Conception

PCOS: what are the therapies to be able to get pregnant?

We spoke extensively with our endocrinologist Isabella Negro about PCOS and fertility

What we will do today is to briefly list the current therapies to improve ovulation in those suffering from this syndrome, recommending that you always speak to your doctor, gynecologist or endocrinologist, to understand which drugs are most suitable for your particular situation. .

1) Weight loss

PCOS is often accompanied by overweight and in these cases the loss of excess pounds should be the first thing to do.

Obesity and a high Body Mass Index predispose to insulin resistance.

In obese women with PCOS, a 5-10% weight loss can restore reproductive function in 55-100% of women within 6 months.

2) Clomiphene citrate (Clomid)

It is a non-steroidal drug with both estrogenic and anti-estrogenic activity. It is usually taken for 5 consecutive days. The dose, depending on the case, ranges from 50 mg/day up to a maximum of 150 mg/day. You should have intercourse from the ninth day of your cycle for at least a week. It is important to monitor with transvaginal ultrasound at least in the first cycle of treatment to verify the response to the drug. Ovulation is expected in 80% of cases of clomiphene intake and pregnancy in 35-40% of treated women. However, there is a percentage of women (20-25%) who do not respond to treatment.

adverse reactions:

  • cervical mucus becomes thicker
  • hot flashes (in 10% of women)
  • abdominal distension (2%), abdominal pain, nausea, vomiting, headache
  • in 1.5% of women it can cause blurred vision
  • in 5% of cases enlarged ovaries
  • ovarian hyperstimulation is rare (less than 1%)
  • multiple pregnancies in 7%-10% of women treated
  • link to ovarian cancer in women with more than 12 courses of clomiphene

3) Gonadotropins

Therapy used when women do not respond to clomiphene or fail to conceive after 6-12 ovulatory cycles. There are very specific protocols that specialists in fertility treatments prescribe according to the situation.

4) Metformin

Controlling insulin levels in women with PCOS improves their clinical and metabolic profile.

The same results can be obtained with the restoration of ideal weight even if the association with this drug helps to obtain the desired results.

It works by reducing insulin levels, free and total androgen levels and improves the clinical consequences of hyperandrogenism.

One study highlighted that:

  • metformin is more effective than placebo at facilitating ovulation in women with PCOS
  • in association with clomiphene it is more effective than clomiphene alone in facilitating ovulation and therefore pregnancy

Adverse Effects:

nausea, vomiting, gastrointestinal disorders, lactic acidosis in patients with renal insufficiency.

Currently  PCOS is not by itself an  indication for the use of metformin. There is still a lack of   randomized clinical  trials to ensure  efficacy and safety.

Other drugs with hypoglycaemic effect such as thiazolidinediones and d-chiroinositol are under study.

5) Laparoscopic ovarian drilling

LOD (Laparoscopic Ovarian Drilling) is a therapeutic option for women with anovulation associated with PCOS.

The technique appears to be successful in thin women with high LH levels.

6) Aromatase inhibitors

Among these, letrozole, an alternative to clomiphene as it has no anti-estrogenic action. Further investigations into its efficacy and safety are needed.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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