Making Sense of PCOS
By Shel Franco
http://www.preconception.com/resourc...enseofpcos.htm
What is likely the most common hormonal disorder among women of child-bearing age? Which disorder has had a name for more than a half century, but its cause is still relatively unknown? What is one of the foremost causes of female infertility?
You might not know the answer. But, if you're having trouble conceiving, you'll probably want to know about Polycystic Ovarian Syndrome (PCOS).
The Basics
What is PCOS?
According to Dr. Charles Glueck, MD, medical director of Alliance Cholesterol Center in Cincinnati, Ohio, PCOS is an endocrine syndrome. Some of the characteristics include, but are not limited to, the abnormal release of luteinizing and follicle stimulating hormones, irregular menstrual cycles, insulin resistance, excessive body hair growth, miscarriage, acne and morbid obesity.
PCOS gets its name from the tiny cysts that form inside the ovaries. These cysts are actually eggs prevented from being released by the abnormal hormone levels.
Who is at Risk?
According to doctors at the Center for Applied Reproductive Science (CARS), in Johnson City, Tenn., PCOS is genetic. The syndrome can be inherited from the mother's side, the father's side or from both sides.
Carla George, of Sacramento, Calif., wonders how many women in her family went undiagnosed with PCOS. "Both my mother and my grandmother suffered from a lot of the same symptoms I do," she says. "If they were alive today, I'm sure they'd be diagnosed with PCOS."
Does PCOS Mean Infertility?
"Most women with PCOS are infertile," Dr. Glueck says. But it is not impossible to conceive. Once ovulation is re-established some women do become pregnant. With proper care, the pregnancy can go full term.
Kindra Hooton Guest, of Birmingham, Alab., found that after months of different fertility drugs and dosages, something finally clicked. "[My OB/GYN] started me on Provera to induce a period and had me chart my cycles and take my temperature every morning," she says. "After two months of no temperature changes, [the doctors] realized I was not ovulating and started me on Clomid. I still did not ovulate, so they increased the dosage."
Six months later, Hooton Guest was sent to a fertility specialist. He tried a higher dose of Clomid at a different time during her menstrual cycle. "I got pregnant that month," she says.
The Diagnosis
What Will an Ultrasound Find?
According to data from CARS, "The PCOS ovaries are typically 1.5 to three times normal size. In some cases the ovary is virtually filled with small cysts."
When Cindy Price, of Franklin, Ind., saw her ovaries on the ultrasound screen, she couldn't determine what she was seeing. "The follicles just looked like a bunch of white dots on the screen to me," she says. But her doctor knew. "She said that [the follicle build-up] was not shedding off like it should, which was classic PCOS," Franklin recalls.
How Will the Blood Work Read?
More than likely, the blood work from a woman with PCOS will show some abnormalities. "Any [hormone] level that is twice the upper or lower limit of normal is particularly important and may indicate a serious problem," note the doctors at CARS.
Both Tiffany Sizemore, of Louisville, Ken., and Christine Vogle, of Peoria, Ill., showed abnormalities in their blood work. "[Mine] showed high-low testosterone levels and high blood sugar levels," Sizemore says. Vogle showed a hormone level greater than twice the normal limit.
Becoming Fertile
What are the Traditional Ways of Treating PCOS?
Women who are not trying to conceive can be placed on special diets and given medications to lessen symptoms. Some women, like Lisa Beamer of Pittsburgh, are put on birth control pills to control the growth of cysts.
However, women who wish to conceive most likely enlist the aid of Clomid, which CARS classifies as "an oral fertility agent."
"I was first treated with Clomid to introduce ovulation," says Devone Hart, of Tamarac, Fla. But Hart, as with some women on Clomid, didn't ovulate, despite increased dosages. In her case, a different approach was necessary.
Sometimes, treating the body's insulin resistance is the key to conception. "The most effective treatment is Metformin," says Dr. Glueck. "Other insulin sensitizing drugs are effective, but Metformin should be the drug of choice, being safe and effective."
Are there Alternative Treatments?
There are non-traditional approaches for dealing with PCOS. Vitamins, herbs and low carbohydrate diets top the list of alternative approaches.
Jackie Rosenzveig, of Modiin, Israel, finds information and advice on Internet discussion lists. "[The people] seem to be highly intelligent and knowledgeable, and their explanations of why one herb or another might help a particular problem always seem to make a lot of sense," she says. "When you start to look at PCOS as a hormonal imbalance rather than a curse, then herbs that are known to help normalize hormones seem more logical than a medicine that tries to trick your body into ovulating."
Even so, Dr. Glueck cautions that the risks of alternative treatments are not well known. And in the words of Lisa Smith, of Jenkinstown, Penn., "Herbs, just because they are herbs, are not necessarily more safe or less potent than prescription drugs."
Seeing a Specialist
What Kind of Physician Treats PCOS?
"My OB/GYN is the one who diagnosed me first," says Annick Vauthier, of Pierrefonds, Quebec, Canada. "He asked me to see the reproductive endocrinologist to confirm the diagnosis."
Many women see multiple doctors before being properly diagnosed. Even during treatment, women can see several physicians. "In my case, my OB/GYN prefers that my reproductive endocrinologist takes care of blood tests and medications. [My OB/GYN] is following me for my annual pap tests," says Vauthier. "And if I do become pregnant, he will be more involved."
The medical community is still trying to make sense out of PCOS. If you suffer from PCOS, you have a growing array of treatment options available. The key to conceiving with PCOS is to learn as much as you can about the condition to make the right decisions for you.
Want to See More?
Find support and information through the Polycystic Ovarian Syndrome Association and Preconception.com.
Join the community on the Polycystic Ovary Syndrome Discussion Board.
Read the Preconception.com diaries of Amy, Calico and Kim, who all suffer from PCOS.
Making Sense of PCOS 
