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  » Infertility  »  Polycystic ovaries and anovulation cause female infertility


Polycystic ovarian syndrome is a common cause of anovulation and infertility in women. Women with this syndrome do not ovulate regularly and have ovaries that contain multiple small cystic structures, usually about 2-9 mm in diameter. This gives the ovaries a characteristic "polycystic" (many cysts) appearance on ultrasound - see images below.

Polycystic ovarian syndrome causes irregularities in the menstrual cycle, and sometimes a total lack of periods - amenorrhea .


Image of an enlarged polycystic ovary as seen at laparoscopy

Ultrasound image of a typical polycystic ovary

A typical, enlarged, polycystic ovary
The numerous small cysts are just under the capsule

Blue circle is around the ovary
Note the numerous small cysts (follicles)
These follicles are about 3-9mm diameter
The larger one at 8 o'clock measures 9mm

For comparison, an ovary with a mature follicle at midcycle in a woman that ovulates monthly
Blue circle is around the ovary, the black area is the fluid in the follicle
The follicle is mature size (here 20mm diameter) and contains a microscopic egg (not visible on ultrasound)

Ultrasound image of a polycystic ovary in a woman with blocked and dilated fallopian tubes - hydrosalpinx
She has at least 2 causes of her infertility - anovulation and tubal factor infertility


The basic problem is that although the polycystic ovaries contain many follicles with eggs, the follicles do not develop and mature properly so that they do not ovulate. Women without polycystic ovaries normally develop one mature follicle each month which ovulates (releases) one egg.

Women with polycystic ovaries are often hyperandrogenic as well. This means that their ovaries produce an excess amount of male hormones testosterone and androstenedione, which can cause increased hair growth - hirsutism , and sometimes-other problems as well.

The typical story seen in women with polycystic ovaries is irregular menstrual cycles, onset of hirsutism in the teens or early 20s, and gradually worsening excess hair growth.

When they attempt to get pregnant, women with polycystic ovaries will usually have difficulty. Some women with this disorder will ovulate (release a mature egg) occasionally; others do not ovulate at all. In order to conceive, sperm must be able to find and fertilize a mature egg. Therefore, they will usually need to undergo induction of ovulation to get pregnant.

The good news is that pregnancy rates are high for women with this condition. The large majority will be able to have a baby, if they will undergo treatment. Details about use of the medications mentioned below are on the induction of ovulation pa ge.
Many will be able to get pregnant using clomiphene citrate tablets to induce ovulation. This is often given by general gynecologists. About 75% of women with polycystic ovaries will ovulate with clomiphene, but only about 40% will get pregnant with it.
If this fails after about 6-9 ovulatory cycles, the next step is usually injectable gonadotropins . About 90% of women that do not ovulate with clomiphene will ovulate with this medication. The majority will get pregnant as well.
If this fails after about 3-6 ovulatory cycles, the next step is usually in vitro fertilization . The majority of women with polycystic ovaries that have not gotten pregnant with the above treatments will conceive with IVF.

A relatively new method of inducing ovulation in women with polycystic ovarian syndrome is to use oral medications such as Metformin in conjunction with clomiphene citrate. Metformin has been used in the past as an oral agent to help control diabetes. Recently, it has been found to facilitate ovulation in some women with PCOS. The medication can have side effects and proper monitoring must be performed. We are currently offering this treatment to appropriate candidates.