Polycystic ovary syndrome is an endocrine disorder seen in 5-15% of women of reproductive age. Although this disease can have metabolic consequences such as insulin resistance and a predisposition to diabetes, it generally leads to menstrual irregularities, increased hair growth, and infertility issues. The frequency of infertility in women with polycystic ovary syndrome is reported to be as high as 70-80%.
Why Does Infertility Occur in Women with Polycystic Ovary Disease?
Ovulation problems frequently occur in these women. Ovulation may occur late in some months and not at all in others. Therefore, in women with irregular ovulation, periods also become irregular, and weight gain and increased hair growth may accompany this. Irregular ovulation also causes infertility or delay in pregnancy.
Evaluation of hormones is also important in women with polycystic ovary disease. Occasionally, abnormalities in the milk hormone called prolactin and in thyroid hormones are observed. It is also important to evaluate insulin resistance and liver tests. When a problem related to insulin and sugar metabolism is detected, lifestyle changes, namely diet and exercise, must be implemented. With the use of certain medications such as metformin, periods may become regular and spontaneous pregnancies may occur.
Overweight polycystic ovary patients should primarily be put on an exercise program, quit smoking, and try to lose 5-10% of their weight within 6 months. In the pregnancies of overweight polycystic ovary patients, the rate of anomalies increases, the likelihood of diabetes and hypertension appearing during pregnancy increases, and the risk of miscarriage and premature birth is higher. For this reason, the probability of problems occurring during pregnancy decreases when pregnancy occurs after weight loss.
When a woman with polycystic ovary disease gets married and does not conceive within 6 months despite regular sexual intercourse (intercourse 2-3 times a week), a uterine film (HSG) and semen analysis (spermiogram) should be performed before deciding on the type of treatment. On the other hand, it is not essential to evaluate the permeability of the tubes before using ovary-stimulating drugs such as clomiphene citrate. However, when there is no response to this medication, it will be necessary to evaluate the tubes and see a uterine film before moving on to other treatment methods, such as stimulating the ovaries with injections.
In a woman with polycystic ovary disease, the treatment method should be decided after considering age, the presence of other causes of infertility, previous treatments, and the couple’s level of anxiety. The ovaries can be stimulated with pills such as clomiphene citrate or together with metformin or letrozole; when there is no response, ovarian stimulation with injections can be started, and as a last resort, IVF (In Vitro Fertilization) treatment can be applied. Of course, the social and psychological status of the couple is also an important factor in determining the treatment processes; this treatment sequence may not be the same for every couple, and some treatment stages may be shortened or skipped for couples with high anxiety levels.
We can say that women with polycystic ovary disease are a “good patient group” in terms of infertility treatments; the probability of pregnancy is high. However, they should be monitored carefully as there may be an excessive ovarian response during the egg stimulation phase.
