Medicine to help get pregnant with pcos

Contents

Treatment


Polycystic ovary syndrome

Medications

A number of medications are available to treat different symptoms associated with PCOS.

These are described below.

Irregular or absent periods

The contraceptive pill may be recommended to induce regular periods, or periods may be induced using an intermittent course of progestogen tablets (which are usually given every 3 to 4 months, but can be given monthly).

This will also reduce the long-term risk of developing cancer of the womb lining (endometrial cancer) associated with not having regular periods.

Other hormonal methods of contraception, such as an intrauterine system (IUS), will also reduce this risk by keeping the womb lining thin, but they may not cause periods.

Fertility problems

With treatment, most women with PCOS are able to get pregnant.

The majority of women can be successfully treated with a short course of tablets taken at the beginning of each cycle for several cycles.

If these are not successful, you may be offered injections or IVF treatment. There’s an increased risk of a multiple pregnancy (rarely more than twins) with these treatments.

A medication called clomifene is usually the first treatment recommended for women with PCOS who are trying to get pregnant.

Clomifene encourages the monthly release of an egg from the ovaries (ovulation).

If clomifene is unsuccessful in encouraging ovulation, another medication called metformin may be recommended.

Metformin is often used to treat type 2 diabetes, but it can also lower insulin and blood sugar levels in women with PCOS.

As well as stimulating ovulation, encouraging regular monthly periods and lowering the risk of miscarriage, metformin can also have other long-term health benefits, such as lowering high cholesterol levels and reducing the risk of heart disease.

Metformin is not licensed for treating PCOS in the UK, but because many women with PCOS have insulin resistance, it can be used “off-label” in certain circumstances to encourage fertility and control the symptoms of PCOS.

Possible side effects of metformin include nausea, vomiting, stomach pain, diarrhoea and loss of appetite.

As metformin can stimulate fertility, if you’re considering using it for PCOS and not trying to get pregnant, make sure you use suitable contraception if you’re sexually active.

The National Institute for Health and Care and Excellence (NICE) has more information about the use of metformin for treating PCOS in women who are not trying to get pregnant, including a summary of the possible benefits and harms.

Letrozole is sometimes used to stimulate ovulation instead of clomifene. This medication can also be used for treating breast cancer.

Use of letrozole for fertility treatment is “off-label”. This means that the medication’s manufacturer has not applied for a licence for it to be used to treat PCOS.

In other words, although letrozole is licensed for treating breast cancer, it does not have a license for treating PCOS.

Doctors sometimes use an unlicensed medication if they think it’s likely to be effective and the benefits of treatment outweigh any associated risks.

Find out more about unlicensed and off-label use of medications

If you’re unable to get pregnant despite taking oral medications, a different type of medication called gonadotrophins may be recommended.

These are given by injection. There’s a higher risk that they may overstimulate your ovaries and lead to multiple pregnancies.

Unwanted hair growth and hair loss

Medications to control excessive hair growth (hirsutism) and hair loss (alopecia) include:

  • particular types of combined oral contraceptive tablets (such as co-cyprindiol, Dianette, Marvelon and Yasmin)
  • cyproterone acetate
  • spironolactone
  • flutamide
  • finasteride

These medications work by blocking the effects of “male hormones”, such as testosterone, and some also suppress production of these hormones by the ovaries.

A cream called eflornithine can also be used to slow down the growth of unwanted facial hair.

This cream does not remove hair or cure unwanted facial hair, so you may wish to use it alongside a hair removal product.

Improvement may be seen 4 to 8 weeks after treatment with this medication.

But eflornithine cream is not always available on the NHS because some local NHS authorities have decided it’s not effective enough to justify NHS prescription.

If you have unwanted hair growth, you may also want to remove the excess hair by using methods such as plucking, shaving, threading, creams or laser removal.

Laser removal of facial hair may be available on the NHS in some parts of the UK.

Other symptoms

Medications can also be used to treat some of the other problems associated with PCOS, including:

  • weight-loss medication, such as orlistat, if you’re overweight
  • cholesterol-lowering medication (statins) if you have high levels of cholesterol in your blood
  • acne treatments

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS, short for polycystic ovarian syndrome, is a common condition related to hormones in which the ovaries don’t always release an egg at the end of the menstrual cycle (the start of a period to the start of the next one). It can lead to difficulty getting pregnant.

It is thought to be very common, affecting about 1 in every 5 women in the UK.

If you have polycystic ovaries (PCO):

  • Your ovaries are slightly larger than normal
  • you have many more follicles (the fluid-filled pockets on the ovaries that release the eggs when you ovulate)

Having polycystic ovaries does not mean that you have PCOS. PCO means your ovaries are slightly different from most women’s ovaries, while PCOS is disorder linked to having hormone levels that are not balanced.

