PCOS is one of the most common causes of female infertility. For women with PCOS, their hormonal imbalance interferes with the growth and release of eggs from their ovaries. If you don’t ovulate, you can’t get pregnant.
What fertility treatment options do I have for PCOS?
There are three main options of fertility treatment for women who has PCOS:
– Timed intercourse
– Intrauterine insemination (IUI)
– In-vitro fertilization (IVF)
For timed intercourse or IUI, it is important to make sure fallopian tubes are open and the sperm counts are normal so the sperm can meet the egg in the fallopian tube and form the embryo.
Oral fertility medications such as Letrozole and clomiphene citrate (Clomid), have been widely used to stimulate follicular growth and egg development. Growth of follicles can be monitored via ultrasound in the office or Ovulation Prediction Kit at home. Around the time of ovulation, timed intercourse or intrauterine insemination (IUI) can be performed.
The typical success rate with IUI is about 15% per cycle. Timed intercourse has lower successful rate than IUI. A woman’s individual success rate with IUI is largely impacted by her age. If pregnancy can’t be achieved after a few attempts of timed intercourse or IUI, or if there are other infertility factors such as blocked fallopian tubes, in vitro fertilization (IVF) will be recommended.
Many PCOS women have elevated LH levels, which can cause persistent positive OPK results. In that case, the kit may have little value in predicting ovulation.
We offer ultrasound monitoring in the office to assess your follicular growth. When the leading follicle is large enough, you will take a trigger shot of hCG to help the ovaries release those mature eggs. Since we know most women ovulate 36-42 hours after HCG shot, we can schedule your trigger shot time, pinpoint when ovulation is likely to occur, and then time sex or your IUI for the best chance of success.
Data have suggested that letrozole is more effective as a fertility treatment than clomiphene in women with PCOS. Ovulation, conception, pregnancy, and live birth are significantly more likely after treatment with letrozole in PCOS women.
Some women with PCOS may resist to Clomid or Letrozole and do not ovulate with oral medication. If you do not respond to oral medication, or did not get pregnant after several IUI attempts, it is reasonable to consider IVF treatment.
Women with PCOS have risks developing ovarian hyperstimulation syndrome (OHSS) during IVF treatment.
OHSS is an excessive response to IVF medications, which leads to fluid leaking into the belly, causing bloating, nausea, and swelling of the abdomen. When OHSS is severe, blood clots, shortness of breath, abdominal pain and dehydration are possible.
Due to the high number of small follicles on the ovaries in women with PCOS, conventional IVF can result in significant ovarian distention and OHSS. Lower dosages of IVF stimulation medication is key to minimizing side effects and severe OHSS.
Mild-IVF uses oral medication and very low dose injectable IVF medications while providing excellent pregnancy rates. It avoids over-stimulating the ovaries and is thus a much safer treatment strategy for women with PCOS.