Polycystic Ovarian Disease

  Polycystic Ovarian Syndrome  (PCOS), also known as polycystic ovarian disease (PCOD), is a common cause of infertility in women. PCOS is characterized by a cluster of symptoms that are seen in most women who have the syndrome. However, one or more of the classic signs may be absent.

PCOS patients typically have elevated androgen levels. Androgens are male hormones, (testosterone and others) which are responsible for many of the symptoms of PCOS. These symptoms can include increased body hair lowering of the voice, a classic apple shaped body appearance, obesity, irregular (or absent) ovulation, ovaries that are covered with many cysts, which are undeveloped ovarian follicles, and diabetes.

PCOS patients usually have chronically elevated insulin levels. The cells within the pancreas overproduce insulin to compensate for the resistance of the cells (such as muscle and fat) to take up insulin. Chronically elevated insulin levels cause the ovaries to overproduce androgens, which leads to lack of ovulation. Many untreated PCOS patients will eventually develop diabetes and cardiovascular disease.

“First line” treatments for PCOS are often   medications such as metformin or Clomid  . Second line treatment includes injectable gonadotropin therapy (FSH).

Glucophage (metformin) is an insulin sensitizing agent that has recently been used with success in women with PCOS. PCOS patients are insulin resistant and metformin sensitizes their cells to insulin. This effectively lowers the levels of insulin thus slowing androgen production and establishing normal ovulation. Clomid is routinely prescribed by many generalists to induce regular ovulation. Clomid works at the level of the hypothalamus, which is a zone of nerve cells located at the base of the brain.

PCOS patients trying to conceive should always be evaluated and treated by a reproductive endocrinologist. The condition is difficult to manage, and PCOS patients can have exaggerated responses to FSH treatment if not managed carefully.