Diagnosing and Treating PCOS | Shady Grove Fertility Center

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Medical Contribution By Dr. Stephen Greenhouse

One of the most common causes of female infertility is polycystic ovarian syndrome, or PCOS. While the name can sound daunting, the truth is PCOS is also one of the most easily treated infertility conditions.

“One of the biggest challenges that PCOS presents is accurate diagnosis,” says Dr. Stephen Greenhouse of Shady Grove Fertility Center’s Annandale and Fair Oaks offices. “Once we’ve made that diagnosis, however, the majority of women will respond successfully to well-monitored fertility treatment.”

Listen to Dr. Greenhouse with Conceive On-Air discuss PCOS

If it’s common, why is PCOS hard to detect?

The difficulty in diagnosing PCOS isn’t because the condition, which is literally a collection of symptoms, is new or even misunderstood. Rather, in spite of the National Institutes of Health coming up with a consensus on defining PCOS several years ago, some practitioners may overlook some subtle signs of this primarily hormonal condition and place too much emphasis on others.

It’s a matter of experience in putting together easily misinterpreted pieces of a puzzle.

“We look at biochemical evidence, from lab work, and physical signs of excess androgens,” says Dr. Greenhouse. “And of course, for women who are trying to get pregnant, our goal is to assess the quality of her ovulation.”

“From a fertility-focused perspective, we look at the length and regularity of a woman’s menstrual cycles,” Dr. Greenhouse explains, adding, “and sometimes the regularity can be more important than the frequency. For example, if a woman consistently has 38-day menstrual cycles, then timing intercourse or even IUI is far more possible than if her cycles vary widely in occurrence - even though menstrual cycles longer than 35 days are generally considered oligoovulatory (less frequent than average.)”

How is PCOS-related infertility treated?

Treating PCOS is mostly dependent on the patient’s ovulatory cycles. In addition to making changes to their eating, exercise, and related body mass, patients are typically started on clomiphene citrate, an inexpensive oral medicine. Patients who do not respond well initially may go on to combine clomiphene citrate with gonadoptropin drugs.

The goal is the induction of average ovulation, not super-ovulation as is sometimes done with IVF. In fact, Dr. Greenhouse explains that treatment cycles will generally be cancelled if a woman produces too many eggs, because moving forward with either intercourse or IUI might result in dangerously high-order multiples.

“In some of those cases,” he adds, “a patient may choose to use in vitro fertilization (IVF) to take advantage of the eggs her ovaries have produced and still maintain control over the potential for multiple pregnancy.”

There’s more to PCOS than infertility.

Besides being relatively easy to treat, there’s another upside to a PCOS diagnosis: many women who learn they have PCOS also begin modifying their lifestyle for better overall health. A number of large studies have directly linked PCOS with diabetes and heart disease. By learning about the condition’s relationship to more long-term, serious health consequences and by taking action to improve their fertility, many women wind up shedding old patterns like poor eating and sedentary lifestyles for positive, longevity-promoting health habits.

“PCOS is one infertility diagnosis in which the patient really can have more control on their fertility outcome as well as positively impact the rest of their health,” Dr. Greenhouse remarks.

Is it necessary for women with PCOS to see a specialist?

The majority of women with PCOS will become pregnant within the first three rounds of clomiphene citrate (Clomid). That’s one of the reasons that some women will be treated for PCOS-related infertility by their OB/Gyn rather than a fertility specialist.

“Most gynecologists are familiar enough with clomiphene citrate’s use to administer it,” Dr. Greenhouse says, “but issues can arise with patients who are resistant to ovulation induction. Adding gonadotropins can be trickier, because these patients can be very prone to over-ovulation.”

Fertility specialists generally offer more experienced monitoring, which results in both increased patient safety and chances for positive pregnancy outcome.

Additionally, women with PCOS may have other fertility obstacles to contend with, and some may be managed better by reproductive endocrinology experts. For example, a woman’s age alone can impact her optimal course of treatment.

“For women younger than mid-30’s and who have no additional factors, including a normal semen analysis for their partner, typical PCOS treatment can mimic nature with pregnancy rates of twenty percent per month. For a woman who is 40, that may be lowered to ten percent chance at conception each month. If they choose IVF, which is only available through specialists, the patient’s chances of pregnancy are greatly increased.”

Dr. Greenhouse recommends gynecologists not stop with a PCOS diagnosis.

“Their threshold for referring a patient to a specialist should also reflect the patient’s age, her male partner’s semen status, and history such as previous pregnancies or other remarkable gynecological conditions.”

“There are a lot of opportunities for conception for women with irregular cycles,” says Dr. Greenhouse. “It’s important to be both patient, to allow an adequate amount of time for lifestyle modifications to enhance fertility naturally, plus vigilant about the appropriate time to become more proactive with medical therapy. In the end, our goal for women with PCOS is healthy ovulation and safe pregnancy -- and it’s very achievable.”

To request an appointment to see Dr. Greenhouse, or any of our other physicians, please fill out this form or call 1-888-761-1967.