Female Fertility: Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is a common cause of infertility among women. PCOS is typically diagnosed when a woman is in her childbearing years, usually between the ages of 20 and 30. The following overview outlines some of the common causes of polycystic ovary syndrome, as well as typical signs and symptoms, treatment options, and how PCOS can affect female fertility.


What is PCOS?

Polycystic ovarian syndrome affects the menstrual cycle in women as a result of the formation of cysts on the ovaries. The ovaries are integral to the regulation of hormones within the female reproductive system, and particularly the ovulation cycle. When a woman is diagnosed with PCOS, ovarian follicles rupture and develop into cysts on the surface of the ovaries.


Causes of PCOS

There is no definitive cause of polycystic ovarian syndrome; however, several factors are believed to potentially cause PCOS:


  • Hormonal Imbalance: low levels of follicle stimulating hormones (FSH) result in impaired egg development each month. In addition, high levels of luteinizing hormones (LH) result in no significant surge of LH levels during mid-cycle which is necessary for the release of a matured egg.
  • Diabetes: PCOS have been linked to diabetes and high levels of insulin. Many women with PCOS have an adverse response to insulin, which results in decreased menstruation and ovulation.
  • Genetics: PCOS often runs in families, and may have a genetic link.


Symptoms of Polycystic Ovarian Syndrome

Some of the common symptoms of polycystic ovarian syndrome include the following:


  • infrequent or no periods (amenorrhea)
  • irregular bleeding
  • irregular ovulation or no ovulation (anovulation)
  • ovarian cysts
  • increased levels of male hormones
  • infertility
  • pelvic pain for more than six months
  • weight gain or obesity
  • diabetes
  • abnormal cholesterol levels
  • high blood pressure
  • abnormal hair growth or hair thinning
  • oily skin or acne
  • dandruff
  • dark coloured, thick patches on skin
  • enlarged ovaries


Diagnosis and Treatment

The most common diagnostic procedures to assess the likelihood of PCOS are the luteinizing hormone test, follicle stimulating hormone test and a pelvic ultrasound. These tests will be performed by an endocrinologist.

Treatment options for polycystic ovarian syndrome include the flowing:


  • Fertility drugs such as clomiphene citrate (Clomid) to induce and restore ovulation
  • IVF and IUI performed once eggs are retrieved
  • Injectable fertility drugs such as Pergonal, Humegon or Metrodin
  • Oral contraceptives to restore hormonal balance and reduce symptoms. However, this treatment option does not restore fertility
  • Surgical procedures such as wedge resection, ovarian drilling and laparoscopic ovarian diathermy (LOD)

Laparoscopic ovarian diathermy (LOD) – which is similar to a laparoscopy – involves burning a section of the ovaries using a laser in order to restore hormonal balance. Surgical procedures such as wedge resection and ovarian drilling have been successful in 70% to 90% of women with PCOS, whose ovulation cycles were restored within a year.