Infertility is one of the most common conditions in women with polycystic ovary syndrome. Menstrual irregularity, hair growth, acne, excess weight, and infertility are the most frequent complaints. This disease is seen in nearly one-fifth of women who want to have children.
How is Infertility Treatment Performed in Women with Polycystic Ovary Syndrome?
1- Regular Exercise
We generally see polycystic ovary syndrome in young, overweight women who have irregular periods and hair growth problems. Our first recommendation for infertility treatment in women with polycystic ovary syndrome is to ensure weight loss and suggest exercise. Sometimes insulin resistance may also be present, making it difficult to lose weight. In this case, the way to break this vicious cycle is through exercise. With a diet low in carbohydrates and high in fiber along with exercise, periods can even become regular spontaneously without medication.
2- Medical Treatment for Insulin Resistance
In PCOS patients where we detect insulin resistance, periods may become regular with medications containing metformin. It is necessary to use these drugs for at least 6 months. There may be elevations in TSH (thyroid gland hormone) or prolactin (milk hormone); when we correct these with medication, spontaneous pregnancies occur.
3- Hysteroscopy Endoscopic Treatment
In women with PCOS who want children, we first need to resolve any problems detected during gynecological examination and ultrasonography. For example, if there is a polyp in the uterus, it must be removed using the endoscopic method we call hysteroscopy. It is appropriate to reveal hormonal problems with blood tests and perform a glucose tolerance test if there is a family history of diabetes. During this period, a semen analysis should be performed to understand if there is a sperm problem in the spouse. Subsequently, a uterine film (HSG) is recommended to reveal if there is a blockage in the tubes.
4- Smoking Should Not Be Used
After this basic evaluation, causes of infertility other than PCOS will be revealed. When a problem is detected, it must first be corrected. Additionally, if there is smoking in both the man and the woman, it is recommended to quit. Smoking negatively affects egg and sperm quality.
If there is no problem in the sperm analysis and the tubes are open, the first step of treatment for PCOS patients to have children is ovulation tracking and timed intercourse recommendation. Since there is an ovulation problem in these patients, egg development from the ovaries is stimulated in a controlled manner with pills or injections during ovulation tracking. After this process, which starts with the period and lasts 10-15 days in total, intercourse is recommended. Follow-up in this manner can be continued for 3-6 months. If pregnancy does not occur or if the woman experiences intense negative psychological feelings, the next stage, vaccination (insemination), can be started.
5- Infertility Treatment
Infertility treatment in women with polycystic ovary syndrome again begins with the period and lasts two weeks. In this process, egg development is ensured from the ovaries with injections, and when the mature egg develops, the sperm taken from the spouse’s semen is prepared in the laboratory and placed into the uterus. Insemination treatment can be applied 2-3 times in this way.
6- IVF Treatment
If results cannot be obtained with infertility treatment—namely insemination—in women with polycystic ovary syndrome, or if the duration of marriage is longer than 5 years, switching to IVF treatment is recommended. The stage of egg development is very important in the IVF treatment of PCOS cases; overstimulation (OHSS) can occur, and in this case, patients may experience fluid accumulation in the abdomen, shortness of breath, respiratory distress, and may need to be hospitalized. It would be best for the IVF treatments of these patients to be closely monitored and followed by an experienced physician.
PCOS patients are a group in which we achieve high rates of pregnancy. When we look at the total, the probability of achieving pregnancy with treatments reaches 80% in these patients. Losing weight before becoming pregnant in PCOS patients ensures that the pregnancies obtained continue healthily and prevents problems such as high blood pressure and gestational diabetes.
In summary, PCOS is a disease that proceeds with ovulation problems. When women with PCOS want a child, it is appropriate to evaluate the husband’s sperm values and the woman’s tubes and hormones, and to plan assisted reproductive treatment according to these results.
