The Diagnosis of Polycystic Ovary Syndrome
Common symptoms of the full polycystic ovary syndrome (as opposed to a mere ultrasound diagnosis of polycystic ovaries, which may occur in up to 20% of normal young women), include the following:
Excess hair growth (most noticeable on the face and chin)
Acne
Obesity
Menstrual disturbances (very irregular and long periods)
Infertility
In extreme cases male pattern balding
Abnormal glucose tolerance test
Abnormal lipid profile
Signs we doctors look for…
A thorough history is taken, with particular regard to the menstrual pattern. I usually perform a vaginal ultrasound scan, looking for the classic “ring of pearls” sign – a ring of small immature egg cysts that lines the perimeter of the enlarged ovary. These cysts are only 3 or 4 mm in diameter A blood test will show a typical pattern of high luteinising hormone( LH), low follicle stimulating hormone (FSH), low oestrogen(E2), low progesterone(P4)… (because there have been no ovulation), and a high normal range androgen level.
Because of the increased risk of both diabetes and heart disease, a glucose tolerance test and a lipid profile will be ordered by me when I first make this diagnosis. Lifestyle changes including diet, will also be addressed. I will probably suggest you see a dietician. There is an excellent book by a Canadian Renal Physician,(see later, on how to lose weight by intermittent fasting) A loss of just 6kg seems to be the magical number of Kg to lose to increase fertility.
An excellent review of polycystic ovaries is also available from Women’s Health Qld wide’s website
Medical Treatment
One of the best “natural” treatments for ovulatory dysfunction in polycystic ovaries is weight loss. Although this may be easier said than done, it is estimated that a woman of 90kg needs only to lose 6kg to actually start ovulating spontaneously. Diet and exercise are the best options here. Pay particular attention to sugar; it is addictive and it is a poison. Similarly, with men, the higher their weight, the lower their fertility.
Alternatively, Clomiphene Citrate or Clomid is a drug (not a hormone), which can help induce ovulation. This drug, usually given in the early part of the cycle, I use 1-2 tables days 2-6 of the cycle, causes an increased production of the patient’s own natural follicle stimulating hormone) which, in turn helps kick-start ovulation. During the first treatment cycle of Clomid, the patient with polycystic ovaries may need to be seen 2 or 3 times for a vaginal scan, to adequately pinpoint ovulation. Once the egg follicles has grown to 1.8-2cm, it is ripe, I then recommend either that ovulation is “triggered” using an injection of HCG (no side effects apart from the sore abdomen). After all, if you have waited this long for an egg, you wouldn’t want to miss the opportunity to have it fertilized. You will then be instructed to have “timed intercourse”, usually 24 to 36 hours later, provided your partner’s semen analysis has been shown to be normal.
More recently, Letrazole, in the aromatase inhibitor class of drugs, seems to have an improved outcome over Clomid. Letrazole is given days 3 to 7 of the cycle and scanning and triggering are the same as for clomid.
Surgical Treatment
Originally, before keyhole surgery, a larger wedge was taken out of the ovary in order to treat what was then called Stein-Leventhal syndrome. This procedure needed a cut the same size as a c/section incision! This did help ovulation, but unfortunately was also associated with a high degree of adhesion formation, which in itself can cause infertility. This treatment is of course, no longer offered.
Instead laparoscopic or keyhole surgery with ovarian drilling is used. Only one ovary should be drilled – that is 6 small holes only, are drilled though the thickened capsule of the ovary. This treatment of course needs a trip to hospital, an anaesthetic, and exposes the patient to a small risk that any laparoscopy has. There is also still a small but definite risk of adhesions formation. I also combine this treatment, with the diligent search for endometriosis, adenomyosis and a dye test to check for tubal patency.