How do we approach PCOS for an IVF Treatment?
PCOS is one of the most common disorder that we come across among our patients, on this page you will find detailed information about PCOS, and also Prof. Dr. Çamlıbel kindly accepted to answer some of our questions about this subject as well. Before we touch on our questions, please find below more information about Polycystic Ovary Syndrome (PCOS).
What is Polycystic Ovary Syndrome?
Let’s start with a simple definition of Polycystic ovary syndrome (PCOS): It is a disorder in which the ovaries are enlarged and contain many small cysts (fluid-filled sacs). Women with PCOS may have irregular or no menstrual periods. PCOS is a condition that can last many years and can have a major impact on women’s health.
Prof. Dr. Çamlıbel, would you please explain PCOS in more detail?
“In women, there are follicle-stimulating hormones (FSH), and luteinising hormones (LH) secreted from the hypothalamus of the brain, which enable the ovaries to function normally and women to ovulate. Of these hormones, FSH promotes the development of oocytes in the ovary while LH helps oocytes mature and crack to provide pregnancy. FSH is always secreted more than LH.
In the opposite case, with higher LH values than FSH values, oocytes in the ovaries cannot crack. In this case, the oocytes in the ovary cumulate without cracking, and when oocytes are visualized with ultrasound, it is observed that tens of small oocytes fill-up the ovary. This is called polycystic ovary (poly means many, cyst means vesicles filled with fluid which are oocytes in this case).”
Possible Causes of Polycystic Ovary Syndrome
Today, what causes exactly PCOS is still unknown, however, many different studies indicate that it is linked to hormonal imbalance.
Everyone has both male and female hormones. PCOS occurs as a result of an increase in the production of androgens (male hormones) by the ovaries and the adrenal glands. In PCOS, the ovaries often become enlarged and contain many small cysts. The increase in androgen causes irregular menstrual periods and may stop ovulation. Because of this, women continue to make estrogen, but they do not produce progesterone.
In some women, the presence of estrogen without progesterone increases the risk that the endometrium will grow too much. This is a condition known as endometrial hyperplasia that may turn into cancer. PCOS is linked to other diseases that occur later in life, such as diabetes, atherosclerosis, and high blood pressure.
Prof. Dr. Çamlıbel, would it be possible to share more details about the possible causes of PCOS?
“Menstrual periods of girls who have such hormonal order as I mentioned above, congenitally start irregularly in adolescence. These children may be a bit overweight than normal and suffer from complaints such as puberty acne, oily skin, and hair loss more frequently. More hair growth may be observed in the facial area, around the abdomen and chest. The reason for these conditions is the male hormone called testosterone secreted by oocytes that are unable to crack in the ovary and accumulate. This hormone is secreted more in patients with polycystic ovaries than in other girls, which causes masculine changes in the body.
We recommend that these children take medications to regulate menstrual periods, avoid gaining weight, and take some special contraceptive pills to prevent hair loss or hair growth during their maidenhood. Otherwise, there may be irremediable disorders that leave marks on the face and body.
PCOS has been linked to diabetes: It has been found in recent years that polycystic ovarian syndrome is carried on the same chromosome as diabetes, which means that these two diseases are interrelated, although remotely. It is, therefore, more likely that patients with polycystic ovaries develop diabetes, cardiovascular disease, high blood pressure, and high cholesterol throughout their lives. Such disorders are also more common in the families of these patients.”
What are the symptoms of Polycystic Ovary Syndrome?
Irregular menstrual periods or no periods
- Bleeding in between periods
- Excess hair on the face and body (known as Hirsutism)
- Acne & Oily skin
How to reduce the risks of PCOS?
Prof Dr Çamlıbel, how would you describe the over-stimulation risk due to PCOS?
“Polycystic ovary syndrome can be recognised not only as a hormonal problem in women but also an internal disease which may affect their lives. We particularly ask such individuals to have their check-up once a year and have tests such as diabetes and cholesterol.
When these patients reach the age of marriage or plan to have a child, they may require additional treatment as they cannot ovulate regularly. Since it is associated with diabetes as we mentioned before, in this case, certain medications that are prescribed for diabetes patients and lower the sugar level can regulate menstruation and enable ovulation in such individuals. First, the patients need to be diagnosed when they consult the doctor to have a baby, which refers to specific visualisation in ovaries, appearances such as oily face skin and body fat and acne formation, a higher level of LH than FSH in blood on the third day of menstruation, and sometimes, higher testosterone in the blood.
Patients with polycystic ovaries may sometimes respond severely to medications, which can lead to life-threatening problems such as overgrowth of the ovary, which we call hyperstimulation, and abdominal water retention. Hence, the treatment of individuals with polycystic ovaries should be applied by specialist physicians so that the patients can have a child.
In individuals with polycystic ovaries, there is impairment in the quality of the cracked oocyte in question aside from enabling it to crack as a treatment. Therefore, when such couples are sometimes subjected to treatments such as IVF, they may have lower chances than normal individuals because oocyte quality and embryo quality may be lower.
