Polycystic ovarian disease, also known as PCOS, is a leading cause of infertility in women. The reason infertility caused by PCOS is so difficult to treat is that while getting pregnant requires ovulation, the release of the egg from the ovaries, the hormonal signal that triggers ovulation actually begins in the brain.
The hypothalamus releases a hormone called GnRH, which is an abbreviation for gonadotrophin releasing hormone . Pulses of GnRh travel to the pituitary gland, which in turn releases FSH (follicle stimulating hormone) and LH (luteinizing hormone). FSH stimulates the ovary to make a follicle for down which the egg travels (among many other functions), while LH dissolves the tough protein keeping the egg inside the ovary.
Over the next 14 days, estrogen travels back to the brain to tell the hypothalamus to start the cycle all over again. If any one of these hormones is secreted in the wrong amount at the wrong time, or if the ovaries or pituitary or hypothalamus fail to respond to them, then ovulation, and pregnancy will not occur. That is why PCOS makes getting pregnant so difficult.
Your gynecologist will start with the simplest treatments and try more and more as you continue attempting to conceive. The first line of treatment is weight loss. From 30 to 60% of women with PCOS get pregnant just after losing weight.
The second line of treatment is chlomiphene citrate, also known as CC or Clomid. This is a drug to induce ovulation. About 22% of women who take the drug get pregnant within 28 days, and about 60% get pregnant within six months, which is the longest time most doctors feel is safe to take the medication.
Doctors used to give women who had PCOS the diabetes drug metformin in hopes it would help them become pregnant, because some the same hormonal changes that cause infertility also cause diabetes. Nowadays metformin is only given for treating diabetes. The third line of treatment is treatment with a synthetic form of GnRH, a hormone described above.
It only works in about 20% of women who are given it, and it results in twins, triplets, or more babies about 7% of the time. Laparoscopic (small-incision) surgery to puncture the ovaries to release an egg is the fourth line of treatment. Also called ovarian drilling, this procedure works about 50% of the time, and may require the addition of other treatments. If none of these procedures work, then the option is in vitro fertilization. It is effective for about 35% of women with PCOS who try it. Unfortunately, there is no way to add these procedures so the chances of pregnancy are 100%, but each procedure will the one that works for a substantial number of women with PCOS who use it.