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What Fertility Treatment is Best for PCOS?

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Women with polycystic ovary syndrome (PCOS) often struggle with fertility for several reasons. Eggs may not be released naturally which leads to irregular periods. There may be high levels of the hormone androgen, a male sex hormone that’s present in females in small amounts. Or, small fluid-filled sacs may form in the ovaries known as cysts, which can affect the way the ovaries work.
The experts at the Center for Reproductive Health help women manage disorders of the reproductive system including PCOS so that they can work toward attaining optimal reproductive health. So, what fertility treatment is best for PCOS?

Lifestyle Changes

Some, but not all, women with PCOS also struggle with obesity. One of the first forms of treatment for PCOS is to work on making lifestyle changes that can benefit overall health such as choosing healthy foods, watching portion sizes, and including regular physical activity in the daily routine.
If you have PCOS, your doctor may ask you to try losing weight before putting you on any type of medication. Losing as little as 5 percent of your body weight over the course of six months can lower glucose levels and sometimes helps to stimulate ovulation.

Medications

Your doctor may prescribe medications that can help ovaries to release eggs naturally. Examples of these medications include:
Clomiphene. This is the most frequently prescribed medication to treat infertility in women with PCOS. However, taking this medication increases the risk of getting pregnant with multiples.
Metformin. This medication is used to treat insulin resistance and diabetes, and it may help to stimulate ovulation when used by itself or together with Clomiphene.
Letrozole. This medication stimulates the production of follicle-stimulating hormone (FSH), which is a hormone the body needs for ovulation. It targets the underlying hormone imbalance in PCOS.
Another option your doctor may suggest for stimulating ovulation is treatment with gonadotrophins, which are hormones such as FSH given by injection. This form of treatment has to be closely monitored and can be costly. If other medications aren’t working, your doctor may recommend a shot of gonadotropins combined with oral medication such as Clomiphene.

In Vitro Fertilization

If other methods of treating fertility in women with PCOS are unsuccessful, in vitro fertilization (IVF) is another option. Injectable fertility drugs are used to stimulate the ovaries into producing mature eggs. Eggs are retrieved and combined with sperm in Petri dishes. After three to five days, one or two fertilized eggs are implanted into the uterus. After two weeks, a pregnancy test is done to see if the treatment was successful.
Another option is called mini IVF which has a low cost and minimal risk. In this treatment method, ovaries are minimally stimulated and immature eggs are retrieved in a minor surgical procedure and allowed to mature in a lab environment. The goal is to create only a few high-quality embryos for transfer to the uterus.

At the Center for Reproductive Health, our caring and compassionate team works with you to find the best fertility treatment for each individual, including those with PCOS. Contact us today to schedule a consultation.

See Dr. Mor’s Publications

Eliran Mor, MD

Reproductive Endocrinologist located in Encino, Santa Monica, Valencia & West Hollywood, CA
Reproductive Endocrinologist located in Encino, Valencia & West Hollywood, CA Doctor Mor received his medical degree from Tel Aviv University-Sackler School of Medicine in Israel. He completed a four-year residency in Obstetrics and Gynecology at New York Methodist Hospital in Brooklyn, New York. Subsequently, Dr. Mor completed a three-year fellowship in Reproductive Endocrinology and Infertility […]
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FAQ

What does a reproductive endocrinologist and infertility specialist do?

Reproductive endocrinology and Infertility is a sub-specialty of Obstetrics and Gynecology. In addition to managing medical and surgical treatment of disorders of the female reproductive tract, reproductive endocrinologist and infertility (REI) specialists undergo additional years of training to provide fertility treatments using assisted reproductive technology (ART) such as in vitro fertilization.

Reproductive endocrinologists receive board certification by the American Board of Obstetrics and Gynecology in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.

When should I see an REI specialist?

In general, patients should consider consulting with an REI specialist after one year of trying unsuccessfully to achieve pregnancy. The chance of conceiving every month is around 20%, therefore after a full year of trying approximately 15% of couples will still not have achieved a pregnancy.

However, if a woman is over the age of 35 it would be reasonable to see a fertility specialist earlier, typically after 6 months of trying.

Other candidates to seek earlier treatment are women who have irregular menses, endometriosis, fibroids, polycystic ovary syndrome (PCOS), women who have had 2 or more miscarriages, or problems with the fallopian tubes (prior ectopic pregnancy).

What are the reasons we are having trouble conceiving?

Approximately 1/3 of the time cause for infertility is a female factor, 1/3 of the time a male factor, and the remaining 1/3 a couples’ factor.

At CCRH, we emphasize the importance of establishing a correct diagnosis. Both partners undergo a comprehensive evaluation including a medical history and physical exam.

Furthremore, the woman’s ovarian reserve is assessed with a pelvic ultrasound and a hormonal profile. A hysterosalpingogram (HSG) will confirm fallopian tube patency and the uterine cavity is free of intracavitary lesions. A semen analysis is also obtained to evaluate for concentration, motility, and morphology of the sperm.

Additional work up is then individualized to direct the best possible treatment option for each couple.

What is IVF? What is the process like?

In vitro fertilization (IVF) is the process that involves fertilization of an egg outside of a woman’s body.

The process starts with fertility drugs prescribed to help stimulate egg development. In your natural cycle, your body is only able to grow one dominant egg, but with stimulation medication we can recruit multiple eggs to continue to grow. After about 8-10 days of stimulation, the eggs are surgically retrieved and then fertilized with sperm in a specialized laboratory. Fertilized eggs are then cultured under a strictly controlled environment within specialized incubators in the IVF laboratory for 3-5 days while they develop as embryos. Finally, embryos (or an embryo) are transferred into the uterine cavity for implantation.

Should I have IVF?

Before deciding if IVF is the right choice, it’s important to sit down with an REI specialist to discuss available treatment options. For some people, other methods such as fertility drugs, intrauterine insemination (IUI) may be the best first choice treatment. At CCRH, we believe each individual couple is unique and not everyone needs IVF.

Is the IVF procedure painful?

While not painful, the fertility medications may some side effects including headaches, hot flashes, mood swings, and bloating. The injection sites may also bruise.

Will IVF guarantee a baby?

Unfortunately, no. Many people think once they start IVF it’s a matter of time that they will be pregnant and have a baby. But according to national statistics per the Society of Assisted Reproduction (SART), on average 40% of assisted reproduction cycles achieve live births in women under age 35. The chances of success then continue to decrease with advancing age.

At CCRH, we employ only evidence-based interventions to ensure patient safety and optimal outcome. While we cannot guarantee a baby, we guarantee that you will receive the best, most advanced, personalized care to help you maximize your chance of a baby.

What is the success rate for IVF?

The average IVF success rate (success measured in live birth rate) using one’s own eggs begins to drop around age 35 and then rapidly after age 40. This is due to the decline in egg quantity and egg quality as a woman ages.

Our clinic’s success rate consistently beats the national average year after year.

Do insurance plans cover infertility treatment? How much does IVF cost?

Individual insurance plans often do not have any coverage for infertility treatments. If you have a group plan, you can call members services to see if they have coverage for infertility (including consultation/workup and IVF).

After your consultation with our REI specialist, one of our dedicated account managers with sit with you to go over the cost of treatment.

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