Polycystic ovary syndrome is found in around 70% of women who have ovulation difficulties causing their infertility. This is more common in women who are overweight, and as a first-line treatment, weight reduction can be very successful in restarting spontaneous ovulation. The amount that needs to be lost is less than most women might expect - around 5% of the current weight is can significantly increase the number of ovulatory cycles.
It is also strongly recommended that women with PCOS stop smoking and only consume moderate amounts of alcohol and caffeine. This is because all three have been shown to worsen the effect of PCOS, particularly in relation to fertility.
Clomifene
Clomifene citrate is the most commonly used drug to stimulation ovulation. It is taken in the early days of the cycle (usually days 2-6) and results in ovulation in around 80% of women overall, and a 6 month successful pregnancy rate of 45-50%.
Ovarian stimulation
When clomifene is unsuccessful, there are two main approaches. The first is to use hormone injections to stimulate the ovary to produce eggs. This is known as ovarian stimulation and, where there is an additional sperm problem, it is combined with insemination of sperm through the cervix around the time of ovulation (intrauterine insemination, or IUI). The hormone treatment must be monitored by blood tests and ultrasound scans to avoid over-stimulation. Live birth rates after ovarian stimulation following failed clomifene treatment reach 54% after 6 cycles and 62% after 12 cycles of treatment.
Multiple pregnancy is always a risk with this type of treatment, but especially so for women with PCOS, whose ovaries are sensitive to the hormones. If ovarian stimulation is unsuccessful, many women resort to in vitro fertilisation (IVF), success rate of which depends very much upon individual characteristics such as age, length of infertility and weight.
Neither IVF nor ovarian stimulation is likely to be successful if a woman is overweight (body mass index greater than 30 kg/m2). This is why most hospitals restrict these treatments until a woman's weight is within the normal range.
Laparoscopic ovarian diathermy
The alternative to ovarian stimulation is an operation called laparoscopic ovarian diathermy (LOD), also known as 'ovarian drilling'. This involves a day case operation, a short general anaesthetic, and a telescope look into the abdomen. The ovaries are identified and several small holes made in each ovary, either with a fine hot diathermy probe or via laser. It is not actually known how this works, but it can restore regular ovulation, or make the ovary more sensitive to clomifene.
By 12 months after LOD the average pregnancy rate is around 60-80%, the greatest success rates being in women with a shorter length of infertility (less than 3 years) and a higher level of the hormone LH (>10 iu/l). Advantages of LOD include the fact that it may improve other symptoms of PCOS, such as menstrual disturbance, as well as avoiding the need for stimulatory drugs and their increased risk of over-stimulation and multiple pregnancy.
Go to Treatment - weight loss
Back to PCOS main page