• Contact us
• About us
• A-Z topics
• Symptom Checker
• Service Finder
• Subscribe to newsletters
• Linking to us
• Information partners
• Terms of use
• Privacy

Pregnancy, Birth and Baby is funded by the Australian Government and operated by Healthdirect Australia.

Pregnancy, Birth and Baby’s information and advice are developed and managed within a rigorous clinical governance framework.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Healthdirect Australia acknowledges the Traditional Owners of Country throughout Australia and their continuing connection to land, sea and community. We pay our respects to the Traditional Owners and to Elders both past and present.

This information is for your general information and use only and is not intended to be used as medical advice and should not be used to diagnose, treat, cure or prevent any medical condition, nor should it be used for therapeutic purposes.

The information is not a substitute for independent professional advice and should not be used as an alternative to professional health care. If you have a particular medical problem, please consult a healthcare professional.

Except as permitted under the Copyright Act 1968, this publication or any part of it may not be reproduced, altered, adapted, stored and/or distributed in any form or by any means without the prior written permission of Healthdirect Australia.

Support this browser is being discontinued for Pregnancy, Birth and Baby

Support for this browser is being discontinued for this site

• Internet Explorer 11 and lower

We currently support Microsoft Edge, Chrome, Firefox and Safari. For more information, please visit the links below:

• Chrome by Google
• Firefox by Mozilla
• Microsoft Edge
• Safari by Apple

You are welcome to continue browsing this site with this browser. Some features, tools or interaction may not work correctly.

Polycystic ovary syndrome

Kuznetsova Ekaterina Viktorovna

Reproductologist, Gynecologist

Novosibirsk Center for Reproductive Medicine

The criteria for the diagnosis of PCOS are:

• absence of ovulation (anovulation),
• hyperandrogenism,
• the presence of polycystic (multifollicular ovaries) with an increase in the volume of the ovaries according to ultrasound.

The diagnosis can be made if two of these three manifestations are present.

As a rule, the examination of a woman begins with an ultrasound examination of the pelvic organs. Often, if the conclusion indicates the presence of "multifollicular ovaries" (MFO), on this basis, the diagnosis of PCOS is erroneously established. The term "multifollicular ovaries" is simply a description of the ultrasound picture, which reflects the presence of a large number of antral follicles in the ovaries.

Such a conclusion, of course, is one of the criteria for PCOS, but, I remind you that not one symptom, but two, is required for a diagnosis. The presence of MFN by ultrasound performed at the beginning of the menstrual cycle does not make it possible to judge from the presence or absence of ovulation in a woman's menstrual cycles. The detection of a large number of follicles in the ovaries and by ultrasound is the norm for young women! With preserved ovulation, the absence of menstrual irregularities, this treatment does not require and does not prevent pregnancy!

To diagnose anovulation, it is necessary to perform ultrasonic folliculometry (FM), preferably within 2-3 menstrual cycles. Moreover, when performing FM, you need to decide on the period until which it makes sense to wait for the appearance of the dominant follicle. This is where mistakes often happen. The fact is that most women have a menstrual cycle of 28-30 days, while ovulation occurs on days 14-16 of the cycle.

But, if this is the case for the majority, should it be so for everyone? No. The normal length of a menstrual cycle is 21 to 42 days. This means that with a 21 day cycle, ovulation occurs on days 7–8 of the cycle, but with a 42 day cycle? On the 20th day? No. With a cycle duration of 42 days, ovulation should occur on days 26-30 of the cycle. Thus, when folliculometry is stopped on the 14th-16th day of the cycle due to the absence of a dominant follicle, an erroneous conclusion is made about anovulation. Although, with a regular, but long (32–42 days) menstrual cycle, ovulatory function can be preserved. Such a delusion is very dangerous, because it entails the start of stimulation therapy in women who are planning a pregnancy, although, in fact, they do not need it. Conversely, women who are not currently planning a pregnancy get the wrong impression that there is no need for contraception, which leads to unwanted pregnancies and, as a result, to abortion.

The next symptom of PCOS is hyperandrogenism, which is an increase in the content of male hormones (androgens). This is a sufficient general statement. Characteristic of PCOS is an increase in testosterone, which is produced in excess in the ovaries. This can lead to appearances such as excessive hair growth on the skin of the abdomen, thighs and even the face (this is called hirsutism), as well as increased activity of the skin sebaceous glands, which is manifested by oily skin and a tendency to acne. But testosterone is not the only androgen in the body.