Symptoms of PCOS

Having PCO does not mean that you have PCOS. To be diagnosed as having PCOS you would have PCO and some of the following symptoms:

  • irregular periods or none
  • more facial or body hair
  • less hair on the head
  • difficulty losing weight or rapid weight gain
  • acne or oily skin
  • difficulty becoming pregnant

Periods are ‘irregular’ if the length of your cycle (the gap between your periods starting) keeps changing. The average menstrual cycle lasts 28 days, although it’s normal for it to be a bit shorter or longer than this.

You may have some of these symptoms of PCOS but they vary from woman to woman, with some women having milder symptoms and others more severe.

What are the causes of PCOS?

The exact cause of PCOS is not known but it may be genetic as you are more likely to have it if any of your relatives (mother, aunts, sisters) have it.

The symptoms of PCOS are linked to hormones:

  • Women with PCOS have slightly higher than normal levels of testosterone – this is linked to many of the symptoms, such as more facial hair.
  • If you have PCOS, your body may not respond to insulin (this is known as insulin resistance), so the level of glucose is higher in your body. High levels of insulin can lead to weight gain and fertility problems. If you are diagnosed with PCOS, you are at increased risk of developing diabetes in later life

Do I have PCOS?

Women who have mild symptoms often only realise they have PCOS when they start trying for a baby, particularly if their weight goes up and down.

Using the combined oral contraceptive (‘the pill’) can stop you noticing you have PCOS because:

  • many of them have a pill-free 7 days every month and a withdrawal bleed, which can be mistaken for a period (It is not a true period as it is unrelated to egg production or thickening of the lining of the womb).
  • women cannot tell whether their period is regular or not.
  • the pill has hormones that can help the symptoms of PCOS. It can improve acne and lessen excess hair growth. (It is a standard treatment for PCOS when women are not seeking to get pregnant.)

A diagnosis of PCOS is made when you have any two of the following:

  • irregular periods or none
  • a transvaginal scan (in which a wand is put inside your vagina) showing polycystic ovaries
  • an increase in facial or body hair or test results showing you have excess levels of testosterone.

If you think you have PCOS visit a GP to get a referral to a gynaecologist.

How does normal ovulation work?

In a normal menstrual cycle with ovulation a number of eggs mature in follicles in your ovaries. The ripest egg is released into one of your fallopian tubes, where it meets the sperm if there is any.

If you have PCOS although the polycystic ovaries contain follicles with eggs in them, the follicles do not develop and mature properly – so there is no ovulation or release of eggs. This is called anovulation.

Many women do not find out they have PCOS until they try to conceive, particularly if they were using contraception that uses hormones, which masks irregular or no periods, because it allows for a monthly bleed.

“Since my diagnosis and journey to conceive began, I have found out so many other women I know have it and have also had problems conceiving. I think a lot of us had the symptoms when we were teenagers but went on the pill which masked the condition for years.”

PCOS sufferer

What is the treatment for PCOS if you are trying to conceive?

There is no treatment for PCOS in itself but the symptoms can be treated. If you have a BMI of over 30, you will be advised to lose weight with healthy eating and exercise. This alone may get your body ovulating. Even if it does not do this, it will allow your medication to work better, and will cut down on risks during pregnancy.

There are a number of different medicines that help with conceiving with PCOS

  • clomifene citrate (the best known brand in the UK is Clomid) – this stimulates your ovaries to release eggs
  • metformin is used to correct insulin resistance, which may also be present with PCOS
  • a combination of the above.

If you are taking clomifene citrate tablets:

  • you will have a transvaginal scan in the first cycle of treatment to check whether it is the correct dose for you. The scan will look at your follicles to see how they are developing.
  • you will not be given it for more than six months as it increases your risk of ovarian cancer.

If clomifene citrate doesn’t work then you may be offered:

  • gonadotrophins (a fertility drug that is based on the gonadotrophin hormones, which stimulate your ovaries to produce and ripen eggs). These are more likely to overstimulate your ovaries and cause a multiple pregnancy but you will have regular scans to check on developing follicles.
  • surgery using a technique called laparoscopic ovarian drilling (LOD). This kills the tissue on the ovaries that is produces the testosterone.
  • IVF – in which the egg is retrieved, fertilised outside the body and transferred into the uterus.

Read more about treatment for infertility.

What are my chances of conceiving with PCOS?

Although it is difficult to give statistics as cases vary so much and different treatments have different success rates, most women with PCOS will be able to have a baby with fertility treatment. For women who are under 35, this is even more the case.

