PCOS — Polycystic Ovary Syndrome

What is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal condition that affects roughly 1 in 10 women of reproductive age. In PCOS the ovaries often do not release an egg every month (anovulation), and the body may make more androgens (male-type hormones) than usual. Many small follicles can be seen on the ovaries on ultrasound, but these are not true cysts. PCOS is one of the most common reasons for irregular periods and difficulty conceiving, and it is also one of the most treatable.

Symptoms and signs

• Irregular, infrequent or absent periods
• Difficulty getting pregnant because ovulation is irregular
• Excess hair on the face, chest or abdomen (hirsutism)
• Acne, oily skin or thinning scalp hair
• Weight gain or difficulty losing weight, especially around the waist
• Dark, velvety skin patches on the neck or underarms (a sign of insulin resistance)

Not every woman has all of these. Lean women can also have PCOS.

Causes and risk factors

The exact cause is not fully understood. PCOS tends to run in families, and insulin resistance plays a major role: high insulin levels push the ovaries to make more androgens, which disrupts follicle growth. Excess weight, a sedentary lifestyle and a family history of type 2 diabetes increase the risk and can make symptoms worse.

How PCOS is diagnosed

Doctors usually use the Rotterdam criteria, which need two of these three features after other causes are ruled out: irregular or absent ovulation, clinical or blood-test signs of high androgens, and polycystic-appearing ovaries on ultrasound. Common tests include:

• Transvaginal ultrasound to count follicles and check the uterus
• Blood tests for testosterone, LH, FSH, AMH, prolactin and thyroid (TSH)
• Fasting glucose, HbA1c or an oral glucose tolerance test, and a lipid profile
• Semen analysis for the male partner and a tubal test before treatment

Treatment options

Lifestyle changes

For women who are overweight, losing even 5 to 10 percent of body weight can restore regular ovulation in some cases. A balanced diet and regular exercise also improve insulin sensitivity.

Ovulation induction

Letrozole tablets are now the usual first choice to help women with PCOS ovulate, with clomiphene as an alternative. Follicle tracking scans time intercourse or IUI. Metformin may be added for women with insulin resistance. If tablets do not work, low-dose gonadotropin injections or laparoscopic ovarian drilling may be considered.

IUI and IVF

IUI with ovulation induction is often tried when tubes are open and sperm counts are adequate. IVF is recommended when other treatments have not worked or there are additional factors such as blocked tubes or low sperm count. Women with PCOS respond strongly to stimulation, so specialists use gentle protocols and preventive steps to lower the risk of ovarian hyperstimulation syndrome (OHSS), such as an antagonist protocol and freezing embryos for a later transfer.

Chances of pregnancy

Most women with PCOS can ovulate with treatment, and many conceive with tablets or IUI. Success depends on age, weight, ovarian response, tubal health and the male partner's semen quality. Iswarya Fertility reports IVF success of about 75 percent for women under 35, but individual chances vary and no treatment can guarantee pregnancy.

When to see a fertility specialist

See a specialist if your periods are irregular and you have been trying for 12 months (6 months if you are 35 or older), or sooner if you have very infrequent periods. Iswarya Fertility has 91+ centres, and EMI options start from ₹9,999 per month for eligible treatments.