Patient Info
Polycystic Ovary Syndrome
What is PCOS?
Polycystic ovary syndrome (PCOS) often results in:
- Many follicles (tiny cysts) developing your ovaries (poly-cystic means 'many cysts'.)
- An imbalance of hormone secretion from your ovaries. In particular, your ovaries make more testosterone (male hormone) than normal.
- A high chance that you may not ovulate each month. If you do not ovulate then you do not have a period.
It is possible to have polycystic ovaries without the typical symptoms; on the other side of the coin, it is also possible to have PCOS without multiple cysts in the ovary.
How common is PCOS?
PCOS is common especially in the Caribbean, with up to 1 in 4 young women having polycystic ovaries. However, many women with polycystic ovaries are healthy, ovulate normally, and do not have high levels of male hormones.
The incidence of PCOS is estimated at 1 in 10 women worldwide, although the incidence seems to be higher in the Caribbean.
What causes PCOS?
Your genes may make you more prone to develop PCOS. However, the exact cause is not totally clear, although hormonal imbalance is thought to be the primary cause.
Hormones: Insulin & Luteinising hormone (LH)
Insulin is a hormone that controls your blood sugar level. Insulin acts on the ovaries to cause them to produce testosterone (male hormone). Women with PCOS have 'insulin resistance'. Their cells are resistant to the effect of a normal level of insulin, so more insulin is produced to keep levels of blood sugar normal. High insulin levels may result in PCOS. As a result, the ovaries secrete too much testosterone which interferes with normal development of follicles. Many follicles develop but often do not develop fully. This causes ovulatory problems: hence period problems and reduced fertility. An increase in testosterone causes excess hair growth on the body, thinning of the scalp hair and weight gain. Being overweight can make insulin resistance worse. Losing weight, although difficult, can help break this cycle.
LH stimulates the ovaries to ovulate and works together with insulin to promote testosterone production. High LH and insulin levels means that the ovaries are likely to produce too much testosterone.
What are the symptoms of PCOS?
- Period problems occur in about 7 in 10 women with PCOS, including irregular or light periods, or no periods at all.
- Fertility problems - you need to ovulate (release an egg) to become pregnant. You may not ovulate each month, and some women with PCOS do not ovulate at all. PCOS is a common cause of infertility.
We advise two types of test to clarify a diagnosis of PCOS. These are:
- Blood tests to measure testosterone and LH (which tend to be high in women with PCOS)
- An ultrasound scan of the ovaries. The scan detects the appearance of PCOS with the many follicles (small cysts) in slightly enlarged ovaries.
Fertility issues
The likelihood of becoming pregnant depends on how often you ovulate. Some women with PCOS ovulate now and then, whilst others never ovulate. If you do not ovulate but want to become pregnant, then we recommend a fertility treatment.
Metformin is a drug that is commonly used to treat people with type 2 diabetes. It makes the body's cells more sensitive to insulin. For certain people with PCOS, we may advise that you take metformin or another insulin sensitising drug.
You are much less likely to become pregnant if you are overweight. Losing weight is advised before any fertility treatment.
Endometriosis
What is endometriosis?
Endometriosis is a condition where endometrial tissue (lining the womb) is found outside the uterus, often in the pelvic area and lower abdomen.
What causes endometriosis?
About 1 in 10 women experience endometriosis, which may begin by some endometrial cells migrating along the Fallopian tubes when you have a period. Common areas where endometriosis may occur include the uterus, ovary, bladder, bowel or Fallopian tubes. Each cycle, the endometrial cells multiply and then break down at the time of your period. However, because they are trapped, the cells cannot escape and form patches of tissue called endometriosis. Areas of endometriosis may attach to organs (known as adhesions) or may form into cysts (known as 'chocolate cysts').
What are the symptoms of endometriosis?
Endometriotic areas can vary in size. Symptoms include painful periods or pain in the lower abdomen and pelvic area. The pain is usually worse before and during a period.
Endometriosis may cause difficulty becoming pregnant due to clumps of endometriotic areas blocking either the passage of the egg into the Fallopian tube or the site of embryo implantation into the womb. Endometriosis may be diagnosed by a laparoscopy and overcome via IVF treatment.
Detailed write up here
Glossary of Terms
Assisted Hatching
Creating an artificially hole in the shell (zona pellucida) around the embryo (using a laser)
Blastocyst
A highly developed embryo on Day 5 of development.
