pcos and fertility positive steps forward dr michelle wellman mbbs franzcog

PCOS and FertilityPositive Steps Forward

Dr Michelle Wellman

MBBS FRANZCOG

• What is Polycystic Ovary Syndrome (PCOS)?

• Why is PCOS important?

• What causes PCOS?• Can PCOS be cured?• Will I be able to have children?

Questions

• Involves more than just the ovaries

• Syndrome = Group of Symptoms or signs

• 2 out of 3

What is PCOS?

MenstrualIrregularities

Androgens Ultrasound

PCOS

PCOS PCOS

PCOS

PCOS Types

• Cycles consistently

more than 35 days

• Less than 10

periods per year

Irregular periods

Hypothalamus

Pituitary

Ovaries

Uterus

GnRH

FSHLH

OestrogenProgesterone

Ovulation PCOSNo ovulation

Infrequent ovulation

Progesterone

• Androgens

= ‘male-type’ hormone• Sometimes increased hair growth on face,

chest, back (hirsutism)• Sometimes loss of hair on the scalp (alopecia)• Sometimes acne• Can be seen on a blood test

Increased androgens

• Transvaginal

(internal)ultrasoun

d is best

Ultrasound

appearance

Single cysts on ultrasound or follicles

Loss of periods due to stress, rapid weight

loss or excessive exercise

Loss of periods due to premature menopause

What is not PCOS?

• Common

- Estimated to affect between 12 and 21% of the

population

- Up to 70% remains undiagnosed• Long and short term consequences

Why is PCOS important?

Short term Long term

• Irregular periods

• Hair growth

• Acne

• Infertility

• Psychological

• Type 2 Diabetes

• Increased risk of

cardiovascular disease eg.

strokes, heart attacks

• Not all women with PCOS are

overweight• Being overweight increases the

signs and symptoms of PCOS• Weight loss has been shown to

reduce the signs and symptoms

of PCOS and reduce the risk of

long-term consequences

Weight and PCOS

• Speak with your GP• They may organise appropriate tests if required

• May require input from other specialists• Gynaecologist• Fertility Specialist• Endocrinologist• Dermatologist• May refer to other allied health professionals• Dietician

If you think you may have PCOS

What causes PCOS?GENETICS LIFESTYLE

Hormonal Changes

↑ Insulin

OVARIESAnovulation

Irregular Periods

CARDIO- VASCULAR

RISK

↑ Androgens

Hair GrowthAcne

• No cure

but very effective treatment options for

managing the associated problems• Removing the ‘cysts’ does not cure the problem• LIFESTYLE CHANGE

first line treatment for all PCOS problems

Can PCOS be cured?

SMALL CHANGES

MAKE A BIG

DIFFERENCE

• Medication - pill, cyclical

progesterone• Mirena® - intrauterine

contraceptive device• Surgery

Menstrual problems

• Cosmetic treatment eg

laser, electrolysis• Medication eg. pill, anti-

androgenic

Hair growth

WILL I BE ABLE TO

HAVE CHILDREN?

• Anovulation

= ovary does not release an egg• In most instances ovulation can be restored with

simple, inexpensive techniques

• If overweight even small (5-10%) reduction in

bodyweight can reduce insulin resistance and

restore ovulation• Other health benefits• Benefits during pregnancy

- reduces miscarriage rate

- reduces diabetes during pregnancy

WEIGHT LOSS

• Laparoscopic banding, gastric sleeve operations• Can be useful for very overweight woman who

are unable to lose weight after prolonged efforts

at lifestyle change• General recommendation to defer conception

for 12 months or until weight-loss stabilised

WEIGHT LOSS SURGERY

• Trade names Serophene® and

Clomid®• Generally low risk and low cost• Twins 5-7%, Triplets 0.3%• Response rate 60-85%• Pregnancy rate 50% after 6

ovulatory cycles

Clomiphene Citrate

Clomiphene trackingAllows assessment of response, intercourse timing and triggering

Progesterone10 days

or blood test

Period

Day 1 Day 9 stop clomiphene

Day 11-13scan

Day 5 start clomiphene

Ovulation + intercourse+/- trigger

Day 21Progesterone

If no responseincrease dose

• Medication used to reduce blood glucose levels

in diabetes• Taken 3-4 times a day• May be useful for women who do not respond to

maximum doses of clomiphene • Sometimes beneficial on its own to induce

ovulation in women with lower BMI

Metformin

• Use synthetic FSH to stimulate ovulation (GonalF® or

Puregon®) • Usually used for women who do not respond to

Clomiphene • Rare not to respond • Additional trigger (ovulation) injection and luteal

(lining)support medication usually required

Gonadotropins

Puregon® Gonal F®

FSH Ovulation Induction ProtocolIncrease dose slowly - can be very sensitive

25-50iu/day

Increase dose by 50%

Increase dose by 50%

Startingdose

Scan d14

Scan d7

Scand21

hCG 5000uFollicle

=16mm

• Day surgery procedure via

keyhole surgery• Can restore ovulation in 60-

80% of women in the short

term (few months)• Lower risk of multiple

pregnancy

Laparoscopic Ovarian Drilling (LOD)

•Generally last option•Increased sensitivity to medication in patients with

PCOS •If other associated factors may be indicated, but

not always necessary i.e semen abnormality

IVF

If IVF is needed FertilitySA has

outstanding pregnancy rates!

• Jean Hailes Foundation Website

www.jeanhailes.org.au• FertilitySA website

www.fertilitysa.com.au• Polycystic Ovary Syndrome Association of Australia

(POSAA)

www.main.posaa.asn.au• Brochures

Resources

Any Questions?

Consulting Clinic345 Carrington Street

Adelaide SA 5000

Phone 8100 2900

e info@fertilitysa.com.au

w www.fertilitysa.com.au