Polycystic ovary syndrom

One of the main diagnostic criteria for polycystic ovary syndrome is the chronic absence of ovulation or a menstrual cycle disorder.

Infertility associated with polycystic ovary syndrome is treated using both medications and surgical procedures.

Polycystic ovary syndrome is manifested by a wide range of clinical symptoms and endocrine and metabolic abnormalities. PCOS is defined as higher levels of androgens (male sex hormones) in combination with the irregular menstrual cycle (longer cycles, missing menstrual bleeding).

The certainty of PCOS diagnosis can be supported by typical morphologic symptoms of ovaries – many small ovarian cysts found by ultrasonography. However, the normal appearance of ovaries does not exclude PCOS diagnosis. This syndrome occurs in about 5 - 10% of all women. It is important not to confuse PCOS syndrome with the condition of normal polycystic ovaries (PCO), which is a normal condition without hormonal swings diagnosed using ultrasound examinations in up to 30% of women of reproductive age. The finding of PCOS alone without other fulfilled criteria does not mean a clinical PCOS diagnosis.

The cause is still not known. The main factor includes lower sensitivity of body cells to insulin, leading to an increase in androgen production via complex chemical processes. Genetic and some other factors also contribute to PCOS.

PCOS Symptoms

(usually occur individually or in combinations):

• Irregular or missing menstruation
• Missing ovulation (releasing of the egg from the ovary)
• Obesity
• Hirsutism (excessive body hair growth)
• Insulin resistance
• Acne
• Numerous small cysts on ovaries
• Enlarged ovaries - up to three times bigger than ovaries of a healthy woman
• Infertility – inability to become pregnant after more than 12 months of unprotected sexual intercourse
• Chronic pelvic pain – more than 6 months
• Dyslipidemia - abnormalities of lipid levels in the blood
• High blood pressure – more than 140/90.

Diagnostic Criteria

• a chronic pattern of missed ovulation or menstrual cycle disorders (menstrual bleeding occurs late or not at all) followed by higher androgen levels after excluding other possibilities of increased androgen levels
• supportive criteria: ultrasound finding of polycystic ovaries, the ratio of Luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels ratio - LH at least two times greater than FSH.

The diagnosis is based on physical examination, presence of the symptoms mentioned above, ultrasound examination, and endocrine examination.

Infertility associated with polycystic ovary syndrome is treated using both medications and surgical procedures.

Infertility treatment associated with PCOS

• Weight reduction – Higher weight is associated with a more frequent occurrence of sterility and menstrual cycle disorders. Weight reduction also helps increase cell sensitivity to insulin.
• Hormonal treatment – Taking medications that decrease androgen levels or their effect on the tissue (antiandrogens or androgen antagonists). Cyproteronacetate is the most frequently used medication. It is used, for example, in the form of a contraceptive pill (DIANE 35, MINERVA, CHLOE) or as ANDROCUR preparation. Some other medications can be applied with a great antiandrogen effect - for example, spironolactone (VEROSPIRON), flutamide (ANDRAXAN) or finasteride (PROSCAR, PENESTER).
• Insulin sensitizers – Preparations that enhance tissue sensitivity to insulin – metformin/ METFORMIN, GLUKOPHAGE, SIOFORF.
• Ovulation induction – Can be combined with additional assisted reproduction methods.

Surgical treatment – Thin layer on the surface of the ovaries is very lightly laparoscopically drilled (ovarian drilling), which improves their ovulation functions and hormone production.