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Polycystic Overarian Syndrome
and Insulin Resistance
The Southeastern Fertility Center is the region's leading center for treatment of Polycystic Ovary
Syndrome. Polycystic Ovarian Syndrome, or PCOS, is the most commonly identified fertility obstacle in women.
In PCOS, there is a disruption of the mechanisms that coordinate the cyclic release of  ovulation-inducing
hormones. This results in absent or infrequent ovulation, as well as bleeding abnormalities and especially irregular and
infrequent periods. Other symptoms of PCOS include unexpected hair growth (around the face, neck, chest, and abdomen),
acne, and weight gain. However, some women will have few if any of these symptoms.
It is important to remember that PCOS is a syndrome, rather than a specific disease. Even the
world's leading experts cannot agree upon a single definition, but a minimal requirement for this condition is an absence
of regular ovulation. This may be determinedby history, temperature charting, urine or blood testing, or ultrasound monitoring.
PCOS typically starts in adolescence, but there are many ways an individual may develop this syndrome
later in life. These include weight gain, medication use, or the development of hormonal disorders or insulin resistance.
Treatment
From a fertility standpoint, the goal of treatment for PCOS is inducing regular ovulation. Weight loss
and exercise are often helpful, but medications are the cornerstone of therapy. Anti-estrogens such as clomiphene and tamoxifen
will induce ovulation in 75% of patients, although only 40-50% will actually conceive. For those patients who do not ovulate
or conceive with oral therapy, low dose injectable hormones (FSH and/or HMG) are extremely effective. Finally, surgical
therapy for PCOS remains a viable option and is a preferred method in certain individuals. We have extensive experience
in both inpatient and outpatient surgical treatment of PCOS.
 Insulin resistance
is a condition in which the pancreas (abdominal gland that makes insulin) must secrete much higher amounts of insulin in
order to keep blood sugars in the normal range. Through a variety of mechanisms, this results in higher male hormone production
by the ovary, often causing anovulation, weight gain, and the other symptoms listed above. The
Southeastern Fertility Center was one of the first centers in the nation to begin testing for and treating this
condition. Our reputation has brought invitations to lecture on this topic at both local and national levels.
Diagnosis of insulin resistance is made by blood testing. However, the condition is suspected clinically
if a woman has coarse, velvety, or darkened skin behind the neck, under the arms, upper thighs, or groin. Treatment consists
of diet, exercise, weight loss, and one of several medications. The choice of medication is of prime importance because
the available options vary significantly in their effectiveness, side effects, toxicity, and propensity to cause weight
loss or weight gain.
Using combinations of medications to treat insulin resistance and PCOS, we have had remarkable success
in helping patients achieve regular ovulatory cycles and pregnancy, as well as weight loss. This has helped many patients
avoid injectable medications and IVF.
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