Ovarian cysts, or polycystic ovaries, are a common disorder in women. One of the main symptoms is weakness or total absence of ovulation. What threats does this problem have on fertility? What is the treatment, especially if you have a pregnancy plan? The answers to your questions.
Polycystic ovary syndrome is the most common hormonal disorder among young women: 5 to 10% are concerned. It is the main cause of menstrual disorders and fertility disorders.
What is polycystic ovary syndrome?
Did you know? Polycystic ovary syndrome (PCOS) is not a problem of cysts. In fact, it is a small follicle that is formed in the ovaries in too many numbers. Paradoxically, few of them mature and this often causes cycle disorders.
Indeed, in the case of polycystic ovary syndrome, male hormones (androgens) modify the growth of these follicles and make them visible on ultrasound. They appear black, like cysts. Hence the confusion when this syndrome was observed for the first time.
Symptoms of Polycystic Ovary Syndrome
The origin of this symptom is not yet fully known. But, it would be partly due to too much manufacture of male hormones (androgens). These androgens alter the growth of follicles that become visible in greater numbers on ultrasound. This has an impact on ovulation, which is often less regular and then causes rule problems ( irregular cycles ).
In addition, in some women, these androgens made in excess can also cause acne, excessive hair ( hirsutism ) and/or hair loss. But, symptoms of polycystic ovary syndrome can be very different from one woman to another. Thus, there are many forms of this syndrome.
The diagnosis of polycystic ovary syndrome
The diagnosis is based on the presence of at least 2 of the following 3 criteria :
- The existence of a hyperandrogenic (clinical or biological): excessive secretion of male hormones that causes the appearance of male characters.
- The disorders of the rules which testify of the problem of ovulation: when the ovulation is no longer done (anovulation), or very rarely, it induces amenorrhea ( absence of rules ).
- The follicles are visible on ultrasound: either because of their large volume (beyond 10 ml) or because of their large number (greater than 12 on at least one of the two ovaries).
Note: the measurement of the hormone secreted by these follicles (AMH) can also give a good reflection of the number of follicles that contain the ovaries. It can be proposed in addition to the ultrasound.
But, the diagnosis is also based on the elimination of other diseases that may have similar symptoms (tumor, the problem of secretion of corticosteroids ). In order to make the diagnosis, your doctor prescribes a blood test (to be done at the beginning of your cycle) and a pelvic ultrasound.
Polycystic ovary syndrome: what treatments?
SYMPTOMATIC TREATMENTS
Some treatments improve the symptoms presented by each woman. For example, if you are embarrassed by acne or hair, an estrogen-progestative contraceptive pill can be proposed to restore the hormonal balance (provided of course that there is no desire for children). Specific drugs against male hormones can also be offered.
WEIGHTLOSS
Some women with this syndrome are also overweight. Overweight and insulin resistance promote symptoms and may decrease fertility. This is why in the case of PCOS associated with excess weight, certain measures of hygiene and food are implemented. A weight loss of 5 to 10% can sometimes restore a normal menstrual cycle and a return of ovulation. Finally, oral antidiabetic agents can be used against insulin resistance problems.
OVULATION INDUCERS
If the infertility problem is only related to a problem dysovulation ) of fertility drugs can be used, first and foremost the clomiphene citrate. The problem is often to determine the dose, which varies according to each woman. Often the 50 mg dose between the 2 th and 6 th day of the cycle is enough to trigger ovulation in 50% of patients. For the others, the doses are increased stepwise up to a maximum of 150 mg. Only 30% of patients are resistant and do not respond to these doses. For those in whom clomiphene citrate works, one gets a pregnancy in 60% of the cases after 6 cycles of induction.
HORMONE INJECTIONS
In case of failure, it is the injectable gonadotropins (FSH) are used. Of injections of the hormones used to boost production of follicles in the ovaries that are going to donate eggs. The final stimulation of ovulation, by injection, is preceded by ultrasound and hormonal assays to avoid the risk of stimulating multiple ovulation and resulting in multiple pregnancies.
INTERVENTION
Another technique can be proposed to stimulate ovulation: the "ovarian drilling". This is a small intervention in the ovaries. These are perforated to reduce the number of follicles, which helps restore normal functioning. This treatment is effective in 50% of cases but can lead to pelvic adhesions.
Whatever the technique, appropriate treatment can restore ovulation and get pregnant in the majority of cases. Admittedly, spontaneous miscarriages are a little more important in cases of polycystic ovary syndrome. And if the induction of ovulation does not work, then other medically assisted procreation techniques must be used.
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