PCOS is an established anovulatory condition where follicles do not develop beyond 6-8 mm and gather at periphery. 60-70% of anovulatory women have mainly PCO. This endocrine disorder of female reproductive system is being increasingly recognized in infertile women of reproductive age. It is inherent too. Clinical features are anovulatory menstrual disturbance, hirsutism, elevated androgen levels, 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, with a high FSH: LH ratio 1:3.
Weight reduction for obese patients with PCOS is beneficial in many ways. Weight loss helps to decrease androgen, luteinizing hormone (LH), and insulin levels. It also helps to regulate ovulation, thereby improving the potential for pregnancy. Management is medical & surgical. 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.
Management schedule for PCO at Puberty and Premarital Cases
- Only diagnosis and no treatment if clinical manifestations are not very disturbing.
- If prolonged menstruation short hormone therapy is given to control bleeding.
- If associated disturbed carbohydrate and lipids metabolism, Medication is given.
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 IVF/ICSI.
IVF is the first line treatment in PCO, long duration of infertility and when there is high insulin:
glucose ratio. IVF success is comparable with normal ovulatory women