Mental health and PCOS

Finding out that you are having fertility issues can be a real shock, and feelings of guilt and failure are not uncommon. However, if you can, think of it as a medical problem that is treatable alongside most other conditions, and not a reflection on you as a woman. Many, many couples use fertility treatment to conceive and the inconvenient start is long forgotten in later years.

For some couples, working through different treatments works is a long, complicated and anxious process, especially if it is combined with having to take time off from an unsympathetic workplace. Try to support each other as much as you can through the consultations, treatments and appointments.

‘When I got diagnosed I had to accept conceiving a baby was going to take time, I needed to be kind to and patient with my body but I would never give up hope that I would become pregnant. I invested time into getting my diet right, started a couch to 5k programme and de-stressed my life.’PCOS sufferer

PCOS and pregnancy

PCOS in pregnancy can increase the risk of pregnancy-induced hypertension, pre-eclampsia and preterm birth. All women should be screened for gestational diabetes by 20 weeks and any medication you are taking should be checked.

More support

A charity called Verity runs a special website with resources and support for women suffering with PCOS.

The Fertility Network UK has forums and support for those who are affected by infertility.

I have PCOS and I want to have a baby, what do I need to know?

health effectsto be aware of, including ovarian hyperstimulation syndrome. This is an over-response to the fertility drugs that are used to stimulate the ovaries to produce multiple eggs. This can lead to abdominal pain, nausea and vomiting, rapid weight gain and blood clots.

For more information

The Your Fertility website has more information on PCOS and fertility. The Centre for Research Excellence in Polycystic Ovary Syndrome has also produced a list of questions for women with PCOS to use in conversations with their healthcare provider and a fact sheet about PCOS, fertility and pregnancy.

While fertility problems are common among women with PCOS, it’s reassuring that, overall, women with PCOS and women without PCOS have similar numbers of children. And, although PCOS is associated with fertility difficulties, women with PCOS should also be aware conception is possible and effective contraception is needed to avoid pregnancy when it’s not wanted.

Explore further

Type 2 diabetes risk up with PCOS regardless of BMI Provided by The Conversation

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PCOS and Infertility – Symptoms and Treatment

PCOS and Fertility Treatment

For those women trying to conceive a pregnancy, the first step in treatment of PCOS is lifestyle modification, including a healthy diet and exercise. The diets shown to be most successful in PCOS patients include those with lower carbohydrates, a reduced glycemic load. Recommended exercise in PCOS patients is at least 30 minutes of moderate exercise three times per week, with daily exercise being the ultimate goal.

Women who still have infrequent ovulation despite lifestyle modifications may require fertility medications to assist with the release of an egg from the ovary. Typical initial therapy for patients with PCOS who do not ovulate and are trying to conceive includes administration of certain fertility medications. These agents are selective estrogen receptor modulators.

For some women with PCOS, fertility tablets do not result in ovulation or pregnancy, and they require fertility injections to release an egg. Fertility injections (Follistim®, Gonal-F®, Bravelle®, and Menopur®) contain the same hormone the brain releases to signal the ovary to produce eggs. Rather than producing one egg in a month, most women on fertility injections will produce two or more eggs. This treatment requires closer monitoring with transvaginal ultrasounds and several blood draws to determine the woman’s estradiol level, which is a hormone produced in the ovary. Fertility injections are also associated with an increased risk of multiple births.

In some instances, women with PCOS require in vitro fertilization (IVF) to achieve a healthy pregnancy. In this scenario, daily fertility injections are used to stimulate the ovaries to produce multiple eggs, which are harvested in a minor procedure. The eggs are fertilized in the lab and then a resulting embryo (fertilized egg) is transferred into the woman’s uterus. Additional embryos can be frozen (cryopreserved) for future use.

What are PCOS Health Risks?

As previously mentioned, insulin resistance can occur in women with PCOS. A simple blood test can determine if a person is insulin resistant. If the test indicates insulin resistance exists, women with PCOS may be treated with a medication called metformin (trade name Glucophage).

Hyperlipidemia, or elevated cholesterol and/or triglycerides, can occur in PCOS women, as well. Women can be screened for this condition with a fasting blood sample. Screening for hyperlipidemia is very important since this condition can lead to cardiovascular disease later in life.

Women with PCOS appear to be at increased risk for endometrial (uterine) cancer later in life due to persistently higher levels of circulating estrogens. Since menstrual periods do not occur regularly, overgrowth of the uterine lining can occur and in some cases can lead to a malignancy.

Women with PCOS also have an elevated risk of ovarian torsion (twisted ovary).

You might also be interested in: In Vitro Maturation Clinic Study for Women With PCOS.

