The best fertility treatment for PCOS

Polycystic ovarian syndrome – or PCOS as it is most commonly known – is not only a chronic medical condition that severely negatively impacts the quality of a woman’s life, it is also a known cause of infertility because PCOS affects ovulation.

While there is no known cure for PCOS, it can be medically well managed over the long term, and there are even treatments that will help you to fall pregnant even though you have PCOS. In this article we look at the PCOS treatments best suited to women who are trying to conceive.

PCOS – which is short for polycystic ovarian syndrome – is actually an endocrine disease of the ovaries.

The symptoms of PCOS includes skin problems, weight issues and associated health problems, as well as problems with ovulation, all of which can severely affect a women’s quality of life.

Infertility in women is also a common symptom of PCOS for two reasons. The first reason is that PCOS causes problems with ovulation – which can range from no menstruation at all to irregular menstruation or very prolonged, heavy and painful menstruation. The second reason is that PCOS is also known to cause recurrent miscarriages.

General treatments for PCOS

Since there is no known cure, PCOS is a chronic medical condition that can be managed like other chronic conditions such as diabetes or asthma.

The cornerstone of treatment for all those with PCOS – whether trying to conceive or not – is weight loss, along with managing cholesterol and insulin levels. Further intervention, perhaps in the form of medication, may be required where a woman is experiencing prolonged and painful periods.

There are different options for treating irregular periods and the right option will depend on whether or not you are trying to fall pregnant. For those who are not trying to fall pregnant, contraceptive pills, Provera, or a Mirena are among the first line treatment options.

PCOS treatments that help with ovulation

For those who are trying to conceive, ovulation is the main issue to address.

PCOS treatment options that will also help you ovulate include specific medications available in tablet form, such as Femara and Clomid or Fertomid, medically known as Clomiphene citrate. Metformin tablets may also be used, and there are also injections available which might be prescribed with tablets or on its own. Beyond these treatments, egg donation, artificial insemination, and IVF are examples of further treatment options.

Medications for ovulation

The tablets that are commonly prescribed for ovulation include Letrozole, which is commonly known by its trade name Femara. It blocks enzymes that trigger the conversion of testosterone into estrogen, instead triggering the production of follicle stimulating hormone (FSH), which instructs the follicles (egg sacks containing individual eggs) to grow and get ready to ovulate. Femara is more likely to stimulate the growth of one, instead of multiple, follicles and has few side effects.

Clomiphene citrate, better known as Clomid or Fertomid could be an alternative. It blocks estrogen receptors, so more follicle stimulating hormone (FSH) is produced, stimulating more follicles to grow eggs. This medication causes more follicles grow, and some women also experience side effects such as hot flushes, headaches and moodiness.

Metformin, which is usually used to manage insulin levels, may also be prescribed to help with ovulation if you have PCOS.

Whichever medication is prescribed by a fertility specialist, it must be taken during a specific time during a menstrual cycle – generally for five days from day 3 of a cycle. An ultrasound 7 or 8 days later is crucial to monitor how many follicles have developed.

If a suitable number of follicles have developed well, the fertility specialist will provide further medication to trigger ovulation around 36 hours later. Having intercourse or artificial insemination at the time of ovulation significantly increases the chances of falling pregnant.

Where a patient does not respond well to the medication, a fertility specialist may suggest waiting a few more days or a new strategy such as injections or a new cycle with only injections.

Because this option entails self-administered injections and is more expensive, injections are usually only used if the medication did not achieve the desired results. It must be said, however, that the self-administered injections are designed to allow the patient to set the dose and has a tiny needle that is not painful.

With the injection option, the treatment should start off at a low dose. Patients inject themselves every day for a few days, and the fertility specialist will also administer injections before beginning the scans. These injections are very effective and might result in five or six growing follicles, creating a high risk of having a multiple pregnancy that comes with a much higher possibility of miscarriage and preterm babies.

How effective is PCOS treatment for fertility?

Because women respond differently to the medications and injections, it is crucial to rely on the expertise and experience of a qualified fertility specialist if you have PCOS and are taking medications to improve your chances of falling pregnant. This is because the effect of the tablets and/or injections must be monitored closely to ensure there is an adequate response and that this response is safe, and to provide further treatment options if the response is not as desired.

Some women may not respond to a certain medication at all, or may simply take longer to respond than others. Some women may respond immediately and grow a healthy egg or two in the same cycle, ready to ovulate. Other may over-respond to the treatment, ovulating multiple follicles that could result in a multiple pregnancy. The risk of hyperstimulation – when the ovaries make too many follicles – must also be closely monitored.

Only a fertility specialist will be able to advise if a different type of medication can be tried, if a patient is not getting a good response from the medication. If a patient is getting an excessive response, and are at risk of having multiple pregnancies, a different treatment plan may be required.

Further treatment options

These medical treatments are very effective to address ovulation as a crucial aspect of achieving a natural pregnancy. However, even with healthy ovulation, pregnancy is not guaranteed.

It is also important to remember that PCOS may not be the only fertility issue you may have as a couple. In as many as a third of fertility cases, there are more than one contributing factor.

As such, your fertility specialist will also check for other potential problems such as sperm quality, endometriosis or blocked fallopian tubes, among many other possible contributing factors. Fortunately, all of these can be addressed through the range of fertility treatments available today.

Where to get the best fertility treatment for PCOS?

If you suspect that you have PCOS, and especially if you are trying to fall pregnant, we would like to invite you to come and meet one of our specialists by clicking here

We offer all these latest and most effective fertility treatments at Cape Fertility, and we believe in making quality fertility treatment affordable, while always striving for higher success rates.

At Cape Fertility, we value each individual patient and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises in the beautiful city of Cape Town.