I have PCOS with endometriosis

Dear Dr Mitchell,

I would like to ask, what are the treatments that I would be eligible for? I have PCOS with endometriosis and I am desperate to become pregnant.

Polycystic Ovary Syndrome (PCOS) is a condition that is associated with infrequent ovulation and in extreme cases, a failure to ovulate, excessive weight gain, excessive facial and body hair growth in a male pattern type of hair distribution, temporal baldness (male pattern type of hair loss), acne, enlargement of the clitoris in some women, deepening of the voice, and an increased tendency to develop diabetes mellitus. The diagnosis can be confirmed by doing a pelvic ultrasound.

The usual finding is enlarged ovaries with multiple immature ovarian follicles. A blood test can be done to check the hormone levels. This includes checking the testosterone levels; follicle stimulating hormone and the luteinizing hormone levels. The blood glucose is usually done to rule out diabetes mellitus, especially in women who have excessive weight gain.

Weight loss utilising an appropriate diet with reduced calorie intake and a regular exercise programme will definitely help the regulation of the menstrual cycle and improve fertility. The use of Metformin and Clomiphene (CLOMID) will also help to induce ovulation and significantly improve your chances of becoming pregnant.

Endometriosis is a condition that is associated with chronic pelvic pain and infertility. In endometriosis, tissues that are similar to the tissues lining the cavity of the uterus are present outside of the uterine lining. These tissues bleed with the onset of the menstrual period. In a lot of women these deposits are present around the ovaries and Fallopian tubes. This results in scarring or adhesion formation which interferes with ovulation and the function of the Fallopian tubes which are sometimes severely bound down.

The management of endometriosis usually involves the use of drugs to suppress the menstrual period, thus allowing the deposits to shrink and improve fertility. In severe cases, surgery has to be done to burn or remove the deposits and the pelvic adhesions. In some women the use of drugs and surgery to treat the endometriosis still does not result in an increased fertility outcome. In these cases, invitro fertilisation has to be done to achieve a pregnancy. This involves removing the egg from the ovaries under ultrasound guidance after giving medication to stimulate the ovaries to produce several eggs in one cycle. The semen is collected from the spouse or a donor and this is used to fertilise the egg which is then put into the uterine cavity where it develops. The outcome with this treatment is good. Invitro fertilisation is available in Jamaica at the Hugh Wynter Fertility Management Unit at the University Hospital of the West Indies.

You need to discuss all the options with your doctor who will advise you further.

In the interim, you should take daily folic acid supplements to decrease your risk of birth defects in the brain and spinal cord of the foetus.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.