Counselling
An opportunity to discuss the implications of treatment, to give emotional support and to help the patient cope.
Donor Insemination
The preparation and injection of screened donor sperm into the uterus (womb) to fertilise eggs that are naturally released.
Egg Donor
A woman who provides her eggs to help another woman become pregnant. All egg donors are anonymous and screened for HIV, Hepatitis B & C.
Egg Collection
The procedure by which eggs are collected from the woman's ovaries using ultrasound.
Embryo
A fertilised egg that divides into many cells.
Embryo Freezing
Surplus embryos that are not transferred can be frozen and stored for future use.
Embryo Transfer
The transfer of one or more embryos to the uterus via an ultrasound guided catheter.
Embryologist
A clinical scientist who looks after sperm, eggs and embryos in a laboratory.
Endometriosis
A condition where endometrial cells grow outside of the uterus or ovaries, causing internal bleeding, pain and reduced fertility.
Epididymis
Coiled tubing outside the testicles which store sperm.
Fallopian Tubes
The tubes which transport the egg from an ovary to the womb.
Fertility Drugs
Fertility drugs are used to stimulate a woman's ovaries to produce more eggs than usual in a monthly cycle
Frozen Embryo Transfer (FET)
Frozen embryos that successfully thawed can be replaced in the womb in a natural cycle.
FSH
Follicle Stimulating Hormone is a hormone that stimulates follicles to grow.
HCG
Human Chorionic Gonadotrophin is a hormone that is artificially given by injection about 34-36 hours before egg collection. HCG helps to ripen the eggs within the follicles. HCG is also the pregnancy hormone that is naturally produced 14 days after successful fertility treatment.
In Vitro Fertilisation (IVF)
Eggs and sperm are collected and put together to achieve fertilisation outside the body in a petri dish. An embry that results can be transferred into the womb to cause a pregnancy.
Intra Cytoplasmic Sperm Injection (ICSI)
A variation of IVF treatment whereby a single sperm is injected into the egg. This technique is commonly used for couples where there is a sperm defect, and sperm cannot naturally fertilise an egg.
Intrauterine Insemination (IUI)
Placing of prepared sperm into the womb to fertilise naturally released eggs.
Ovarian Hyperstimulation Syndrome (OHSS)
A rare but serious consequence of over-response to fertility drugs.
Ovaries
The female reproductive organs which produce eggs.
Percutaneous Epididymal Sperm Aspiration (PESA)
The surgical collection of sperm from the epididymis.
Sperm Donor
A man who provides his sperm help to help another woman become pregnant. All sperm donors are anonymous and screened for HIV, Hepatitis B & C.
Ultrasound
Investigation using ultrasonic waves to image the womb and ovaries to monitor egg development. Ultrasound is used at egg collection and embryo transfer.
Vitrification
A new method for storing eggs and embryos in liquid nitrogen for future treatment.
Risks you should be aware of
Fertility treatment may carry risks that can vary depending on the patient's diagnosis as well as the response to specific medications. Two of the most common risks are ovarian hyperstimulation syndrome and multiple births.
Ovarian hyperstimulation syndrome (OHSS)
This side effect occurs in about 1-5% of cycles where superovulatory fertility drugs are used, most notably for IVF treatment. The ovaries become enlarged due to overstimulation by fertility medications. The blood vessels supplying the ovaries become 'leaky' and this results in fluid collecting in the abdomen. In severe cases (~1%) hospitalization is required for close monitoring. The problem lasts for 1-2 weeks but can be longer if pregnancy results.
Your safety is our priority throughout treatment. If we think you might be suffering from OHSS we will either cancel your treatment cycle or vitrify your embryos for future use.
Multiple births
Since fertility medications cause more follicles to be stimulated, there is a higher rate of multiple births. The multiple birth rate with clomiphene citrate is 5-10% and with gonadotropins it is 15-20% per pregnancy. In order to put these statistics in perspective, the chance for a couple to have a multiple birth spontaneously is about 1-2%.
The risks of multiple pregnancy and birth are not just confined to the serious risks to the health and long-term wellbeing of the child. Mothers themselves can be exposed to health problems as well as the increased risk of losing their babies.
During IVF treatment we will transfer one or two embryos only to your womb. We aim to maximise your chance of pregnancy whilst mimimising the risk of a multiple birth.
Link: http://www.oneatatime.org.uk/