Polycystic Ovary Syndrome (PCOS), Fertility and Pregnancy

PCOS — short for polycystic ovary syndrome — is one of the most common causes of female infertility. Because it affects as many as 5 million American women (or about 5 to 10 percent of women of childbearing age), there’s a good chance that you or someone you know has it. While this condition can make conceiving more challenging (and it raises the risk of certain pregnancy complications once you do conceive), women with PCOS deliver healthy babies every day. Here’s what you need to know to boost your odds of getting pregnant and having a healthy pregnancy.

What is Polycystic Ovary Syndrome (PCOS)?

Eggs grow in the ovaries inside tiny fluid-filled sacs called follicles. When an egg reaches maturation each month, the follicle containing it breaks open to release it (the ovulation process). PCOS interferes with ovulation. Women with PCOS produce higher-than-normal levels of the male hormone testosterone, and those high levels of male hormones get in the way of ovulation, causing women with PCOS to have irregular or absent periods and ovulation. These fluid-filled follicles don’t burst, and instead remain in the ovaries as cysts — thus the name poly (meaning many)-cystic ovary syndrome.

What causes PCOS?

While doctors are not sure about the precise causes of PCOS, the following factors have been linked to the condition:

  • Genetics. PCOS appears to run in families, so if your mom or close female relative has PCOS, your chances of also having it are higher.
  • Excess insulin. Researchers have found that women with PCOS tend to have high levels of insulin (the hormone that regulates how your body breaks down sugar) because their bodies have a hard time using it properly. Insulin also controls ovarian function, and too much insulin in the body can cause irregular or absent ovulation.
  • Being overweight or obese. While overweight women are at greater risk for PCOS and women with PCOS are at greater risk of becoming overweight, the jury is out on whether excess weight causes PCOS or vice versa. Even so, if you’re trying to conceive, it’s a good idea to start eating healthy foods and exercising.

What are the symptoms of PCOS?

An irregular period isn’t the only sign of PCOS (and an unpredictable cycle isn’t necessarily a sign that you have PCOS, either). You might also notice acne, excessive hair growth on the face or other parts of the body, thinning hair on the scalp (or male-pattern baldness), weight gain and occasionally prolonged vaginal bleeding. More than 1 in 2 women with PCOS also develops type 2 diabetes (insulin resistance) or pre-diabetes (impaired glucose tolerance) before the age of 40.

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Because many women who don’t have PCOS may also have these symptoms, you’ll want consult your doctor if you have irregular periods or suddenly develop any of the symptoms above. Your practitioner will consider whether you’ve had them in the past and look carefully at your family history. She’ll also examine areas of increased hair growth, conduct blood tests and perform a pelvic exam or ultrasound to check for ovarian cysts (though it’s totally possible to have PCOS but no cysts).

Treating PCOS

While PCOS can’t be cured, a healthy lifestyle can help manage your symptoms. Your practitioner can help determine the best treatment for you based on your medical history. A well-balanced diet that’s rich in complex carbs and low in refined carbs and sugar may help restore ovulation and regular periods in women with PCOS. Losing weight can also help treat PCOS. Studies suggest that losing even 5 to 10 percent of your weight can improve insulin levels, normalize your hormone levels and regulate your menstrual cycle. (Of course, more weight loss is better if you have more than 5 to 10 percent of your body weight to lose to reach an ideal BMI, so get a personalized weight-loss recommendation from your practitioner.)

If you’re not currently trying to conceive (or are done having kids), your practitioner may recommend taking birth control with progesterone to reduce levels of male hormones and regulate your period.

Conceiving with PCOS

If you’ve been diagnosed with PCOS and are having trouble conceiving, there are number of treatment options for you:

  • Metformin. Although this diabetes medication, which helps regulate the amount of insulin in your blood, isn’t approved by the FDA for treating PCOS, research suggests that it and other diabetes medications may help with fertility, so ask your doctor if it’s right for you.
  • Clomiphene citrate (Clomid). This drug stimulates ovulation and has been a standard infertility treatment for years, including in women with PCOS. Clomid might sometimes be used in conjunction with metformin in helping women with PCOS conceive.
  • Letrozole (Femara). This ovulation inducer is being used more and more often to treat ovulation issues, and can work very well for women with PCOS. Femara can also be used with metformin to help boost the odds for conception success.
  • Hormone shots. If Femara or Clomid, with or without metformin, doesn’t help with conception, injectable fertility drugs can be the next step for women with PCOS.
  • IVF. If none of the above treatments work, in vitro fertilization can help make pregnancy a reality for women with PCOS.
  • Ovarian drilling. In this surgical procedure, the doctor inserts a thin needle through the abdomen (laparoscopically) and cauterizes (burns) small areas of the ovaries to lower the levels of male hormones they produce. The idea behind the procedure is to help improve ovulation, but studies show the results of ovarian drilling are inconsistent and not all practitioners recommend this treatment for PCOS.

