I. Definition
Polycystic Ovarian Syndrome is defined as endocrinologic diseases caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries as resulting of enlarged ovaries, leading to hormone imbalance( excessive androgen), resulting in male pattern hair development, acne,irregular period or absence of period, weight gain and effecting fertility. It effects over 5% of women population or 1 in 20 women.

II. Symptoms of PCOs
1. Irregular or absent menstrual periods
2. Male pattern hair growth
3. Acne and oily skin
4. Over weight
5. Obstructive sleep apnea
Closure of the upper airway, causing stop breathing while sleeping
6. Difficult to conceive

III. Diagnosis
If you have above symptoms, you may have PCOs. It is for your benefit to visit your doctor or gynaecologist immediately, because it may effect your chance of fertility. It is easy to identify through your medical history, physical exam and a blood test. In fact, the most effective long term treatment for PCOs can be done naturally at comfort at your own home.
The blood test includes testing of
DHEAS, testosterone, SHGB, LH and FSH ratio, TSH, IGTT level ( fasting insulin) and several other androgens are used to evaluate adrenal function. If there are abnormal secretion of certain hormones, you may be in a high risk of having PCOs. You may also require to have an ultra sound to look at your ovaries.


IV. Causes of PCOs
The causes of polycystic ovarian syndrome is still unknown, but there are some suggestions
1. Genetic predisposition
A genetic predisposition is defined as a genetic problem of some women who were born predisposed to certain health problem. In this case, it is polycystic ovarian syndrome.

2. Insulin resistance
Insulin resistance is defined as above normal level of insulin in the blood of a person. It may be caused other health problem such as diabetes, abnormal function of pancreas or caused by low numbers of the insulin sensitivity of cells, which impairs the process of glucose in energy conversion and high blood glucose levels in the body, leading to hormone imbalance resulting in increasing the risks of cystic follicles or ovarian cysts development.

3. Obesity
Obesity is defined as a person whose BMI index is over 24. As we known, obesity women is always associated to insulin resistance, leading to the same problem as mentioning above.

4. Hyperandrogenism
Hyperandrogenism is a medical condition characterized by excessive production and/or secretion of androgens leading to male pattern hair growth.

a) Hirsutism
Hirsutism develops when follicles in androgen sensitive areas start to form thick, pigmented hair as opposed to thin, short, non-pigmented hair normally seen in those areas in women.

b) Cushing syndrome
Cushing's syndrome is a chronic illness caused by over production of cortisol hormone leading to lower sperm production in male and abnormal ovulation in women.

c) Disorders of cortisol metabolism,
Cortisol is usually referred to as the stress hormone, as it is secreted in large volume for our body to response to stress and anxiety. Disorders of cortisol metabolism is defined as a condition of which cortisol hormone has losen its function in restoring homeostasis after stress and inhibited insulin, causing blood sugar to rise.

d )Hyperprolactinemia
Prolactin is produced by the anterior pituitary gland primarily which plays important breast development during pregnancy and milk production after birth. Hyperprolactinaemia effects the normal function of the hypothalamus and pituitary gland, leading to ovulatory infertility, a decreasing in menstruation and sometimes lost of menstruation and lost of sexual desire.

e) Acromegaly
Acromegaly is defined as over production of growth hormones caused by a benign tumor or of the pituitary gland and in rare case, it may be caused by tumors of the pancreas, lungs, and adrenal glands, leading to excess GnRH, resulting in male pattern hair growth.

5. Environmental chemicals
Environment chemicals such as xanoestrogen can causes over production of certain hormone and reduction of others, leading to abnormal function of the reproductive organs including the development of follicles and increasing the risk of PCOs.

6. Food adulterantion
Food adulterantion is defined as admixture or substitution of inferior substances or by the removal of some valuable ingredient in foods, leading to hormone imbalance and distorting the natural process of women reproductive system.

7. Chronic inflammation
Prolonged inflammation, known as chronic inflammation, leads to a progressive shift in the type of cells which are present at the site of inflammation and is characterized by simultaneous destruction and healing of the tissue from the inflammatory process.


