Polycystic Ovarian Syndrome and Fertility

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder and one of the common causes of infertility among women.  

It is characterized by an ovulation dysfunction or impedance to the normal growth and release of eggs from the ovaries.  It is commonly seen in women of childbearing age and is rare after menopause.

The hormonal imbalance results in enlarged ovaries containing several small cysts (fluid-filled sacs).

Causes of Polycystic Ovarian Syndrome (PCOS)

The exact cause of polycystic ovarian syndrome is unknown. However, several factors including genetics have been implicated to play a role in the development of PCOS.

Women with a family history of polycystic ovarian syndrome are at a higher risk of developing this condition.

Researchers have also found an association between excessive insulin production and development of PCOS. Insulin hormone regulates blood sugar levels and any disorder affecting the insulin mechanism may result in excessive insulin secretion, which triggers androgen secretion from the ovaries.

Low grade inflammation, in response to ingestion of certain foods, may lead to the release of substances that can cause insulin resistance and cholesterol accumulation in the blood vessels or atherosclerosis.

Clinical studies have demonstrated the presence of low-grade inflammation in women with PCOS. Excessive exposure to the male hormone during the fetal period may disrupt the function of normal genes and increase the risk of insulin resistance and low-grade inflammation.

Symptoms of Polycystic ovarian syndrome (PCOS)

The symptoms of polycystic ovarian syndrome vary from person to person and depend upon the nature and severity of the condition.

Some of the symptoms of PCOS include

  • infertility,

  • absent or irregular menstrual cycle

  • obesity or accumulation of fat usually around the waist.

  • abnormal facial and body hair,

  • adult acne

  • male pattern baldness or hair thinning may develop due to excessive androgen secretion.

In some patients black or dark brown patches are seen around the skin of the neck, arm, breasts or thighs. 

Diagnosis of Polycystic ovarian syndrome (PCOS)

The diagnosis of polycystic ovarian syndrome is based on the medical history along with a physical and pelvic examination to evaluate the condition of the patient and help identify the underlying cause.

Test conducted could include:

  • Blood tests are conducted to determine the level of various hormones.

  • Glucose tolerance test

  • Evaluation of blood cholesterol

  • Pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining.

Treatments for Polycystic ovarian syndrome (PCOS)

The treatment of polycystic ovarian syndrome is based on the symptoms and individual concerns such as infertility, irregular menstrual cycle, acne or obesity.

Both medications and surgical treatment can be used for the management of PCOS. Infertility may be treated by fertility therapy with ovulation-inducing drugs.

Drug Therapy

Clomiphene citrate may be prescribed to patients 25mg-100mg dose can be given day2 to day 6 of the cycle, it can also be given day 5 to day 9 of the cycle. In some patients, Dr Cook may add metformin to clomiphene to enhance the function of the drug and help induce ovulation. Another oral drug is Letrozol, the usual dose 2.5-5 mg and given day 3 to day 9 of the cycle. Dr Cook will be doing ultrasound to check the growth of follicles and determine the time of ovulation.

In patients not responding to clomiphene and metformin, gonadotropins, namely, follicle-stimulating hormone (FSH) can be administered by injection.

Lifestyle Modifications

Lifestyle and anti-diabetic medications may be prescribed for the management or prevention of obesity and diabetes mellitus.


Surgery may be recommended in patients who do not respond to medications. Laparoscopic ovarian drilling a surgical procedure, may be used to treat the condition and induce ovulation.

If PCOS is Not Treated

Patients with polycystic ovarian syndrome frequently develop other serious medical conditions such as

  • diabetes mellitus,

  • cardiovascular diseases,

  • pregnancy induced high blood pressure,

  • miscarriage or premature delivery.

These patients are also at risk of uterine cancer, anxiety or depression.