Since I see a lot of patients with PCOS in my practice, it might be helpful to share some information about what it is, how it’s diagnosed, and what some of the treatment options are.

About 7% of reproductive-age women present with PCOS, often with a history of irregular menstrual cycles and infertility. While there is no universally accepted definition for PCOS, it is a disorder characterized by elevated male hormones or excessive hair growth (hirsutism) in areas where hair is normally absent or minimal in women, such as the face or chest, along with menstrual abnormalities (infrequent periods or no periods, and therefore no ovulation), and/or polycystic ovaries.

No specific genetic etiology or environmental factors have been clearly identified as being the cause of PCOS, but abnormalities in insulin metabolism are not uncommon in PCOS patients. Blood tests, along with ovarian ultrasound, help confirm the PCOS diagnosis.

Once Polycystic Ovary Syndrome has been diagnosed, I usually start my patients on metformin, with a goal of controlling insulin levels, decreasing the male hormones, and improving ovulation rates. However, metformin alone is rarely enough to help a PCOS patient conceive. Further treatment may include ovulation induction, using oral medication, such as letrozole, that can induce the growth and release of a single mature egg. Letrozole can be combined with an IUI (intrauterine insemination) to enhance the chances of pregnancy. Women who fail to respond to letrozole or do not get pregnant with letrozole treatment may be candidates for injectable fertility medications (gonadotropins). Gonadotropins can be combined with an IUI or can be part of an IVF (in vitro fertilization) cycle. Success in conceiving is frequently achieved using letrozole or gonadotropins.

Dr Susan Sarajari, MD, PhD

Learn more about Polycystic Ovary Syndrome (PCOS) by checking out the definition in our fertility glossary.