PCO is an established anovulatory condition where follicles do not develop beyond 6-8 mm and gather at periphery. 60-70% anovulatory women have mainly PCO.
Reduced Fertility Rate in PCO is due to an ovulation and hormonal imbalance. When classic ovulation induction fails IVF is the choice. In PCO more oocytes retrieved but fewer fertilize, because of greater number of immature ones. IVF success is comparable with normal ovulatory women. IVF is the first line of treatment in PCO in old age, long duration of infertility and when there is high insulin: glucose ratio.
This endocrine disorder of female reproductive system is being increasingly recognized in infertile women of reproductive age. It is believed that its incidence has increased as a result of high protein diet, especially androgen related feeds for poultry products. It is inherent too.
Clinical features are anovulatory menstrual disturbance, hirsutism, weight increase and abnormal fat distribution. In some there is associated disturbed carbohydrate and lipids metabolism. Diagnosis is based on TVS observations and hormones assays. TVS shows a peripheral ring of less than 8 mm follicles and increased stroma. FSH and LH are high with FSH: LH ratio 1:3.
Management is medical & surgical. Although well recognized and diagnosed, it is not properly managed by the clinicians. Menstrual disturbances do not need treatment unless bleeding is heavy or extends over prolonged period. Ovarian function is responsible for menstruation, so that needs care. Ovulation is prime requirement for fertility. The treatments should be aimed to restore and maintain ovulation and not to regulate menstruation. Metformin is given in such cases if insulin and triglycerides are found disturbed.
Ovulation Induction is often associated with OHSS which is acceptable and managed.71 % couples succeed to conceive in 2 years. IVF is the first line of treatment in PCO in old age, long standing infertility and high insulin: glucose ratio.
Management schedule for PCO. At Puberty and Premarital Cases;
- Only diagnosis and no treatment if clinical manifestations not very disturbing.
- If prolonged menstruation short hormone therapy is given to control bleeding.
- If associated disturbed carbohydrate and lipids metabolism, Metformin tablets 500 mg three times daily.
It is common practice to give Clomiphene to all. This is an ovulatory drug and should be used only for that purpose in selected cases for fertility restoration. It does not help to cure PCO.
In married women the aim is to achieve conception. Ovulation is induced with Clomiphene citrate tablets or with gonadotrophins after down regulation. It is supplemented with ART.