Marina Soto Sogorb, Dr.
Gynecologist & Obstetrician at PHI Fertility , PHI Fertility
Category:
PCOS, Success Rates
PCOS is a hormonal condition affecting 1 in 10 women of reproductive age. The exact cause of this condition is unknown but its accepted that it is a combination of genetic and environmental factors. Unbalanced hormone levels are also key factors why PCOS leads to fertility issues. In this webinar, Dr Marina Soto Sogorb, Gynaecologist and Obstetrician at Phi Fertility, talks about polycystic ovary syndrome and answers the important question: Can IVF help to overcome infertility caused by PCOS?
According to Dr Marina Soto Sogorb, in order to understand polycystic ovary syndrome (PCOS) one has to understand what’s going on in a normal menstrual cycle. Brain structures called the hypothalamus and pituitary gland control the menstrual cycle. Together with the ovaries and the uterus, they follow a sequence every month. The objective of this sequence is to prepare the body for pregnancy. Hypothalamus produces FSH (follicle-stimulating hormone) and LH (luteinizing hormone) while the ovaries produce oestrogen and progesterone. These hormones make the lining of the uterus thicker to prepare the body for pregnancy. During the first half of the menstrual cycle, FSH increases. This increase stimulates the ovaries to produce the cord of follicles, among which one stands out of the rest. This is the so-called ‘dominant follicle’. It produces A rising level of oestrogen and this, in turn, causes the thickening of the endometrium (the lining of the uterus). The increase of oestrogen also causes the release of LH in the pituitary gland. At the moment of LH peak, the ovulation occurs.
Ovulation is the release of an egg from the ovarian follicle. After ovulation, the next phase of the cycle begins. The follicle, that was left by an egg, starts to produce progesterone. When fertilisation doesn’t take place, the follicle contracts inside the ovary and the levels of oestrogen and progesterone begin to shrink. This causes the endometrium to shed and results in menstruation – and the start of the next menstrual cycle.
After this detailed explanation of the menstrual cycle, Dr Marina Soto Sogorb goes on to talk about PCOS ( polycystic ovary syndrome) itself. PCOS is the most common endocrinopathy in women of reproductive age. Its prevalence oscillates among 10%. The causes of PCOS are generally unknown – however, genetic and environmental factors are taken into account.
PCOS is characterised by hormonal imbalance. What we understand by that is a higher production of LH (in comparison with FSH) and an increase in androgens. Hormonal imbalance causes ovulatory disfunction, resulting in excessive follicular recruitment: large cohorts of follicles and growth of follicles ceases.
The changes in hormone levels influence women’s health, well-being and physical appearance. One of the symptoms is hyperandrogenism which manifests itself as acne, increased body hair, scalp hair loss, as well as weight grow. Ovulatory dysfunction on the other hand, results in an absence of, or irregular menstrual periods and difficulty in getting pregnant. Dr Marina Soto Sogorb admits that the symptoms can be very variable but in many cases the first symptom is infertility.
Dr Marina Soto Sogorb says that women often ask how they can know if they have PCOS. In order to diagnose PCOS, a gynaecologist should conduct an interview to determine a patient’s medical history. An ultrasound scan of ovaries is also needed. The ultrasound description of a polycystic ovary consists of more than 12 follicles with the diameter of 2-9 millimetres. A gynaecologist may request a hormonal determination, too. When the latter shows an increase in LH levels and androgens, it is a sign of PCOS.
However, due to phenotypic heterogeneity, the diagnosis of PCOS is very complex. Medical criteria used by doctors for diagnosis are : hyperandrogenism, ovulatory dysfunction (absent or irregular periods) and polycystic ovaries on ultrasound. At least 2 of these 3 criteria have to be met in order to recognise PCOS in a woman. Dr Marina Soto Sogorb says that according to these criteria, we can observe 4 phenotypes: A,B,C and D. The most common is ‘A’ and it arises from the combination of hyperandrogenism, ovulary dysfunction and polycystic ovaries morphology by ultrasound. About 60% of women with PCOS are classified with phenotype ‘A’. The phenotype ‘B’ is a combination of hyperandrogenismand ovulary dysfunction while ‘C’ (called an ‘ovulatory phenotype’) conflates hyperandrogenism and polycystic ovaries morphology. The last phenotype ‘D’, which is also the least common one, combines both ovulary dysfunction and ultrasound criteria.
