Women with PCOS should spend as much time as they can trying Assisted
Reproductive Therapy (ART) before proceeding on to IVF. This is because ART
does not have the risks or the costs of IVF. Further, since the main reason
women with PCOS have trouble conceiving is the fact that their cycle is erratic
and unpredictable, ovulation induction should be able to address this issue. It
is only when complications arise, or unexplained infertility persists after
several cycles, that couples might find they need to try IVF.
Metformin
Research over the past decade has shown that treatment strategies aimed at
lowering blood insulin levels by exercise, diet, weight loss and the 50 year
old medication Metformin can restore fertility in some PCOS patients.
According to Sydney-based endocrinologist Dr Warren Kidson, Metformin can:
-
Restore regular menstruation and ovulation in 70% -80% of women with PCOS.
-
Reduce the need for IVF by 25% - 30%.
-
Increase the clinical pregnancy rate in IVF from 30% to 70% per treatment
cycle.
Meformin help also help with non-reproductive health issues, such as:
-
Clear acne in the majority of young women with PCOS.
-
Reduce progression towards type 2 diabetes.
Ovulation Induction using Clomid (Clomiphene Citrate)
Clomid (Clomiphene Citrate) is often the first drug used to induce ovulation in
women with PCOS. It is a tablet taken for five consecutive days early in the
menstrual cycle. It works on the pituitary gland by forcing it to stimulate the
production of eggs. Regular ultrasounds should be done to monitor follicle
growth and to help predict ovulation
Clomid is also implicated in causing ovarian cancer and should never be used for
more than twelve cycles. Generally, if pregnancy has not occurred after six or
seven it will not occur using Clomid and another therapy should be tried.
Clomid can be made more effective by increasing the dosage if ovulation has not
occurred, or by combining Clomid with other medications. Many women with PCOS
have become pregnant by taking a combination of Clomid and metformin
(glucophage).
Clomid is known to make cervical mucus more hostile to sperm. This problem can
be solved by combining Clomid treatment with artificial insemination with
husband’s sperm.
Because it acts on the pituitary gland, Clomid can cause headaches, blurred
vision and extreme mood swings. The mood swings are the most common side
effect. Many women with PCOS have discussed the stress these mood swings put on
their relationships. Before going on Clomid, take the time to explain to your
partner that this medication will make you moody and you may be a little
“difficult” for the duration of treatment.
While some would call Clomid the “Relationship Killer”, it is possible that some
of the stress on your relationship is the fact that you have just entered a new
phase. For most couples, taking Clomid is their first real experience of
fertility treatment. It represents a failure to conceive normally, and it is a
harsh reality to accept. This may also be a couple’s first ever experience of
clinical sex. One of the key aspects of ovulation induction is being told when
ovulation is expected. A couple will generally be instructed to have sex at
least once every 48 hours until ovulation has been confirmed by blood test.
Needless to say, it’s not very romantic.
Ovulation Induction using Follicle Stimulating Hormone (FSH)
Ovulation induction can be done using FSH in a very similar manner to Clomid,
however there are more complications. FSH is administered by injection and
getting the dosage high enough to ovulate, but keeping it low enough not to
superovulate, is a medical challenge. It may take several cycles to get the
dosage right, but since FSH is not implicated in causing ovarian cancer it can
be used on numerous cycles.
FSH has a couple of other benefits over Clomid. FSH acts directly on the ovary,
as opposed to the pituitary gland, and therefore does not have the side effects
of headaches and extreme mood swings. FSH does not make the cervical mucous
hostile to sperm.
FSH can be combined with other therapies like artificial insemination. FSH is
the main treatment used to stimulate ovulation in IVF, however IVF uses much
higher doses than used in ovulation induction.
Ovarian Drilling
Ovarian Drilling is performed during a laparoscopy under a general anaesthetic.
Sometimes called ‘golfballing’, holes are drilled or cauterised on the surface
of the polycystic ovaries in an attempt to break through the white outer shell
and remove some of the stroma of the ovary. In women with PCOS, the stroma is
enlarged and surrounded by a circle of undeveloped follicles. This stroma is
known to produce excessive amounts of testosterone and can prohibit ovulation.
Ovarian drilling achieves approximately six months ovulation in women who don’t
normally ovulate. After this time, the effects of ovarian drilling have worn
off. Women who did not respond to ovulation induction with Clomid often respond
to it after having their ovaries drilled.
Artificial Insemination or Intrauterine Insemination (IUI) with Husband’s Sperm
This procedure is a fairly simple procedure carried out in the doctor’s rooms,
however the husband’s sperm needs to be prepared first in a lab. Sperm is
washed and prepared for insertion, either into the cervix, or directly into the
uterus. Bypassing the cervix eliminates the possibility of sperm being
destroyed by hostile mucous or cervical antibodies and is far more common.
Cycle tracking is necessary so that ovulation can be predicted. It is also
possible to artificially create ovulation by giving an injection of HCG and
timing the IUI appropriately. Having sex the night before and the night after
IUI will also increase the chances of conception.
Copyright © by POSAA All Right Reserved.
