Polycystic ovary syndrome (PCOS) is a common cause of female infertility. In fact, one in eight women have PCOS but only 50 percent know it. About.com asked some of the top reproductive endocrinologists across the nation to answer the most common PCOS questions they receive from patients. Representing Shady Grove Fertility, Isaac Sasson, M.D., of SGF’s Chesterbrook, Bala Cynwyd, and Chadds Ford, PA offices, was selected to participate.
According to Dr. Sasson, these are among the most common PCOS questions he receives:
What’s in those follicles and should I be worried there are so many?
Answer: A follicle is a fluid-filled sac that contains one egg and the cells that prepare the embryo for early embryo development. In women with PCOS, the ovary does not produce all of the hormones in the necessary sequence for an egg to fully mature. The follicles may start to grow and then stop, or simply not grow at all. Because of the imbalance of sex hormones, and with the eggs inside the follicles not growing, the follicles (mistakenly called cysts) stay small through the entire cycle. “Without follicular growth, ovulation does not occur and the ovary does not produce the critical hormone progesterone, which is important in maturing the uterine lining. This can result in an irregular menstrual cycle or, in some cases, no cycle at all, which is an early indicator of PCOS,” says Sasson.
What is the real challenge with PCOS?
Answer: The real challenge with PCOS is getting the eggs to grow. We often use medications such as clomiphene citrate (Clomid or Serophene) for women with PCOS to help one or two follicles grow in size and induce ovulation. There should not be a concern about the number of follicles a woman produces from these medications. “From a fertility perspective, having too many follicles is a fantastic problem to have,” commented Sasson. “This ultimately means there will be more eggs to work with,” he adds.
What happens after the follicles grow?
Answer: Once the follicles have grown, Dr. Sasson recommends starting with timed intercourse or intrauterine insemination (IUI). The typical success rates for IUI are about 15 to 25 percent per cycle, with higher chances among younger women. While many patients have success with more basic, “lower-tech” methods, a patient may require several treatment cycles to achieve a pregnancy. If still unsuccessful, moving on to another treatment option such as injectable medication or in vitro fertilization (IVF) may be necessary to achieve a pregnancy.
About.com also asked other reproductive endocrinologists about blood clots passed with periods, worry and difficulty concentrating, metformin, carb cravings, and more.
PCOS is very common and many patients with PCOS go on to have children either with or without the help of treatment. If you have PCOS and are trying to conceive and have had 3 to 4 rounds of Clomid, we recommend seeing a specialist. To get more of your PCOS questions answered or to schedule an appointment with one of our 34 reproductive endocrinologists, please call our New Patient Center at 1-877-971-7755 or click to schedule an appointment.