Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive age group women, with impacts from adolescence to post menopause. PCOS prevalence is between 10-13%.

PCOS is the common cause for anovulatory infertility and the incidence is higher between 70-80%. Hence, the fertility treatment for women with PCOS are mainly targeted on treating anovulation.

Fertility treatments for women with PCOS:

In an interview with HT Lifestyle, Dr Nandini Devi, Gynecologist, Obstetrician and Infertility Specialist and Center Head at Indira IVF in Chennai, revealed that fertility treatment options for women with PCOS are non-pharmacological, pharmacological intervention and assisted reproduction treatments. She elaborated -

1. Non pharmacological intervention: 40-60% of women with PCOS are overweight or obese. Obesity leads to increase in insulin resistance and ovarian hyperandrogenism, causing hirsutism, anovulation, infertility and also metabolic disorders like diabetes, hypertension or increased risk for cardiovascular disease. Hence, lifestyle modifications like exercise and dietary modification is imperative. The new international PCOS guideline recommends a minimum of 150 mins/week of moderate intensity physical activity or 75mins/week vigorous intensity and muscle strengthening activities on 2 non-consecutive days/week. Low calorie diet with adequate nutritional intake and healthy food choices have improved fertility outcome. The current recommendations to achieve weight loss, is achieving an energy deficit of 30% or 500-750 Kcal/day.

2. Pharmacological treatment: The principle for this treatment is to treat anovulation as PCOS represents 80% of anovulatory infertility. Oral ovulation induction drugs (like clomiphene citrate and letrozole) and insulin sensitisers (like metformin) are the first line drugs. Gonadotropins are used as second line agents, following unsuccessful treatment with first line oral ovulogens.

3. Assisted reproductive technology: Intra uterine insemination can be considered when ovulation induction with timed intercourse fails. In vitro fertilisation (IVF)/Intracytoplasmic sperm injection (ICSI) can be considered as the last option for anovulatory PCOS. PCOS is a multifaceted condition hence, multidisciplinary care is needed to address anovulation and also metabolic syndrome and psychological issues that are associated with this condition.

Bringing her expertise to the same Dr Nithya Rengaraj, New Medical Centre - Multispecialty Hospital in Pondicherry, echoed that many women with PCOS can still achieve pregnancy with the right interventions. According to her, a variety of treatments are available to help improve fertility -

1. Lifestyle modification: Weight reduction (5 to 7 percent) with balanced diet and exercise is the initial recommendation for patients with PCOS as it helps to restore ovulation in more than 75 percent of women.

2. Medications: Metformin is a common medication for people with PCOS and insulin resistance. For women who don’t ovulate regularly, medications like Clomiphene Citrate (Clomid) or Letrozole may be prescribed to stimulate the ovaries to release an egg. These drugs are often the first line of treatment for women with PCOS who are trying to conceive. In some patients, addition of drugs like Gonadotropins or dopamine agonists may be required to achieve ovulation.

3. IUI: In case of failed conception despite ovulation for 3 cycles or a combined male factor, artificial insemination can improve pregnancy rates.

4. In Vitro Fertilization (IVF): For women who don’t respond to ovulation-stimulating drugs, IVF may be a more advanced option. In IVF, eggs are harvested from the ovaries, fertilised in a lab, and then implanted into the uterus. Although it’s a more invasive procedure, IVF has high success rates for women with PCOS who experience fertility challenges.

5. Surgical Options: In some cases, a procedure known as ovarian drilling may be considered. This laparoscopic surgery involves making small holes in the ovaries to reduce androgen production and stimulate regular ovulation. However, it is typically only considered when other treatments have failed or when the AMH levels are very high.The tubal patency can be simultaneously tested.

What can you do to improve fertility with PCOS?

Dr Nandini Devi, answered, “PCOS is the most common cause of anovulatory infertility. Lifestyle modification could help in improving fertility. Lifestyle modifications like exercise and dietary changes helps in lowering insulin resistance and restores spontaneous ovulation and thereby clinical pregnancy and live birth rates. Supplements like Inositols such as myoinositol and delta chiro inositol, act like insulin sensitisers and improve ovulation.”

She added, “Vitamin D, calcium and Vitamin B12 supplements promote follicular maturation and improve pregnancy rates. Thyroid supplements in case of hypothyroidism, improve fertility. Adequate sleep is important, as it improves fertility. Poor sleep or circadian clock disruption contributes to menstrual and reproductive dysfunctions. Synbiotics and probotics supplement in women with PCOS improves hormonal, oxidative and inflammatory indices in the condition.”

Dr Nithya Rengaraj advised -

1. Maintain a Healthy Weight: Even modest weight loss can improve insulin resistance, lower androgen levels, and restore ovulation. A balanced diet rich in whole grains, proteins, fruits, and vegetables can help support weight management and hormone regulation.
2. Exercise Regularly: Physical activity can help reduce insulin levels and improve ovulation. Aim for at least 30 minutes of moderate exercise like a combination of aerobic exercises like brisk walking, jogging, or cycling and flexibility exercises such as yoga or stretching.
3. Maintain a menstrual calendar to keep track of your cycles.

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