A 2017 study from the University of Pennsylvania School of Medicine found that adequate vitamin D levels could help women with PCOS conceive and have successful, healthy pregnancies. Researchers found that women with PCOS who were vitamin D deficient were 40 percent more likely to have trouble getting pregnant and giving birth to healthy babies than those who weren’t vitamin D deficient.

And a small 2014 study also found that taking 1.5 grams of cinnamon daily — a spice known to help regulate insulin levels — may be a safe and possibly effective way to help normalize your cycles and boost your odds of conceiving, too. It can’t hurt to try, so see if sprinkling a spoonful on your morning oatmeal for a few months makes your period more regular.

What you need to know about PCOS during pregnancy

If you’ve been suffering from PCOS, getting pregnant was likely a hurdle. Once you conceive (congratulations!), it will hopefully be smoother sailing ahead — though you should be aware that moms-to-be with PCOS are more likely to experience certain pregnancy complications. Women with PCOS are three times more likely to miscarry and are more at risk for gestational diabetes, inflammation, prenatal depression, heart disease, high blood pressure and preeclampsia. Moms-to-be are also more likely to require a C-section, while their babies are more likely to be born preterm and spend time in a neonatal intensive care unit (NICU).

Your best bet if you’re expecting with PCOS? Work with your doctor to outline a plan of attack. Gaining the right amount of weight based on your preconception BMI by eating well and staying active is always a good way to reduce your risk of pregnancy complications. Researchers also think the diabetes drug metformin may reduce the chances of having problems while pregnant, since it lowers male hormone levels and can limit weight gain if you’re overweight or obese. More research needs to be done to confirm its safety, but so far the studies that have been done show promising results. Talk to your practitioner about whether it’s an appropriate option for you.

PCOS can have an impact on your fertility and your pregnancy, but with the right care and treatment, conception and a healthy pregnancy are completely possible — and probable!

3 Things to Do If You’re Trying to Get Pregnant With PCOS

In addition to irregular or infrequent periods, women with PCOS often also experience weight gain, unwanted facial or body hair growth, hair loss from the head, acne, and mood changes.

These symptoms are thought to be linked to excess androgen—or male—hormones, Dr. Fino says. Women with PCOS often also have increased levels of insulin, which may be linked to weight gain.

It’s important to get PCOS diagnosed, says Erin Dawson-Chalat, MD, of Women’s Coastal Healthcare in Maine, not only to address any fertility issues you might be having, but to avoid other long-term consequences of PCOS as well. “PCOS can have lifelong health implications like metabolic syndrome, type 2 diabetes, and possibly cardiovascular disease and endometrial cancer,” she says.

RELATED: 8 Signs You Could Have PCOS

Why some women with PCOS struggle to conceive

The average woman in her mid-30s has a handful of follicles that contain egg cells in each ovary during her menstrual cycle. The brain secretes follicle stimulating hormone (FSH) to help select one of these follicles to mature and then release an egg.

But for women with PCOS, these follicles do not mature and ovulation doesn’t happen. Instead, they accumulate, and women with PCOS can have at least a dozen in their ovaries. Without ovulation, there can’t be conception.

RELATED: 6 Ways to Lose Weight If You Have PCOS

So can you still get pregnant with PCOS?

Yes, although it may take some extra effort. Here are a few things to try.

Eat a balanced diet and exercise regularly. Women with PCOS need to regulate ovulation, and in many cases, that can be done with diet and exercise, explains Dr. Fino.

Because symptoms of PCOS include weight gain and difficulty losing those extra pounds, eating a balanced diet that focuses on protein, healthy fats—olive oil, avocados, and nuts—vegetables, and whole grains can be an effective way to manage the condition.

“While not all women with PCOS are overweight, in overweight women, weight loss alone can restore ovulation—as little as a 5% or 10% reduction in weight,” says Dr. Dawson-Chalat.

Aim for about 30 minutes of moderate-intensity exercise three to five times a week, Dr. Fino says—but be careful not to overdo it. “Some women with PCOS are so stressed about fertility that they don’t eat and exercise 10 times a week, and you still don’t get your period,” she warns. “That’s a common pattern, this extreme overcorrection. You need a balance.”

RELATED: What Actually Causes PCOS—and What to Do About It

Consider medication. If adjusting your diet and exercise habits has been unsuccessful, your doctor may suggest medication to help with PCOS.

Common meds to induce ovulation are clomiphene and letrozole. Women with PCOS who are trying to get pregnant will take the clomiphene for five days and then confirm with a doctor if they’re ovulating, explains Dr. Fino, while letrozole is generally taken over the long term.

