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

17. SMALL CHANGES MAKE A BIG DIFFERENCE

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

20. WILL I BE ABLE TO HAVE CHILDREN?

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 www.jeanhailes.org.au
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