Polycystic Ovary Syndrome (PCO)
Perhaps 5% to 15% of all women are born with some degree of polycystic ovaries. Many, if not most of these women, will never find out since they will be able to conceive. These women have a very mild degree of PCO.
Women with more severe PCO will, at least temporarily, lose the regularity of their menstruations (become anovulatory) and may need medical help to conceive.
In its most severe forms, polycystic ovarian syndrome can make it quite difficult or even impossible for a woman to ovulate and conceive even with ovarian stimulation.
This lack of ovulation is accompanied by a hormonal imbalance which, in some women, involves abnormal insulin production and glucose metabolism.
Polycystic ovaries are by far the most common cause of lack of ovulation. The term "polycystic" refers to the increased number of ovarian follicles (not cysts) present within the ovaries of most women with PCO.
The ultrasound image below shows an unstimulated PCO ovary. Notice the periphery of the ovary studded with follicles like a necklace of pearls - a hallmark of PCO.
Women with PCO who need medical treatment to get pregnant comprise a special group of patients. Their ovaries can be very sensitive to stimulatory medications, their eggs tend to be more immature, and they have an increased risk of multiple pregnancies and ovarian hyperstimulation.
The physician must be aware of the presence of even the mildest degrees of PCO before In Vitro Fertilization ovarian stimulation begins. PCO ovaries do need to be stimulated differently than ovaries of women without the polycystic ovary syndrome.
Women with PCO who are ovulatory (have regular menstrual periods) can be excellent candidates for the Soft-IVF treatment, all but avoiding the possibility of ovarian hyperstimulation.
We rely primarily on the Ovarian Reserve Assay (ORA) and ultrasonic ovarian assessment to guide us in selecting the most appropriate method of ovarian stimulation for women with PCO.
