PCO Patients FAQ | Answers to frequently asked questions about polycystic ovary syndrome | Dr N Layyous

Polycystic Ovary Syndrome - PCO Patients FAQ

Polycystic ovary includes many symptoms associated with hormonal imbalance in the body, so it is not one disease; it is multiple symptoms associated with each other.

- What is the prevalence of Polycystic Ovary Syndrome?

The prevalence of PCO in the world is 5-10%, and it is a major cause of infertility.

- What are the most important symptoms of Polycystic Ovary Syndrome?

Any of these symptoms can occur in this syndrome:

• - No periods or scanty periods.
• - Ovulatory disorders.
• - High testosterone level which leads to increase growth of hair over chin, chest and thighs.
• - Infertility due to disorders in ovulation.
• - The ovary on ultrasound has a larger size than normal ovary with multiple small follicles on its edge like a pearl necklace.
• - Over weight.
• - Insulin resistance which leads to increase insulin level although there is normal level of blood glucose.
• - Lipid profile disorder.
• - Elevated blood pressure.
• - Acne and oily skin.

- What is the cause of Polycystic Ovary Syndrome?

The main cause is still unknown, but there are many studies refer it to a genetic cause because it is clustered in the same families

- Other studies showed that there is a role for insulin receptors effectiveness.

- There is also a role for antiepileptic drugs in unmasking the symptoms of this disease.

- Is there a definitive treatment for Polycystic Ovary Syndrome?

No, not yet, all treatments available only decrease the symptoms, but don’t cure it.

- Is there a specific laboratory investigation should be done to diagnose Polycystic Ovary Syndrome?

No, no specific test, because there is no specific cause.

- How the diagnosis is made?

It depends on the clinical examination, and ultrasound examination beside blood test.

- How is the diagnosis made by vaginal ultrasound?

The ovaries look like a necklace of pearls with 8-10 follicles in each ovary, and the ovary is larger than normal ovary.

- What is the laboratory test that should be done routinely?

- Random blood sugar.

- Lipid profile.

- Thyroid stimulation hormone.

These tests should be done once a year at least.

- Does every PCOS woman have infertility?

It depends on the severity of the disease, so if it causes disordered ovulation it will lead to infertility.

- Is it possible to have regular menses without ovulation?

Yes, but the ovulation depends on the period between two consecutive cycles.

- Does the body temperature predict the time of ovulation in PCOS patients?

It depends on the severity of the disease.

- Does clomid have a role in PCOS cases?

Yes, it may have a role in inducing ovulation, but only 40% will get pregnant, and it can be used for 3-4 cycles.

- Does PCOS affect the quality of the oocyte?

Yes, this may be due to high insulin level, or due to delayed ovulation.

- What is the role of cortisone treatment in addition to induction of ovulation?

Cortisone has a role in lowering androgenic hormones serum level which are increased in those patients, and by that induces ovulation, but its use should be after consulting your doctor, because it may affect insulin level.

- Is it necessary to use progesterone in PCOS patients?

Usually PCOS patients have low level of progesterone so they need to take them either orally or per vagina in order to support the endometrium.

- May we use oral hypoglycemic drugs with ovulation induction drugs?

Yes, you can, even sometimes you may be given oral hypoglycemic drugs 3-16 months before using induction of ovulation drugs, and this depends on insulin serum level.

- Does PCOS carry a risk of ovarian hyper-stimulation syndrome?

Yes, and this occurs due to the presence of multiple small follicles, and the use of induction of ovulation is to induce growth of certain follicles without inducing those small ones, and the use of metformin will reduce the risk of ovarian hyper-stimulation.

- Is it necessary to take baby aspirin during induction of ovulation in PCOS patients?

This decision is left for your doctor, but there is some studies that confirm that using baby aspirin will reduce pregnancy complications.

- Is there a relationship between PCOS and endometriosis?

It is unknown, but if both diseases coincide with each other; there may be a genetic cause.

- What is the surgical treatment for PCOS?

There are two types of surgery:

1- Partial oopherectomy, which is an old method done through an abdominal incision, it may lead to adhesions, and by that may lead to infertility.

2- Laparoscopic ovarian drilling, which is done using a laparoscope, and the success rate 50-70%, but it may be only 25%, according to the surgeon skill.

- What is hyper-prolactinemia, and what is its treatment?

It is the increase of prolactin level in blood, which may lead to production of milk from the breast or irregularity of menses, it is rarely due to pituitary tumors, which is diagnosed by doing pituitary magnetic resonance ionization, if it is positive you may be advised to underwent resection of the tumor, but if MRI is negative there is a medical therapy.

- Does the risk of abortion increase in cases of PCOS?

The incidence of abortion is increased up to 45% in PCOS patients for unknown reason, but there are some opinions that this is related to high LH level, others say that it may be due to high level of insulin which affects embryo implantation, and fetal development.

- Does metformin reduce the risk of abortion?

Yes, especially if it is used during the first 3 months in patients with recurrent abortion.

- Does PCOS patient have a risk of developing diabetes mellitus later in life?

Yes, there is a higher risk for developing diabetes.

- Is there a hope for permanent cure for PCOS once pregnancy occurs?

No, definitive cure for Polycystic Ovary Syndrome, but there may be hormonal changes which leads to regularity of the cycle.

- What are the drugs used for treatment of PCOS?

1- Oral contraceptive pills used to regulate the cycle.

2- Anti-androgenic drugs.

3- Acne treatment drugs.

- What are the ways used to induce menstruation?

Oral contraceptive pills could be used, but some patient refuse these drugs, so they may use oral progesterone.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist