What is Polycystic Ovary Syndrome? Pregnancy Treatment

"Polycystic Ovary Syndrome" (PCOS), especially common in women who are overweight, can make it difficult to conceive, but it is not an insurmountable barrier.

Women experiencing this issue also have the opportunity to become mothers through in vitro fertilization (IVF) treatment.

Symptoms of Polycystic Ovary Syndrome

Hair Loss
Acne
Hirsutism
Irregular Menstrual Cycle
Pelvic Pain
Infertility
Weight Gain
High Testosterone Levels

Polycystic Ovary Syndrome is a hormonal disorder characterized by an excess accumulation of immature eggs in the ovaries. It is not a disease but a congenital condition. The underlying issue is insulin resistance, which places overweight women in the high-risk group for PCOS. Polycystic Ovary Syndrome is seen in 30-40% of women wishing to conceive and brings along issues such as lack of healthy ovulation, irregular periods, hirsutism, and infertility.

The treatment approaches vary according to the symptoms caused by the condition. For example, if a patient complains of hirsutism, an appropriate treatment is applied; if they wish to conceive, another treatment method is introduced. In this article, we will discuss what steps are taken to achieve healthy ovulation in cases of infertility caused by polycystic ovary syndrome, specifically the path followed for IVF treatment. Anadolu Health Center’s Gynecology and Obstetrics Specialist and IVF Center Director, Assoc. Prof. Dr. Tayfun Kutlu, along with Gynecology and Obstetrics Specialist Op. Dr. Ebru Öztürk Öksüz, explain how women with polycystic ovary syndrome can enhance their chances of motherhood through IVF treatment.

How is the Diagnosis Made?

In diagnosing Polycystic Ovary Syndrome (PCOS), the first step is an ultrasound assessment to check the number of eggs in the ovaries (it is expected that there are more than 12 eggs for a polycystic ovary appearance). Some hormone tests are also conducted, and the patient's insulin resistance is evaluated. Additionally, the patient's medical history, menstrual regularity, and complaints are reviewed, and a physical examination is performed to assess the degree of hirsutism

First Step: Diet and Exercise

For all the complaints associated with Polycystic Ovary Syndrome, the first approach in treatment is to implement a diet and exercise plan to help lose excess weight. This lifestyle change not only helps the patient achieve their ideal weight but also reduces hirsutism.

The Goal of Medication Treatment: To Induce Ovulation

Before progressing to in vitro fertilization (IVF), it should be noted that there is a two-step treatment process. After the patient reaches their ideal weight, the first step begins with a medication treatment aimed at promoting egg production, typically planned in three cycles. Medications that reduce the patient's insulin resistance may also be added at this stage. If ovulation occurs after treatment, the patient has a chance of conceiving even through natural intercourse. However, if ovulation is not achieved, the second step of treatment is initiated, which involves injections and insemination treatments.

Injection and Insemination Treatments

Injection therapy is administered to promote the development of higher-quality eggs, allowing for the maturation and release of one or more eggs. Following this treatment, during the insemination phase, sperm collected from the male is concentrated in a laboratory setting to ensure higher quality, and then it is placed as close to the time of ovulation as possible for optimal fertilization. Injection and insemination treatments can also be applied in three cycles. It should be emphasized that in these stages, the primary competitor to treatment success is the "age" criterion. Moreover, if the patient's medical history includes additional risk factors related to having children (such as advanced age, surgical history, or blocked tubes), some of the aforementioned steps may be skipped to proceed directly to a higher stage. For instance, if the patient's age is over 35, the likelihood of success in medication, injection, and insemination treatments is very low, so they can proceed directly to IVF treatment. In such patients, success rates in IVF are generally higher compared to earlier treatment stages

Multiple Attempts with IVF!

IVF treatment is a method that allows for the development of multiple eggs, thus providing multiple chances for success. In this treatment, ovarian stimulation can be achieved with relatively lower doses of medication, and the harvested eggs are collected. However, if the number of eggs in patients with polycystic ovary syndrome exceeds expectations, certain risks can arise. One of these is that an excessive number of eggs may reduce the chances of the resulting embryos implanting in the uterus. Another risk is ovarian hyperstimulation. However, there are ways to mitigate these risks.

Rather than fresh transfer, the harvested eggs can be frozen at their optimal stage and stored until the next menstrual cycle, allowing the uterus and body to rest. This also provides time for hormonal balances to return to normal physiological levels. With this uterine rest technique, the patient’s chances of pregnancy are increased.

Despite all this, if pregnancy does not occur in the first attempt, new attempts can be made with previously harvested and unused embryos (which can be stored for up to 5-10 years). In this regard, it should be reiterated that IVF is a method that gives women multiple chances.

Is IVF Pregnancy Challenging?

The first few months are crucial.

For patients with Polycystic Ovary Syndrome, the first months of IVF pregnancy are extremely important, as they have a slightly higher risk of miscarriage compared to other patient groups, particularly due to hormonal imbalances.

Possible Risks and Accurate Information
Since insulin resistance is at the core of Polycystic Ovary Syndrome, pregnancy-related diabetes, hypertension, and early pregnancy losses are also more frequently observed in these patients. Therefore, it is essential that patients are accurately informed about all risks and the treatment process.