V. Types of Conventional treatments
1. Metformin
a) The effectiveness of metformin
It is an oral anti-diabetic drug used to treat type II diabetes. It is also used widely in treating PCOs by suppressing the production of endogenous glucose by the liver as it helps to make insulin working more effective without changing the level of insulin in the body, thereby helping to regulate the production of certain hormones resulting in ovulation and egg production.

i) Gastrointestinal upset including diarrhea, cramps, nausea and vomiting.
ii) Buildup of lactic acid in the body.
iii) Abdominal pain or cramps.

2. Clomiphene (Clomid)
a) The effectiveness of chomiphere
It is considered as a fertility medication. The effectiveness of clomiphere is that it helps to induce ovulation in women who are not ovulating at all and to increase the production of egg for women with letual phrase defect by stimulate the function of pituitary gland in series of hormone production, including LH, FSH and egg follicles.

b) Side effects
i) abdominal pain and cramps.
ii) Breast tenderness.
iii) Ovaries swelling,
iv) Sleeplessness
v) Gastrointestinal disorder including nausea, and vomiting.

3. Hcg
a) The effectiveness of HCG
Human Chorionic Gonadotropin (HcG) is defined as a hormone secreted by specialized cells called trophoblasts and later by the placenta. Since it is similar in structure to LH, it helps to induce ovulation by stimulating the release of mature egg, approximate 36 hour after taking it. HCG not only pinpoint the best time for sexual intercourse with success conception or assisting intrauterine insemination in egg retrieval.

b) Side effects
Although side effects of HCG is not common, but some women may experience
i) Headaches
ii) Irritability
iii) Restlessness, slight
iv) Water retention
v) Breast tenderness
vi) Depression

4. Gonadotropin (HMG)
a) The effectiveness of HMG
HMG contains natural FSH and LH, is a purified form of urine of post menopausal women. By stimulating production of LH and FSH to right levels, it helps to induce ovulation and develop mature follicles. if you are found to have low natural gonadotropin or estrogen levels or you need to have multiple egg follicles for artificial insemination. The medication may be also used if chomiphere therapy and other medication have been failed to induce ovulation.

b) Risks and side effects
i) Risk of miscarriage ( Quality of egg does not address here)
ii) Ovarian enlargement ( Caused by over stimulation)
iii) Ovarian hyper stimulation syndrome (OHSS)
iv) Multiple pregnancy
v) Headache and abdominal pain and cramps.
vi) Breast tenderness


5. Dexamethasone
a) The effectiveness of dexamethasone
Dexamethasone is a synthetic member of the glucocorticoid class of steroid hormones and a prescribed medication for fertility but does not use frequently as the other medication. It helps to induce ovulation by suppressing the androgen levels, resulting in increasing the chance of fertility.
b) Side effects
i) Stomach upset
ii) Glucose intolerance
iii) Moodswing and irritability
iv) Depression
v) Water rentention
vi) Hypertension

6. Artificial Insemination (In Vitro Fertilization (IVF))
a) The effectiveness of IVF
In Vitro Fertilization (IVF) may also be offered, if other medication treatment have failed to induce pregnancy for women with PCOS by using HCG or other medication to induce ovulation and egg retrieval.

b) Risks and side effects
a) Ovarian hyperstimulation
b) Pelvic pain and cramps,
c) Shortness of breath,
d) Blood chemistry abnormalities

7. Surgery
Surgery is not commonly performed. If necessary, PCOs can be treated by either a laparoscopic surgery also is known as ovarian drilling or wedge resection. Both methods have not proven to be effective for women with PCOs. It is your benefit to forgo this type of expensive treatment in favour of other such as IVF.

Remember the most effective long term treatment for PCOs can be done naturally at comfort at your own home.

We have spent most of our times in discussing "Fertility and PCOs in Conventional medication Perspective", we will come back with another article " Fertility and PCOs with General Perspective". At the meantime, enjoy reading.

Always keep yourself positive and work together with your doctor, you may get pregnant sooner than you think.