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Female Fertility |
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Polycystic Ovary Syndrome |
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Naava Carman, who runs The Fertility Support Company, has a special interest in dealing with Polycystic Ovary Syndrome (PCOS). She has found that a multi-dimensional approach to treating the condition, hormonally, aerobically, nutritionally, metabolically and emotionally, yields the best results.
The Fertility Support Company has a comprehensive programme which tackles the root cause of PCOS. Over three months, we look at diet, lifestyle, basal temperature charts, hormone panels, and ovulatory patterns, to regulate all aspects of this issue.
At the end of six weeks:
Anecdotal evidence collected from within our practice shows 50% of our patients will have had a period, effectively reversing amenorrhoea.
At the end of three months:
Anecdotal evidence collected from within our practice shows that 80% of the women who have had a period within this time frame will have gone on to have another two periods, thereby re-establishing their cycle once again. By the time we finish working with these patients, we find that they will be ovulating with regularity, will have lost a minimum of 5% of their body fat (if appropriate), will know how to eat and exercise in a way which suits their body, and will also know how to determine their own most fertile times.
For those of whom PCOS has been diagnosed as the reason for difficulty conceiving, this will be specifically addressed, and will also result, in most of our cases, in a pregnancy within 3-8months after completing the programme.
If you have any questions regarding PCOS, would like to discuss your condition or would like to arrange an appointment please feel free to email us at through our contact form or call on 020 8621 0798.
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| Key facts: |
Polycystic (literally, many cysts) Ovary Syndrome (PCOS or PCO) is a complex condition that affects the ovaries (the organs in a woman's body that produce eggs). In PCOS, the ovaries are bigger than average, and the outer surface of the ovary has an abnormally large number of small follicles (the sac of fluid that grows around the egg under the influence of stimulating hormones from the brain).
In PCOS, these follicles remain immature, never growing to full development or ovulating to produce an egg capable of being fertilised. For the woman this means that she rarely ovulates (releases an egg) and so is less fertile. In addition, she does not have regular periods and may go for many weeks without a period (amenorrhoea). Other features of the condition are excess weight and excess body hair and loss of head hair.
The condition is relatively common among infertile women and particularly common among women with ovulation problems (an incidence of about 75 %). In the general population, around 25 per cent of women will have polycystic ovaries seen on ultrasound examination but most have no other symptoms or signs of PCOS and are perfectly healthy. The ultrasound appearance is also found in up to 14 per cent of women on the contraceptive pill.
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| What causes PCOS? |
While it is not known if women are born with this condition, PCOS seems to run in families. This means that something that induces the condition is inheritable, and thus influenced by one or more genes and it seems that PCOS is associated with a predisposition to diabetes and problems with weight control. Ongoing research is trying to clarify whether there is a specific gene responsible for PCOS and it seems likely that in the future one or two genes will be identified as playing a fundamental role in determining a woman's likelihood of developing this condition.
Women are also more at risk of PCOS if they are overweight. Maintaining weight or body mass index (BMI) below a critical threshold is probably very important to determine whether some women develop the symptoms and physical features of the condition. Just how much weight (or what level of BMI) is difficult to say because it will be different for each individual. Certainly, for patients who are considered obese (with BMI greater than 30) or overweight (BMI 25 to 30), weight loss improves the hormonal abnormalities and improves the likelihood of ovulation and thus pregnancy. |
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| What are the symptoms? |
| PCOS is characterised by the following: |
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Absent or infrequent periods (oligomenorrhoea): a common symptom of PCOS. Periods can be as frequent as every five to six weeks, but might only occur once or twice a year, if at all. |
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Increased facial and body hair (hirsutism): usually found under the chin, on the upper lip, forearms, lower legs and on the abdomen (usually a vertical line of hair up to the umbilicus). |
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Acne: usually found only on the face. |
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Infertility: infrequent or absent periods are linked with very occasional ovulation, which significantly reduces the likelihood of conceiving. |
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Overweight/obesity: a common finding in women with PCOS because their body cells are resistant to the sugar-control hormone insulin. This insulin resistance prevents cells using sugar in the blood normally and the sugar is stored as fat instead. |
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Miscarriage (sometimes recurrent): one of the hormonal abnormalities in PCOS, a raised level of lutenising hormone (LH - a hormone produced by the brain that affects ovary function), seems to be linked with miscarriage. Women with raised LH have a higher miscarriage rate (65 per cent of pregnancies end in miscarriage) compared with those who have normal LH values (around 12 per cent miscarriage rate). |
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These symptoms are related to several internal changes.
Hormonal abnormalities, including: |
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Raised lutenising hormone (LH) in the early part of the menstrual cycle. |
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Raised androgens (male hormones usually found in women in tiny amounts). |
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Lower amounts of the blood protein that carries all sex hormones (sex-hormone-binding globulin). |
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A small increase in the amount of insulin and cellular resistance to its actions. |
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Characteristic changes in the appearance of the ovaries on ultrasound scan. The ovaries are polycystic, with many small follicles scattered under the surface of the ovary (usually more than 10 or 15 in each ovary) and almost none in the middle of the ovary. These follicles are all small and immature, generally do not exceed 10mm in size and rarely, if ever, grow to maturity and ovulate. |
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Most women with PCOS will have the ultrasound findings of multiple cysts on the ovaries, whereas the menstrual cycle abnormalities are found in around 66 per cent of women and obesity is only found in 40 per cent. The increase in hair and acne are found in up to 70 per cent whereas the hormone abnormalities are found in up to 50 per cent of women.
It is likely that there are different stages of the disease throughout life. Younger women tend to have substantial difficulties with their periods, whereas older women have other problems such as diabetes and hypertension (high blood pressure), though their menstrual patterns tend to become more regular. |
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| How is PCOS diagnosed? |
The diagnosis is based on the patient's symptoms and physical appearance. If the diagnosis seems likely because the patient's history contains many of the symptoms described already, certain investigations are carried out to provide confirmatory evidence or to indicate another cause for the symptoms.
These include blood tests such as: |
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female sex hormones (at a certain point in the cycle if possible) |
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male sex hormones |
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sex-hormone-binding globulin |
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glucose |
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thyroid function tests |
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other hormones, eg prolactin |
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ultrasound examination. |
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Your own GP can do the initial blood investigations, ensuring they are carried out at the correct time of the cycle if appropriate. Your GP may also be able to arrange an ultrasound scan. http://www.netdoctor.co.uk/womenshealth/facts/pcos.htm
The Fertility Support Company refers to Mr Geoffrey Trew or Mr Stuart Lavery at 92 Harley Street for all private consultations and investigations, which can typically be carried out a week after referral.
Once the diagnosis is made, nothing more needs to be done for some women. For example, if their fertility is not an issue, if their weight is within normal limits, and if they do not have excess body hair.
For other woman, there are a number of issues which need tackling and taking Metformin, the drug commonly prescribed to help weight loss, or Dianette, the contraceptive pill which regulates periods, has side effects, and moreover, does not teach either the patient or the patient's body how to deal with the root cause of the problem. Taking these drugs simply deals with the symptoms, and when the drugs are withdrawn, these symptoms will recur.
If you have any questions regarding PCOS, would like to discuss your condition or would like to arrange an appointment please feel free to email us at through our contact form or call on 020 8621 0798.
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