Fertility and Polycystic Ovarian Syndrome (PCOS)
For patients who desire pregnancy, we often begin with therapy to improve insulin sensitivity as patients with PCOS are typically insulin resistant. A significant number (about 20%) of women who are not ovulatory will ovulate and achieve pregnancy with this treatment alone. Insulin sensitizers are less effective in women who are not insulin resistant, and are often reserved for those with an increased BMI. When Metformin is used, we prefer long acting forms to reduce the significant gastrointestinal upset that is associated with standard Metformin therapy.
To further increase chances of conception, we use oral ovulation induction medications such as Clomid, Femara, and Tamoxifen. These medications can be used in combination for resistant patients.
We also recommend weight loss in those who desire pregnancy because insulin levels and excess hair growth can be reduced with weight loss that is only 5-10% of one's initial weight. Even better, weight loss is sometimes associated with resumption of ovulation and pregnancy.
Lastly, ovarian wedge resection and ovarian drilling are surgical approaches that are very effective in patients with PCOS. These procedures are usually reserved for difficult PCOS cases.