In addition, other male hormones are present in the body: androstenedione, DEHA, 17-OH progesterone, etc., which are produced mainly by the adrenal glands. Their determination is necessary during the examination in case of suspicion of PCOS, the presence of manifestations of hyperandrogenism, anovulation, but is not a sign of PCOS, since they are produced not in the ovary, but in the adrenal glands. So the determination of DHEA is necessary to exclude formations of the adrenal glands that produce hormones (hormone-producing tumors), the determination of 17-OH progesterone is performed to diagnose such a congenital disease as VDKN (formerly called adrenogenital syndrome - AGS), which can also lead to cycle disorders and anovulation, but, however, is not synonymous with PCOS and requires different treatment. With HCHD, there is at least a three-fold increase in the level of 17-OH progesterone, while a slight increase of 1-2 ng / ml or nmol / ml is neither a sign of HCHD nor PCOS, and, as a rule, is asymptomatic and does not require treatment.

Often, hormonal disorders in PCOS are accompanied by impaired insulin function (insulin resistance) and/or its excessive production (hyperinsulinemia). This leads to the fact that PCOS is accompanied by a complex of symptoms called metabolic syndrome (MS) and is manifested by obesity, hypertension, high cholesterol, and impaired glucose uptake. This manifestation of PCOS is dangerous with very serious consequences: if left untreated, type 2 diabetes mellitus, coronary heart disease, etc. develop over time, which is the main cause of death along with cancer. Insulin resistance, of course, requires medical correction with special drugs, but a woman herself can help the drugs work more efficiently. How? Weight loss, proper nutrition and regular physical activity. Agree, it is available to everyone.

It's time to move on to treating PCOS.

Speaking about the treatment of this disease, it is important to answer the question: is a woman planning a pregnancy at the moment or not? So, if pregnancy is not planned in the near future, then combined oral contraceptives (COCs) are the best suited to normalize the cycle, prevent and treat endometrial hyperplasia, dysfunctional bleeding, and cosmetic problems. These drugs are quite effective, inexpensive and easy to take, which allows you to solve these problems.

On the topic "COC - to drink or not to drink?" many copies have been broken, but there is still no tool more effective, safer and easier to use. Like any other drug, COCs have both contraindications and side effects, so these drugs should be prescribed by a doctor who has experience working with them, after identifying possible contraindications to taking, for example, a tendency to thrombosis. There are a lot of drugs from this group on the market now, and their tolerance can be quite different. But I am convinced that among the existing variety it is possible to choose the right drug, it just does not always happen the first time, even if the appointment is made by a very experienced doctor. Unfortunately, in the medical literature, there is no unequivocal answer to the question of how long it is safe to take COCs. Based on my own experience, I can say that on average this is up to 5 years. I emphasize that this is an average value - in each individual case, this issue should be resolved individually.

If a woman diagnosed with PCOS is planning a pregnancy, she needs to contact a reproductive specialist in a specialized clinic. Since for the onset of pregnancy it is necessary not only to make the menstrual cycle regular, but to establish the ovulatory function of the ovary, since without the release of the egg from the ovary, that is, ovulation, pregnancy is impossible. In such cases, ovulation induction (stimulation of ovulation, stimulation of ovarian function) is carried out using special preparations.

It is good if ovulation stimulation is carried out by a reproductive specialist who knows ultrasound and can independently monitor the growth of follicles and prescribe appropriate drugs. Before using ovulation induction, it is necessary to perform a study of the patency of the fallopian tubes and a diagnosis of the state of the sperm in the husband/partner (spermogram, MAP test, strict morphology according to the Kruger criteria) and other examinations that are mandatory when planning a pregnancy. Since, unfortunately, the lack of ovulation may not be the only reason for the lack of a desired pregnancy.

Often, a replacement for ovulation stimulation is the appointment of progesterone preparations from days 16 to 25 of the cycle. However, this is not at all the case. The appointment of these drugs will help to even out the cycle, make it 28 days, may be an alternative to COCs for the prevention and treatment of endometrial hyperplasia, but will not help the onset of pregnancy. On the contrary, it's more likely to get in the way. The fact is that under the influence of these drugs, changes occur in the endometrium that are characteristic of the second phase of the cycle, that is, after ovulation has occurred, which allows you to get a menstrual-like reaction, but their effect does not extend to the ovary, does not allow you to establish ovulation. But, in the event that ovulation suddenly decides to occur (this happens, including with PCOS once a year or once every several years), then taking these drugs can desynchronize the development of the embryo and the preparation of the endometrium, and this is one of the necessary conditions for pregnancy .

Previously, to normalize the cycle and restore ovulation, the method of cauterization of the ovaries (“notches”, resection of the ovaries) was used, which was performed during laparoscopy. For a long time, this was almost the only means of restoring the functioning of the ovaries in the absence of special drugs, the wide availability of ultrasound and qualified reproductologists. But now this method is not the method of choice, since among its consequences there is often premature ovarian exhaustion, that is, the irreversible disappearance of the follicular apparatus.

These are very difficult situations when young women begin menopausal manifestations, and there are no own eggs left, and pregnancy planning becomes possible only with the use of donor oocytes. In addition, I want to note that ovarian biopsy during laparoscopy is also not a modern criterion for the diagnosis of PCOS and you will not find indications of its need in any modern manual on operative gynecology. Since, unfortunately, even a slight damage to the ovarian tissue can lead to irreversible consequences.