A new surgical method called laparoscopic ovarian drilling is also used in people with polycystic ovaries. With this method, the abdomen is entered with a small pipe, which is called laparoscopy, and then, heat is applied with devices called cautery into ovaries, the oocyte is entered through the perforation of the oocyte shell membrane at several points, and there, the damage is caused via heat by cautery. As LH hormone is secreted from the internal tissue of oocyte, this damage can lower the LH level in blood and sometimes cause natural ovulation and natural regularity in menstrual periods.
Some publications report that this procedure creates a chance of pregnancy up to 50 per cent in polycystic ovary patients in the first year.”
Why endometrial cancer can be observed more frequently in PCOS patient?
Prof Dr Çamlıbel:
“Endometrial cancer (uterine cancer) is observed more frequently in polycystic patients who have not been treated for long and menstruating irregularly. Because these patients do not ovulate, hence do lack the protective hormone called progesterone which is secreted after ovulation; therefore, oestrogen, which leads to uterine cancer, prevails since it has not had any counterbalance, increasing the risk of cancer in uterine.
Such patients should be examined regularly in future and checked for cholesterol, high blood pressure and cardiovascular diseases. Since the daughters of these people may be suffering from the polycystic ovarian syndrome, diagnoses, follow-up, and treatments should be started consciously at an early age.”
What will happen after PCOS patients become pregnant?
Prof Dr Çamlıbel:
“After polycystic ovary patients become pregnant and give birth, living on a certain kind of contraceptive pill to regulate their menstruation between two deliveries is required both for their skin health and to have regular menstruation. These patients may need menstruation-regulating drugs until 40 years of age and even after that following the end of their pregnancy because polycystic ovarian disease lingers on.
Due to being a disease observed in the society at a rate of ten to 20 per cent, polycystic ovary syndrome has now become a disease more frequently observed, more easily recognised and treated by every gynaecologist. When young girls have complaints about irregular menstruation, acne and oily skin, and hair growth, they should absolutely consult a gynaecologist and should be checked about this issue and start the treatment.
Humans are born and die with polycystic ovary syndrome. Hence, they need to be followed up by gynaecologists and internists as a team during adolescence, pregnancy, and in the pre-and post-menopause period. After these follow-ups and treatments, these patients can live a healthy, good life like other people.”
Optimizing your chances of success in IVF with Polycystic Ovary Syndrome (PCOS) at IVF Turkey
First of all, we would like to reassure you that we have had many IVF with PCOS success stories at IVF Turkey.
The protocols that we create are unique for each patient’s needs with the PCOS cases. After our IVF experts perform a complete exam including blood tests for each patient with PCOS symptoms, they design a personalized plan for their fertility journey. Please note that the type of treatment you receive depends on your symptoms and whether you want to become pregnant.
To treat irregular menstrual periods, we may prescribe either the hormone progesterone or birth control pills depending on your treatment reason. Women who wish to become pregnant may be given fertility drugs instead of birth control pills. We would like to underline the fact that with proper treatment, the condition can be managed and your symptoms can be relieved!
Your doctor may also prescribe birth control pills and other medications to slow the growth of new excess body hair. If you are overweight, losing weight can help relieve the symptoms of PCOS. Weight loss can also help lower the risk of other long-term conditions.
Let’s have a closer look at our approach for PCOS cases before their IVF treatment with IVF TURKEY:
For any women with PCOS and would like to become pregnant, usually, the first recommended medicine is Clomiphene citrate (Clomid) for women with PCOS, then to encourage monthly ovulation Clomifene can be prescribed. In some cases, if Clomifene does not encourage ovulation, medicines called Metformin or Gonadotropins can be recommended.
As Prof. Dr. Çamlıbel, mentioned previously, there is also a possibility to have a surgery called laparoscopic ovarian drilling in case the medications are not successfully helping with your treatment.
Regarding the stimulation medications to be prescribed for PCOS cases, we usually start with a low dose such as 150-200 IU to avoid hyperstimulation. Then we closely monitor the estrogen levels of these patients during the whole treatment.
In addition to the stimulation medications, Cetrotide (Orgalutran) needs to be prescribed to control the overgrowth of eggs.
Depending on the patient’s treatment schedule (short or long stay), after the HCG injection, patients are required to be in Istanbul for the egg collection, however for PCOS cases, HCG level can increase suddenly and which can lead to ovarian hyperstimulation syndrome (OHSS). According to the PCOS Awareness Organisation, OHSS is explained as below: “Ovarian hyperstimulation syndrome (OHSS) causes swelling of the ovaries with the leaking of fluid within the body.”
It would be highly recommended to choose the long-stay option for all PCOS cases.
Please note that a similar situation also applies to a high AMH level. If the AMH level is too high, then there is also the risk of hyperstimulation.
Whilst checking Oestradiol regularly, if the level is above 4000 pg./ml, these patients are at a high risk of hyperstimulation, and it can be dangerous to use these embryos; hence there is a possibility to freeze the embryos, which means that patients are required to come another time for a frozen embryo transfer. We are very aware that it is not the ideal situation from a patient view, as additional costs & travel are involved; however, this is a medical obligation to avoid any risks of hyperstimulation.
Therefore, we always mention from the beginning to all our patients with PCOS would like to have an IVF Treatment at IVF Turkey, there is a possibility to freeze the eggs due to the risks of hyperstimulation.
Please get in touch with us to find out more about PCOS and your options for an IVF Treatment.