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PCOS and Fertility Positive Steps Forward Dr Michelle Wellman MBBS FRANZCOG.

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Presentation on theme: "PCOS and Fertility Positive Steps Forward Dr Michelle Wellman MBBS FRANZCOG."— Presentation transcript:

1 PCOS and Fertility Positive Steps Forward Dr Michelle Wellman MBBS FRANZCOG

2 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

3 Involves more than just the ovaries Syndrome = Group of Symptoms or signs 2 out of 3 What is PCOS?

4 Menstrual Irregularities AndrogensUltrasound PCOS PCOS Types

5 Cycles consistently more than 35 days Less than 10 periods per year Irregular periods

6 Hypothalamus Pituitary Ovaries Uterus GnRH FSH LH Oestrogen Progesterone

7 OvulationPCOS No ovulation Infrequent ovulation Progesterone

8 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

9 Transvaginal (internal)ultrasoun d is best Ultrasound appearance

10 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?

11 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?

12 Short termLong term Irregular periods Hair growth Acne Infertility Psychological Type 2 Diabetes Increased risk of cardiovascular disease eg. strokes, heart attacks

13 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

14 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

15 What causes PCOS? GENETICS LIFESTYLE Hormonal Changes ↑ Insulin OVARIES Anovulation Irregular Periods CARDIO- VASCULAR RISK ↑ Androgens Hair Growth Acne

16 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?


18 Medication - pill, cyclical progesterone Mirena® - intrauterine contraceptive device Surgery Menstrual problems

19 Cosmetic treatment eg laser, electrolysis Medication eg. pill, anti- androgenic Hair growth


21 Anovulation = ovary does not release an egg In most instances ovulation can be restored with simple, inexpensive techniques

22 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

23 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

24 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

25 Clomiphene tracking Allows assessment of response, intercourse timing and triggering Progesterone 10 days or blood test Period Day 1 Day 9 stop clomiphene Day 11-13 scan Day 5 start clomiphene Ovulation + intercourse +/- trigger Day 21 Progesterone If no response increase dose

26 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

27 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

28 Puregon® Gonal F®

29 FSH Ovulation Induction Protocol Increase dose slowly - can be very sensitive 25-50iu/day Increase dose by 50% Increase dose by 50% Starting dose Scan d14 Scan d7 Scan d21 hCG 5000u Follicle =16mm

30 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)

31 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

32 If IVF is needed FertilitySA has outstanding pregnancy rates!

33 Jean Hailes Foundation Website FertilitySA website Polycystic Ovary Syndrome Association of Australia (POSAA) Brochures Resources

34 Any Questions?

35 Consulting Clinic 345 Carrington Street Adelaide SA 5000 Phone 8100 2900 e w

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