In conclusion, I want to say that although PCOS is a common pathology that leads to serious consequences, in the modern world there are many means to cope with it and realize the reproductive function. Take care of your health, contact qualified specialists and be happy!

Make an appointment

to the doctor - Kuznetsova Ekaterina Viktorovna

Novosibirsk Center for Reproductive Medicine

Polycystic ovary syndrome (PCOS) is one of the most mysterious diseases in the practice of a gynecologist-reproductologist. There are several classifications and various criteria for this diagnosis.

Types and causes of polycystic ovaries

In 2012, an expert group report on this pathology was presented to the entire medical community, on the basis of which four types of disorders were identified in patients with PCOS.

The first type was characterized by a combination of an increased level of androgens in the blood (hyperandrogenism) and a violation of ovulation processes. The second type, respectively, had a combination with ultrasound signs of polycystic ovaries. The third type is the absence or decrease in the frequency of ovulation in combination with ultrasound changes in the ovaries. The fourth type was a combination of all previously described types. Based on the data obtained, any of the above combinations of PCOS signs can be a confirmation of this diagnosis.

Among the causes of PCOS, there is a violation of the regulation of maturation of follicles, as well as a change in the enzyme systems involved in the biosynthesis of ovarian androgens (male hormones in the female body), which can lead to an imbalance between the process of division and reverse development of cells (apoptosis) of ovarian tissue. In addition, the role of genetic factors that can disrupt the regulation of cytochrome P450c17, a key enzyme in the biosynthesis of ovarian and adrenal androgens, is not denied. It is important to note that PCOS often develops against the background of neuroendocrine syndromes, obesity, hyperprolactinemia, congenital dysfunction of the adrenal cortex, Cushing's disease. Such women often report menstrual irregularities, overweight, increased blood insulin levels, impaired glucose tolerance, and type 2 diabetes.

Pregnancy with polycystic ovaries

It is believed that about 70% of patients with infertility caused by impaired egg maturation have some form of PCOS. Achieving pregnancy through the IVF program or ovulation stimulation as part of artificial insemination in such a contingent of patients are the most effective methods of treating this disease.

Commonly used drugs included in the ovarian stimulation protocol are clomiphene citrate, as well as gonadotropins, hormonal drugs that promote the maturation of eggs and the restoration of ovulation, as well as the onset of pregnancy.

Clomiphene citrate is most effective in patients under 30 years of age, the duration of menstrual irregularities in which does not exceed about 5 years with a short duration of infertility. When using this drug in 50% of cases, it is possible to achieve ovulation (the release of an egg from the ovary), but pregnancy occurs in only less than 25% of women.

Patients with PCOS who are over 30 years of age, overweight, markedly increased ovarian volume, decreased estrogen levels in the blood, have low sensitivity to clomiphene citrate. In such cases, the prescription of medications that affect insulin resistance, weight loss, and therefore improve the response to hormonal stimulation of ovarian function, comes to the rescue in such cases before the IVF program. An example of this is the drug metformin. According to some researchers, this makes it possible to increase the effectiveness of the ovulation stimulation protocol by up to 10-15%.

Complications of the IVF program for polycystic

The key to the correct implementation of hormonal treatment in patients with PCOS is to assess the risk of complications in the IVF program. The most common of which is ovarian hyperstimulation syndrome (OHSS). It should be noted that in patients with PCOS, the risk of developing OHSS reaches 10-12%, while in the general population of women it does not exceed 3%. It is more common in those who have many follicles and increased ovarian volume, as well as more than 20 maturing oocytes during stimulation. To help overcome this complication of assisted reproductive technologies, patients with PCOS come with the use of small doses of gonadotropins (hormonal drugs to stimulate ovarian function), the use of "soft protocols", the mandatory determination of anti-Müllerian hormone in the blood serum, which characterizes the ovarian reserve. In severe cases, an alternative tactic for reproductologists is the abolition of embryo transfer and their cryopreservation with the possibility of completing the IVF program only after 1-2 menstrual cycles.

In addition to developing OHSS, these women remain at risk of multiple pregnancies, especially in programs with intrauterine insemination. With the development of a large number of follicles in such women, this procedure is proposed to be abandoned, and an ovarian puncture should be performed as part of the IVF program with a complete collection of eggs for in vitro fertilization.

Learn more

• 
  How to save money for child future
• 
  Is mozzarella soft cheese
• 
  Fetal position oblique
• 
  How to conceive a child naturally
• 
  How to help braxton hicks
• 
  How to win custody of my child as a mother
• 
  How to heal a relationship with your child
• 
  When should i worry if im pregnant
• 
  Pregnancy genetic testing results
• 
  How to check child support balance owed
• 
  Can throwing up be a sign of pregnancy