Dr Marina Soto Sogorb says that there are few options for PCOS treatment. If the problem is weight related then one of the most effective approaches is weight loss. Manifestations of hyperandrogenism may be treated with contraceptive pills – assuming, of course, that a patient is not planning a pregnancy. Another option here are antiandrogens – a group of medicines that counteract the effects of the male sex hormones.
What is the solution for infertility problems resulting from PCOS? According to Dr Marina Soto Sogorb, the main problem here is anovulation – the failure of ovaries to release an oocyte during a menstrual cycle. Assuming that the only pathological factor is the lack of ovulation, then doctors usually recommend an available reproduction technique as a cure.
The first step of the treatment is clomiphene citrate. It’s an ovulation inductor administered orally that stimulates the ovaries to realise follicles. It’s an easy and economic way of treatment. The results are quite impressive – the ovulation rate is 80% while cumulative gestation rate equals 40% (in 6 cycles). However, the main risk here is multifollicular development and, as a result, a multiple pregnancy.
If a woman doesn’t get pregnant with clomiphene citrate, artificial insemination is the second step. It consists of ovarian stimulation with low doses of gonadotropins (either FSH or LH) in subcutaneous injections. After the ovulation occurs, the semen (collected on the day of the insemination) is introduced into the uterine cavity. Dr Marina Soto Sogorb assures that insemination isn’t a painful procedure and it doesn’t need anaesthesia. Again, like in case of clomiphene citrate, the main risk is multifollicular development and a multiple pregnancy. The gestation rate here is 15% in one cycle while cumulative pregnancy rate is 30%.
If a woman does not get pregnant by artificial insemination, IVF is the next step. It is the most expensive and also the most complex technique as it consists of several phases. The first one is ovarian stimulation with high doses of gonadotropins to achieve the development of multiple follicles. When the follicles achieve an adequate size, the ovarian puncture for oocyte extraction takes place. The puncture is performed in an operating room under general anaesthesia. Then the fertilisation of the egg is conducted in a laboratory. Embryonic laboratory development takes about 2-6 days and then the embryo transfer is made. The gestation rate in PCOS patients after IVF is up to 75%. Having said that, Dr Marina Soto Sogorb admits that IVF is a real solution to infertility caused by polycystic ovary syndrome.
- Questions and AnswersDisclaimer:
Informations published on myIVFanswers.com are provided for informational purposes only; they are not intended to treat, diagnose or prevent any disease including infertility treatment. Services provided by myIVFanswers.com are not intended to replace a one-on-one relationship with a qualified health care professional and are not intended as medical advice. MyIVFanswers.com recommend discussing IVF treatment options with an infertility specialist.
Contact details: The European Fertility Society C.I.C., 2 Lambseth Street, Eye, England, IP23 7AGNecessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
Cookie | Duration | Description |
---|---|---|
_ga | 2 years | This cookie is installed by Google Analytics. The cookie is used to calculate visitor, session, campaign data and keep track of site usage for the site's analytics report. The cookies store information anonymously and assign a randomly generated number to identify unique visitors. |
_gat_UA-38575237-21 | 1 minute | No description |
_gid | 1 day | This cookie is installed by Google Analytics. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. The data collected including the number visitors, the source where they have come from, and the pages visted in an anonymous form. |
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet.
Cookie | Duration | Description |
---|---|---|
_gat_FSQM52 | 1 minute | No description |
cf_ob_info | No description | |
cf_use_ob | No description |