Some of your patients with polycystic ovarian syndrome (PCOS) may have questions about their fertility. The link between PCOS and infertility is strong: According to Clinics, about 80 percent of infertility cases that involve anovulation are tied to PCOS. But there's good news for women with PCOS: Infertility caused by this condition is largely treatable, thanks in part to ultrasound technology that can help diagnose and direct treatment options.
PCOS and Infertility: What's the Link?
PCOS is a hormonal disorder that affects about one in 10 women of reproductive age. Researchers are uncertain about what causes the condition, but it seems to be related to overproduction of androgens such as testosterone. High insulin levels in the bloodstream and high insulin resistance are also common among those with PCOS. As a result, excess hair growth, acne and weight gain may occur.
PCOS can increase the likelihood of fertility problems. Women with PCOS tend to have an inappropriate production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This in turn leads to limited follicular development and a lack of egg development. As a result, these women experience irregular ovulation or anovulation that sometimes leads to infertility. The weight gain associated with PCOS can also have negative effects on fertility.
Assessing Options: Fertility Treatment for PCOS
Despite these obstacles, many women with PCOS are able to conceive and have healthy pregnancies with treatment. The first-line pharmacological approach to inducing ovulation involves clomiphene citrate, which has an estimated 70 percent success rate, according to the Clinics study. The study also found ovarian drilling, a laparoscopic procedure that uses laser or electrocautery to destroy androgen-producing tissue in the ovaries, to be effective in about 50 percent of cases. The use of gonadotropins can also be effective.
Lifestyle changes such as weight loss may help address infertility in women with PCOS as well. For patients who don't respond to or who aren't well suited to lifestyle changes, ovarian drilling or medication, in vitro fertilization (IVF) may be useful, notes the International Journal of Clinical and Experimental Medicine.
The Role of Ultrasound for PCOS Diagnosis and Infertility Treatment
When it comes to the condition itself, transvaginal ultrasound for PCOS remains one of the most critical technologies for its evaluation. Dynamic images from this exam, combined with blood tests, a physical exam and complete patient history, allow for precise evaluation and accurate diagnosis. Compared with transabdominal ultrasound, transvaginal ultrasound is more effective for detecting the appearance of polycystic ovaries in women with PCOS.
The Rotterdam criteria, devised in 2003, require the presence of two out of three markers for a PCOS diagnosis: polycystic ovaries, hyperandrogenism and ovulatory dysfunction. The morphology of polycystic ovaries is a critical part of the most up-to-date guidelines for diagnosing PCOS, published in Human Reproduction.
Ultrasound has an important use for PCOS-related infertility treatment, too. Ultrasound is superior to biochemical methods for follicular monitoring because of its ability to demonstrate the number and sizes of follicles. It's also the best approach to guide oocyte retrieval: Visualization provided by ultrasound-guided transfer techniques may help reduce peritoneal and vaginal bleeding.
It's natural for patients with PCOS to wonder about their fertility, but the fact is that there are a number of effective treatment options available. Reassurance and more detailed information about their treatment choices can help put your patients at ease.