In some cases, women who experience weight gain due to PCOS might find fertility success with medication that targets insulin, like metformin, says Dr. Fino. “But this doesn’t work in the absence of following a healthy diet. You still have to eat well and exercise,” she says.

Don’t put off having kids. That is, if you’re ready to have children, don’t wait, says Dr. Fino. The older a woman gets, the harder it is to conceive, regardless of whether she has PCOS.

“If you have a factor that puts you at risk for infertility , you need to think about that early,” she says. You don’t want to end up spending years on hormonal birth control to manage PCOS only to realize later that you need more complex infertility treatment, she adds.

Women with PCOS who are not ready to have children by the time they’re 35 may want to consider freezing their eggs, Dr. Fino says. “If you decide later that you want kids, you might need in-vitro fertilization, and it’s better to go back to a younger egg than one that’s 40 or 42 years old.”

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Fertility drugs for women: What to know

Some fertility drugs try to prompt ovulation in a woman who is not ovulating regularly.

Others are hormones a woman must take before artificial insemination.

Drugs to cause ovulation

Share on PinterestSome fertility drugs can treat ovulation issues.

Some women ovulate irregularly or not at all. About 1 in 4 women with infertility have issues with ovulation.

Drugs that can treat ovulation issues include:

  • Metformin (Glucophage): This can decrease insulin resistance. Women with polycystic ovary syndrome (PCOS), especially those with a body mass index over 35, may be insulin resistant, which can cause problems with ovulation.
  • Dopamine agonists: These drugs reduce levels of a hormone called prolactin. In some women, having too much prolactin causes ovulation issues.
  • Clomiphene (Clomid): This drug can trigger ovulation. Many doctors recommend it as the first treatment option for a woman with ovulation problems.
  • Letrozole (Femara): Like clomiphene, letrozole can trigger ovulation. Among women with PCOS, especially those with obesity, letrozole may work better. A 2014 study found that 27.5 percent of women with PCOS who took letrozole eventually gave birth, compared to 19.1 percent of those who took clomiphene.
  • Gonadotropins: This group of hormones stimulates activity in the ovaries, including ovulation. When other treatments do not work, a doctor may recommend using a follicle-stimulating hormone and a luteinizing hormone in the group. People receive this treatment as an injection or nasal spray.

In about 10 percent of infertility cases, a doctor cannot find a cause. The medical term for this is unexplained infertility.

Drugs that aim to stimulate ovulation may help in cases of unexplained infertility. These drugs can enable a woman to optimize the chances of conceiving by timing intercourse. They can also reduce the effects of unidentified ovulation issues.

Hormones before artificial insemination

Drugs cannot treat some causes of infertility.

When this occurs, or when a doctor cannot identify the cause of infertility, they may recommend artificial insemination.

Intrauterine insemination (IUI) involves inserting sperm directly into the uterus around the time of ovulation.

It may improve the chances of conceiving when there is an issue with the cervical mucus or the mobility of the sperm, or when the doctor cannot detect the cause of infertility.

A doctor may recommend taking the following before IUI:

  • Ovulation drugs: Clomiphene or letrozole, for example, can induce the body to ovulate and, possibly, to release extra eggs.
  • Ovulation trigger: Because timing the moment of ovulation is essential, many doctors recommend an ovulation “trigger” shot of the hormone human chorionic gonadotropin (hCG).
  • Progesterone: This hormone can help sustain early pregnancy, and a woman usually takes it via a vaginal suppository.

In vitro fertilization (IVF) involves removing one or more eggs so that a doctor can fertilize them with sperm in a petri dish. If the eggs grow into embryos, the doctor implants them into the uterus.

IVF requires several drugs, including:

  • Ovulation suppression: If a woman ovulates too early, IVF may not work. Many doctors prescribe gonadotropin antagonist hormones to prevent early ovulation.
  • Ovulation drugs: IVF is more likely to succeed, like IUI, if the ovaries to release several eggs. A doctor will prescribe clomiphene or letrozole to cause this.
  • Ovulation trigger shot: IVF also has a better chance of success if the doctor can control the moment of ovulation using a trigger shot with the hormone hCG.
  • Progesterone: A woman receiving IVF will take progesterone to help support early pregnancy.

When treating infertility, a doctor may recommend taking hormonal birth control temporarily to help regulate the menstrual cycle. It can also help prepare the body for artificial insemination.

PCOS Treatment for Pregnancy – Fertility Success Rates

What is the treatment for PCOS and infertility?

Polycystic ovarian syndrome is a common cause of female infertility. The ovaries in these women contain multiple small cystic structures, or antral follicles, that are 2-9 mm in diameter.

