstimulation) may require hospitalization.

If you have been diagnosed with PCOS, the fertility and PCOS experts at UAB have extensive experience working with this disease. They provide highly individualized treatment using the most appropriate technologies.

PCOS, also known as polycystic ovarian disease (PCOD), is a common cause of infertility in women. PCOS is characterized by a cluster of symptoms that are seen in most women who have the syndrome. However, one or more of the classic signs may be absent.

Unexplained infertility means a “cause” for a couple’s infertility cannot be identified, which is perhaps the most frustrating conclusion. Unexplained infertility does not mean there is no cause, rather, science has not developed to the point where the cause (s) can be identified.

Many authorities believe that failed fertilization and genetic abnormalities of the egg or sperm are causes of unexplained infertility. The embryo might also fail to divide and develop properly or implant in the endometrium. One advantage of in vitro fertilization in these patients is that it allows the physician and embryologist to observe fertilization and formation of the embryo. Many reproductive hormone interactions and processes have been identified and undoubtedly new ones will be discovered.

First level treatment of unexplained infertility may involve stimulated IUI. If this is not successful, many patients become candidates for IVF.