Polycystic Ovary

Polycystic Ovary Syndrome and Infertility
Polycystic Ovarian Syndrome (PCOS) usually progresses with menstrual irregularities, increased hairiness, and obesity in women. Although the real reason is unknown, a variation occurs in the monthly cycle. The name of polycystic is actually an unfortunate metaphor. Because women think that there are multiple cysts in their ovaries. However, what is meant here is not multiple cysts, but multiple oocytes. It arises in about one in ten women and may cause problems for young families who are planning to have a child. Early diagnosis, early approach will also prevent some other developments such as diabetes and heart disease at later ages.

What is Polycystic Ovary Syndrome?

Signs and Symptoms

Menstrual irregularities. They are the most common signs. Irregularity refers to the menstruations occurring later than 35 days. This condition may show up with the first menstruation during puberty, as well as much more later with weight gain. Increased androgen symptoms. Increased hair growth on the face, breast, abdomen, back, upper leg and arm (hirsutism), acne, and male pattern hair loss may be seen. But it is not necessary for all women with polystic ovaries to have all these findings.
Enlarged ovaries and multiple oocytes. It is usually an ultrasonographic finding. However, multiple oocytes do not always mean polycystic ovarian syndrome.

Childlessness. Since PCO leads to infertility menstrual and ovulation irregularities, it may cause infertility. It is one of the most common causes of female infertility in the United States.
Obesity. About half of women with polycystic ovarian syndrome have a tendency to gain weight. Lipoidosis arises especially in the waist, abdominal and thoracic region.
Prediabetes or type 2 diabetes. Susceptibility to diabetes occurs. Prediabetes is called glucose tolerance disorder.
Acanthosis nigricans. They are dark colored, velvety skin spors on the neck, armpit, genital area, under the breast or on the neck. It’s rare.
Other findings: Apart from those listed above, hypertension, high cholesterol, elevated levels of C-reactive protein (which may be associated with cardiac problems), liver damage, and sleep apnea may also be present in these women.

Why polycystic ovarian syndrome occurs?

First of all, polycystic ovarian syndrome is not acquired, it is congenital. This ovary structure is with you from birth. It is noticed by puberty when it begins to function.
In those with polycystic ovarian syndrome, the rate of FSH and LH hormone secretion varies, androgens are overproduced. Ovulation may be less than normal (oligo-ovulation) or may not be present at all (anovulation). When there is no ovulation, menstruations becomes irregular or do not occur. Although the cause is not completely known, some studies indicate that the effect of increased it increases the production of androgens from the ovaries. It is also believed that some genetic factors play a role in the development of PCOS.

How is it diagnosed?

Unfortunately, there is no specific test to identify policystic ovarian syndrome. Diagnosis is usually made by a combination of several findings and by elimination of other possible diagnoses. Therefore, patients may sometimes receive different diagnoses from different doctors.
Blood tests LH, FSH, 17-hydroxy progesterone, prolactin, TSH, testosterone, DHEA sulphate, fasting blood glucose, cholesterol and triglyceride levels are measured.
Ultrasound. The size of the enlarged ovaries and alignment of the oocytes in the form of ‘pearl necklace’ are helpful in the diagnosis.

Treatment and Drugs

Polycystic ovarian syndrome is not a disease, but a structural variation of the body. Therefore, it should not be expected to disappear completely by using drugs for a certain period of time. Whichever main problem such as infertility, hirsutism, acne or obesity is evident, it is focused in treatment. However, it should not be forgotten that the previous symptoms will return when the treatment is discontinued.

Drugs for Menstrual Regulation

Low-dose contraceptive pill, synthetic estrogen and progesterone combined preparates help reduce androgen production and maintain menstrual cycle. This will also reduce the risk of endometrial cancer.
Metformin, used for diabetes, both provides protection from diabetic susceptibility and helps in ovulation. It has also been shown to reduce androgen levels.


In case where long-term medication is not desired, some of the oocytes in the ovaries are removed by an operation called laparoscopy. Thus, it is believed that the number of oocytes reduced to normal level creates a more normal hormonal environment and facilitates ovulation.

Prevention of Hairing

There are many other options besides the prescription drugs used for this purpose. Wax, depilator creams and lotions, gels can be used for the same purpose. Permanent Eflornithine cream is especially recommended by the doctor against hair growth in the facial region. For permanent hair removal:
Electrolysis. It is known as electrical epilation. A very thin needle is advanced to the hair follicle and electric current is applied to kill the follicle. It is useful for small areas of the body. Because large areas may require a long time and multiple sessions. Rarely, scarring or skin infection occurs.
Laser epilation. Visible laser epilation. It is effective on short visible hair. Multiple sessions may be required for the target region. Within a few months, one third or more of the hair will removed. Even after multiple treatments, you may experience some hairiness, but the new ones will be thin and light.

Pregnancy Treatment

For women desiring to have a baby, treatment may be needed to trigger the ovulation. For this purpose, clomiphene citrate can be used with or without metformin. Since the risk of multiple pregnancy and ovarian hyperstimulation are rare, they are considered to be among the safe drugs. Ultrasonographic follow-up of the oocyte and the egg cracking shot will increase the chance of pregnancy. In cases where no response is received with the pill, the oocyte growth treatment with injection can be performed. Pregnancy and multiple pregnancy rates are slightly higher than the pills and should definitely be used under the supervision of a doctor. The treatment can be switched to inoculation or IVF only in women in whom the oocyte growth treatment is insufficient.
Needle-shaped drugs are used for 10-14 days, it has various types, such as subcutaneous and intramuscular. Doses vary according to the characteristics of the woman.
The treatment can be switched to inoculation or IVF only in women in whom ovulation treatment is insufficient.

Nutrition and Diet

There may be inconsistent recommendations about weight management from the media, support groups and health professionals. Most of the disagreement focuses on carbohydrates.
For example, when a low-carbohydrate diet is followed in women with polycystic ovarian syndrome, the level of sugar entering the cell is considered to be low, since the amount of it, as well as blood glucose will not increase too much. However, the restriction of carbohydrate intake may increase the risk of heart disease by leading to an increase in fatty acids and cholesterol in the blood. So it is better to limit them, not to restrict them. Complex carbohydrates with high fiber content should be selected in the diet. Fibrous foods are digested more slowly and the blood glucose increases more slowly. Although this information is generally known by every woman, it is not known which foods are rich in fiber. Cracked wheat, whole-grain bread, whole wheat pasta, barley, brown rice and dry beans can be included in this group. Simple carbohydrates such as too much fruit juice, appetizers, cakes, sugar, ice cream should be restricted.
Do Exercise
Exercise helps maintain a low blood glucose level.
Polycystic ovarian syndrome (PCO) is not a disease but a structural variation of the body. So it is not possible to talk about a specific treatment. Whicever problem becomes evident it should focused.