PCOS, or polycystic ovarian syndrome

PCOS is among the most common causes of female infertility. In essence, women with PCOS do not ovulate or release eggs monthly because their hormones are out of whack.  This is not only one of the most common causes of infertility, luckily it is often one of the less expensive problems to treat.

The first treatment approach are the drugs clomiphene (brand name Clomid) or letrozole (Femara). These drugs block or decrease estrogen to the brain and stimulate egg release. We can get about 80 percent of women with PCOS to ovulate on one of these medicines and ultimately get more than half of women with PCOS pregnant spending only about $10 a month.

When oral infertility medications don’t work for PCOS patients, then it’s time to move on to more aggressive therapy.

At this point there are several options and should be individualized with the patient. Everything becomes more expensive so choosing the right options for your budget is key.  Adding intrauterine inseminations, doing surgery, adding injectable medications or moving on to IVF may all be reasonable paths. 

A surgery called ovarian drilling involves cauterizing approximately six holes in each ovary laparoscopically to reduce their volume. This decrease in the ovarian’ volume makes it easier for the patient to produce more normal hormonal levels trigger egg release. 

The goal of the procedure is to help women ovulate spontaneously; it also helps people with PCOS respond better to medications.

Endometriosis

Endometriosis is a disease where the lining of the uterus, which is normally shed each month during a menstral period, escapes the uterus, often back flows through the tubes and attaches itself to the walls of the pelvis and other pelvic structures. The result of this backward flow is scar tissue and inflammation than can be detrimental to fertility.

Endometriosis is diagnosed through laparoscopic surgery but hinted at when someone has very painful heavy cycles, chronic pelvic pain or otherwise unexplained infertility.

Endometriosis pain can be avoided when someone doesn't want to be pregnant.  It can be treated both surgically and medically.  Often hysterectomy becomes a good solution for the pain in many patients after they are done having children. 

Fibroids (benign uterine muscle tumors)


Fibroids are muscular tumors that grow in the wall of the uterus. Researchers aren’t sure why these benign tumors begin to grow, but a good percentage of women will develop them in their lives — in fact, fibroids are found in about 40 percent of women before menopause.

In addition to causing heavy menstrual bleeding, fibroids can have a devastating effect on attempts at conception if they push into or distort the uterine cavity where the baby grows.

The surgical procedure, called a myomectomy will get rid of the fibroids and return the uterus to a more normal shape.  This can be done through the abdomen or though the cervix.

There are very few surgeons that can handle fibroids with very little or no incisions.  I have taken out fibroids that have filled up a patient's whole belly using only tiny incisions.  This causes less scar tissue is much less disfiguring than the more traditional open laparotomy.

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Tubal reanastamosis
Sometimes life is unpredictable and you find yourself wanting more children after you had your tubes tied.  There are only two good options if you want to have your own babies. IVF (in-vitro fertilization) is used get the eggs out and avoid using the tubes or tubal reanastamosis can be done to surgically reconnect the tubes.  Both procedures have very similar success rates in younger patients success but at Pennington Women's we offer tubal reanastamosis at about half the price of an IVF cycle. 

Signs of PCOS

1.  irregular periods

2.  dark hair growth, acne

3.  infertility

Common sites of endometriosis

Infertility is diagnosed if a couple has been trying to conceive for 12 months and have had no success. If the potential mother is over 35 we like to start treating infertility after 6 months of trying.  Infertility is a unique problem in medicine because if can be primarily female, primarily male or a combination of both or even sometimes unexplained.  Some infertility is very easy to fix and some is not. In its simplest, you need 4 things to make a baby.    You need good eggs, you need good sperm, you need open fallopian tubes to get the sperm and eggs together and you need a good uterus to grow the baby.  Infertility can be caused by one of these problems and often couples will have more than one to overcome.