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PCOS and Fertility Positive Steps Forward

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Presentation on theme: "PCOS and Fertility Positive Steps Forward"— Presentation transcript:

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

2 Questions • What is Polycystic Ovary Syndrome (PCOS)?
• Why is PCOS important? • What causes PCOS? Can PCOS be cured? Will I be able to have children?

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

4 PCOS Types Menstrual Irregularities PCOS PCOS PCOS Androgens Ultrasound PCOS

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

6 Hypothalamus Pituitary Ovaries Uterus GnRH FSH LH Oestrogen
Progesterone Uterus

7 Ovulation PCOS No ovulation Infrequent ovulation Progesterone

8 Increased androgens 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

9 • Transvaginal (internal)ultrasound is best
Ultrasound appearance • Transvaginal (internal)ultrasound is best

10 What is not PCOS? 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

11 Why is PCOS important? Common
- Estimated to affect between 12 and 21% of the population - Up to 70% remains undiagnosed Long and short term consequences

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

13 Weight and PCOS 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

14 If you think you may have PCOS
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

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

16 Can PCOS be cured? 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


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

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


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

22 WEIGHT LOSS 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

23 WEIGHT LOSS SURGERY 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

24 Clomiphene Citrate 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

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

26 Metformin 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

27 Gonadotropins 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

28 Puregon® Gonal F®

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

30 Laparoscopic Ovarian Drilling (LOD)
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

31 IVF 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

32 If IVF is needed FertilitySA has outstanding pregnancy rates!

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

34 Any Questions?

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

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