  • The ovaries have a characteristic “polycystic” (many cysts) appearance on ultrasound


Ultrasound image of PCOS ovary at “PCO”
Bowel at “B”

For a more detailed general explanation of PCOS, see: Polycystic Ovarian Syndrome, PCOS

  • Women with PCOS syndrome do not ovulate (release eggs) regularly and therefore have irregular menstrual cycles
  • Therefore, treatment for infertility caused by PCOS is directed at getting the woman to ovulate
  • Doctors call this “induction of ovulation”

What is induction of ovulation?

Ovulation induction involves the use of medication to stimulate development of one or more mature follicles (where eggs develop) in the ovaries of women who have ovulation problems and infertility.

PCOS Fertility Treatment – Inducing Ovulation

Treatment Options

There are several possible ways to attempt ovulation induction in women with polycystic ovaries, including:

  • Clomid, clomiphene citrate
  • Metformin
  • Clomid and metformin together
  • Femara, letrozole
  • Injectable gonadotropins
  • IVF, In Vitro Fertilization

PCOS Pregnancy Statistics

Pregnancy success rates with induction of ovulation vary considerably and depend on:

  1. The age of the woman
  2. The type of PCOS meds used
  3. Whether the medication used is effective at stimulating ovulation in that woman
  4. Whether there are other infertility factors present in the couple

In general, successful treatment resulting in pregnancy is more likely to occur in the first 3 to 4 months of treatment. After that, the monthly success rate drops off considerably.

The approximate average monthly pregnancy success rate (female age under 35, normal sperm) for the major types of treatment used for PCOS are:

Treatment for PCOS Expected “Monthly” Success Rate
Metformin alone About 1-2%
Clomid 15% – if ovulating
Femara 15% – if ovulating
Injectable gonadotropins 20%
IVF, In vitro fertilization 60% – at our IVF clinic

A brief overview of each PCOS treatment option is below
For details see the pages that discuss each treatment option

Clomid

  • The least complicated method is the use of Clomid tablets, also called Serophene, or clomiphene citrate
  • Many will be able to get pregnant using clomiphene to induce ovulation
  • Clomiphene is usually the first line of treatment

Details about Clomid for treatment of polycystic ovarian disease and infertility

Femara (Letrozole)

Femara (generic name is letrozole) is an oral drug which can be effective in stimulating ovulation in some women with polycystic ovaries and anovulation.

Some women that do not respond and ovulate with Clomid will respond well to letrozole. Other women that do ovulate with Clomid may never get pregnant on it, and could do better with letrozole.

Details about Femara (letrozole) for PCOS treatment

Injectable Gonadotropins (FSH Hormones)

For women that do not ovulate with clomiphene, the “traditional” next step has been to use injectable gonadotropins. The woman takes daily shots of FSH hormone for about 7 to 15 days in order to stimulate mature follicle development.

Risks and Side Effects

  • The injectable medications are expensive
  • Beware of multiple birth risks with this treatment option – there are risks for triplets and higher order multiple pregnancies
  • There are risks of ovarian hyperstimulation syndrome
  • The daily injections and multiple trips to the office for monitoring are inconvenient

Injectables for PCOS treatment

IVF – In Vitro Fertilization

The large majority of women with PCOS that have not gotten pregnant with other treatments will be able to have success with IVF if they are under 40 years of age and have their IVF performed at a high quality clinic.

IVF clinics are not all the same – learn more about IVF pregnancy success rates

Success Rates

  • In general, IVF success rates are excellent in cases with infertility caused by PCOS
  • In our in vitro fertilization program we see PCOS pregnancy statistics of about 60% for a live birth rate (woman under age 35)
  • Our IVF success rate statistics

We specialize in treating women with PCOS and have many IVF PCOS success stories

  • We usually use a PCOS IVF protocol combining metformin, oral contraceptive pills, and the Lupron down-regulation stimulation protocol
  • Recent advances in IVF technologies have resulted in the ability to maintain high success rates while controlling multiple pregnancy risks
  • Blastocyst embryo transfer is a variant of standard IVF treatment that is useful in controlling multiple birth risks

Details about IVF treatment for PCOS

Metformin

Oral medications such as metformin (brand name Glucophage) can be used to try to stimulate ovulation with PCOS. It can be used with or without Clomid.

  • Metformin is an “insulin sensitizing agent” primarily used to control diabetes.

Not many couples will get pregnant using metformin alone. However, some women will respond to metformin and clomiphene when they are used in combination.

Some will not ovulate even with the combination therapy and will need either injectable FSH medications, or IVF to have a baby.

Side Effects

Metformin has unpleasant gastrointestinal side effects such as diarrhea in about 25% of patients.

