This month we are focusing on Polycystic Ovaries Syndrome (PCOS) and to get the lowdown on the condition we spoke to the brilliant Nikos Christoforidis MD, FRCOG, DFFP, the scientific and clinical director of Embryolab from Embryolab, in Greece.
PCOS is a common hormone problem that can affect fertility and make it more difficult to have a baby. As many as 25 per cent of women of childbearing age have PCOS, but most don’t even know that they have it until they begin trying to get pregnant.
The term ‘polycystic ovaries’ describes the appearance of the ovaries on an ultrasound scan – they contain many small follicles (perhaps ten or more) and the dominant follicle does not develop as easily. Many of the small follicles produce differing levels of hormones.
Dr Christoforidis said: “In Embryolab, women diagnosed with polycystic ovarian syndrome are being assessed and managed according to the International Evidence-Based Guideline published in 2018, very important work provided by health professionals and consumers internationally. We are all aligned to improve lives of women with the polycystic ovarian syndrome worldwide and to ensure high quality of services in fertility assessment and treatment.”
Does the diagnosis of PCOS mean I will need to undergo IVF in order to get pregnant?
No. A lot of women are diagnosed with PCOS but most of them do get pregnant spontaneously. Having a regular cycle – albeit sometimes long, maintaining a normal body weight and exercising regularly will help them avoid unnecessary interventions while they are trying for a pregnancy. Women that more often require assistance are the ones with anovulation, ie the ones who do not see a period unless taking medication. Even within this population, weight loss and exercise may promote fertility. In any case if a couple tries for a year without success then they need to seek expert advice as there may be other issues involved.
What are the side effects and complications I might expect, if I have PCOS?
A woman with PCOS undergoing IVF treatment may encounter ovarian hyperstimulation syndrome (OHSS). It has different degrees of severity, starting from mild bloating and small amount of fluid in the abdomen- very usual and sometimes necessary in an IVF setting, to – very rare – severe reaction and dangerous for the patient requiring hospital stay. Nowadays the different medications that we use and the evolution on cryopreservation techniques give us the opportunity to avoid completely severe complications by freezing all embryos and postponing embryo transfer, thus allowing us to have OHSS-free clinics.
What is the effect of PCOS in IVF?
When PCOS leads to infertility it can be due to anovulation, which can easily be solved with ovarian stimulation, but it can also imply other problems, such as immature oocytes.
Oocyte maturity cannot be measured with some test prior to IVF nor does it mean that all patients with PCOS will have such an issue. It remains to be seen at the time of the egg retrieval. This maturation process may affect most but not all of their oocytes, so, through the stimulation protocols and drugs that we use in IVF, we try to change the maturity rate and get as many mature oocytes as possible for fertilisation, in order to increase their success rate.