PCOS
PCOS means polycystic ovarian syndrome, where many small cysts filled with fluid are seen in the ovaries. PCOS is an ovarian disorder having effects on all body systems.
PCOS is common and affects 10 to 20% of all reproductive-age females.
Common symptoms
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that can affect women of reproductive age. Key symptoms include:
Irregular Menstruation: Periods may be very infrequent, irregular, or completely absent.
Infertility: Difficulty in conceiving due to disrupted ovulation.
Excess Male Hormones (Androgen Excess): Leading to increased facial and body hair (hirsutism), acne, and male-pattern baldness.
Obesity and Metabolic Issues: Tendency to gain weight, disturbed lipid profile, and impaired glucose tolerance.
Increased Risk of Miscarriage: Hormonal imbalances can affect pregnancy outcomes.
In PCOS, the ovarian environment is often not conducive for egg maturation and ovulation. Multiple small follicles may be present, but they do not grow or release eggs. On ultrasound, these follicles often appear in a “necklace” pattern near the ovarian periphery, giving the term polycystic ovaries. When these ovarian changes are accompanied by effects on other body systems, it is referred to as Polycystic Ovarian Syndrome (PCOS).
Causes of PCOS
Hormonal Imbalance
Androgen Excess: High male hormone levels lead to hirsutism, acne, and hair thinning.
Insulin Resistance: Elevated insulin can increase androgen production, worsening PCOS symptoms.
Low-Grade Inflammation: Chronic inflammation may contribute to elevated androgen levels.
Genetic Factors
PCOS may run in families. A family history of PCOS or related metabolic disorders increases the risk.
Environmental Factors
Lifestyle influences: Poor diet, low physical activity, and exposure to environmental toxins can trigger or worsen PCOS symptoms.
Obesity
While obesity is not a direct cause, it exacerbates insulin resistance and hormonal imbalances, intensifying PCOS symptoms.
Diagnosis
For women of reproductive age, PCOS (Polycystic Ovary Syndrome) is diagnosed when at least two of the following three features are present:
Irregular Menstrual Periods – cycles that are infrequent, very long, or absent.
Signs of Male Hormone Excess – such as increased facial/body hair, acne, or hair thinning.
Polycystic Ovaries on Ultrasound – multiple small follicles seen in the ovaries during sonography
Treatment
Lifestyle Modifications
Achieving an ideal body weight is the first-line treatment.
The recommended BMI is <22.5.
Even a 5–10% reduction in body weight can significantly improve ovulation and fertility.
Fertility treatments
1. Oral Medications
Medications can stimulate ovulation in 70–80% of women with PCOS.
About 50–60% may conceive with oral medicines alone; the rest may require advanced treatments.
2. Injectable Hormones for Egg Growth
Hormones like FSH and LH, naturally secreted by the pituitary gland, can be given via injections to stimulate egg development.
These are particularly useful if oral medicines fail to induce ovulation.
Multiple eggs may develop, increasing the risk of OHSS (Ovarian Hyperstimulation Syndrome) and multiple pregnancies.
Must be used under the supervision of an experienced fertility specialist.
3. IUI (Intrauterine Insemination)
Washed semen from the partner is injected directly into the uterus during ovulation.
Average success per cycle: 12–16%.
Usually up to 4 cycles are recommended.
4. IVF-ICSI (In Vitro Fertilization – Intracytoplasmic Sperm Injection)
Eggs are fertilized outside the body in the lab, and resulting embryos are transferred into the uterus.
Advantages in PCOS:
Control over the number of embryos transferred, reducing the risk of multiple pregnancies.
Extra good-quality embryos can be frozen for future use, with frozen embryos having results equal to fresh ones.
Methods to prevent OHSS, including “freeze-all” strategies, create a safe environment for implantation.