Metformin for PCOS and fertility treatment

Cost for Induction of Ovulation and PCOS Treatments

The costs associated with induction of ovulation depend on:

  1. The type and dose of medication required.
  2. The number of ultrasound and blood tests required to properly monitor the cycle.
  3. Sometimes artificial insemination will be recommended, which increases the chances for a pregnancy, as well as the cost.
  • A Clomid cycle usually costs between $100 and about $1200, depending on what is done.
  • A cycle with injectable gonadotropins usually costs between $1500 and $6000, depending on what is done and the doses of injectables needed to stimulate follicles to grow.

Details about costs of various fertility treatments

  • Polycystic ovarian syndrome, PCOS
  • Metformin for PCOS fertility treatment
  • Clomid for fertility treatment with PCOS
  • Clomiphene and Glucophage for PCOS
  • Femara (Letrozole) for PCOS treatment
  • Injectables for PCOS Treatment
  • IVF treatment for PCOS

Metformin Therapy for the Management of Infertility in Women with Polycystic Ovary Syndrome

  • 11Legro RS. Obesity and PCOS: implications for diagnosis and treatment. Semin Reprod Med 2012; 30: 496– 506.
  • 12Teede HJ, Misso ML, Deeks AA, Moran LJ, Stuckey BG, Wong JL, et al.; Guidelines Development Groups. Assessment and management of polycystic ovary syndrome: summary of an evidence‐based guideline. Med J Aust 2011; 195: S65– 112.
  • 13 Royal College of Obstetricians and Gynaecologists. Long‐term Consequences of Polycystic Ovary Syndrome. Green‐top Guideline No. 33. London: RCOG; 2014.
  • 14Rena G, Pearson ER, Sakamoto K. Molecular mechanism of action of metformin: old or new insights? Diabetologia 2013; 56: 1898– 906.
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  • Polycystic Ovary Syndrome (PCOS) Treatment

    PCOS at a glance:

    • Polycystic ovary syndrome (PCOS) is a hormone imbalance problem that can interfere with normal ovulation. The disorder affects 5-10 percent of women of childbearing age, or about 6.1 million women in the United States alone.
    • Like any “syndrome,” PCOS is a collection of problems. Its cause is unknown but it is the most common hormonal abnormality in reproductive age women and a principal cause of female infertility.
    • Treatment for women experiencing infertility due to PCOS generally involves taking medications that promote healthy ovulation.
    • Advanced Reproductive Medicine was part of a recent National Institutes of Health study showing that Letrozole increased the chances of pregnancy by up to 45 percent over the previous gold standard treatment drug, Clomiphene citrate.

    PCOS symptoms

    Symptoms tend to build gradually, and often begin in the early teens due to hormone changes. PCOS symptoms include:

    • Missed menstrual periods, irregular periods, heavy bleeding during periods, or long times between periods
    • Increased hair growth (hirsutism) on the face, chest, back and other areas
    • Hair loss on the scalp
    • Being overweight (other symptoms may be noticeable after weight gain)
    • Acne problems
    • Having trouble becoming pregnant

    PCOS risks

    Women experiencing these symptoms should seek medical attention. When PCOS interrupts the ovulation cycle, estrogen can damage the uterine lining and cause thickening of the lining and possible abnormal bleeding. Continued presence of estrogen without ovulation can lead to uterine cancer or pre-cancer.

    Women with PCOS often have metabolic syndrome, which can result in high blood pressure, high cholesterol, weight gain and insulin resistance. These increase the risk for heart disease.

    PCOS diagnosis

    A physical exam, review of medical history, blood tests and ultrasound are used to detect PCOS. A woman is diagnosed as having PCOS if she has two of three issues: anovulation (lack of ovulation), high testosterone levels, and polycystic ovaries (ovaries that have multiple cysts containing eggs).

    Ultrasound tests show that many women with PCOS have enlarged ovaries with small cysts. Blood tests may show high levels of male hormones, cholesterol and/or blood sugar.

    PCOS treatment

    Treatments should be tailored to the individual. For women who are not concerned with immediate fertility, hormone medications usually correct symptoms, and oral contraceptive pills can reduce acne and hirsutism.

    Women with PCOS seeking to get pregnant can take medications that promote ovulation. The oral medication Letrozole has been proven (in part by Advanced Reproductive Medicine) to increase ovulation and improve the chances of successful pregnancy after ovulation. It also has fewer side effects than Clomiphene, another medication often used to treat infertility due to PCOS.

    If these drugs are not successful, fertility medicines known as gonadotropins may be injected to stimulate egg growth. Since gonadotropins are associated with higher risk of ovarian hyperstimulation syndrome and multiple pregnancy, women taking this medication should be closely monitored.

    Drug Treatments for Polycystic Ovary Syndrome

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