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Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a condition where there is a disturbed hormonal function of the ovaries and is the most common endocrine disorder in women. It occurs in 10-15% of women.
In order to be diagnosed with PCOS, two of the following three criteria must be met:
1) Irregular menstrual cycles
- Interval between cycles longer than 35 days;
- Or complete absence of menstruation (amenorrhea).
2) Hyperandrogenism
- Clinical: pronounced acne, increased sallowness (face, body), hair loss;
- Or laboratory: elevated levels of androgenic hormones (testosterone, etc.)
3) Polycystic appearance of ovaries on ultrasound
Infertility treatment for PCOS patients at the Gyn. Fertility Clinic Milenković
For the treatment of infertility in patients with polycystic ovaries, the treatment usually begins with drug therapy, and if the desired results are not achieved, it is switched to surgical options.
There are various oral preparations that are used to stimulate ovulation, and most often they are taken between days 3 and 7 of the cycle.
The first ultrasound examination (folliculometry) is performed around 10-11 days of the cycle in order to determine the exact moment of ovulation, i.e. the period when the chances of conception are greatest.
Determination of ovulation can be supplemented by hormone analyzes or urine ovulation tests.
About 80% of women ovulate after using this therapy, while approximately 30% achieve pregnancy. The risk for twin pregnancy is about 10-15%.
In a certain number of women with polycystic ovary syndrome (PCOS), certain preparations can lead to regulation of the cycle and ovulation. However, large studies have not shown a significant effect on increasing pregnancy and birth rates. These preparations are often used in combination with ovulation stimulation therapies to achieve better results.
Surgical treatment - laparoscopic drilling of the ovaries is used in women in whom stimulation of ovulation did not give results. This procedure is performed using a minimally invasive surgical technique to improve ovarian function and increase the chances of spontaneous ovulation.
Ovarian drilling - an effective treatment for PCOS
Laparoscopic ovarian drilling represents an advanced surgical treatment for women with PCOS, especially when other forms of treatment do not produce the desired results.
During this procedure, a needle connected to a monopolar energy generator is used to make small openings in the ovary.
This precise intervention reduces the number of cells that produce androgenic hormones, which leads to a significant reduction in their levels in the body.
Here's what the process looks like:
The patient has a detailed consultation with the gynecologist before a definitive decision on treatment and fills out a detailed questionnaire about her health condition.
- Laparoscopic drilling is performed under general anesthesia. It is necessary to do a blood type and a blood count, and then an examination by an anesthesiologist.
- The patient comes to the hospital on the day of surgery, possibly the evening before the planned day of surgery, and takes a shower with an antiseptic shampoo that she gets at the Gyn-Fertility Clinic Milenković.
- It is not allowed to take food and water 8 hours before the operation.
- The patient receives general anesthesia in the operating room.
- After placing the catheter in the bladder and antiseptic preparation of the operative field, a 10-15 mm incision is made on the skin in the area of the navel.
- Carbon dioxide gas is injected into the abdominal cavity, which expands the space inside the stomach in order to obtain a better view and room for work.
- A camera is inserted through the incision on the navel, and then, under the control of the camera, two more 5 mm skin incisions are made, through which surgical instruments are inserted.
- The organs in the small pelvis are examined in detail.
- After that, the ovary is "pierced" in 5-10 places at a depth of about 5 mm with a needle connected to a monopolar current source.
- The gas is "ejected" from the abdominal cavity and the instruments are removed.
- The skin incisions are sutured with dissolvable sutures.
- The patient goes to the patient room, where she first receives pain-relieving drugs.
- The catheter is removed from the bladder shortly after the surgery. 2-3 hours after the surgery, the patient is first given a liquid to drink, and then a light meal.
- It is desirable for the patient to start standing up and walking as soon as possible after the operation.
- The patient is usually discharged from the hospital the day after the surgery.
- After leaving the hospital, pain relief therapy is advised: Paracetamol tablets 500 mg 2 tablets up to 4 times a day in combination with Brufen tablets 400-600 mg up to 3 times a day.
- It is advised to avoid work for up to 7 days, depending on how the patient feels.
- Showering is allowed on the same day after the surgery, except that it is necessary to change the protective patch that is placed on the place of the incision on the skin.
- Showering in the bathtub and swimming are not allowed ten days after the operation until the skin wound has healed.
- Physical training and sexual intercourse can usually be started 7-10 days after the surgery, that is, when the patient herself feels that she can do it. The patient can try to get pregnant already in the next menstrual cycle after the operation.
Complications after laparoscopic drilling are very rare.
In case of elevated body temperature or stomach pain, contact +381 69 50 22222 or info@drmilenkovic.com.
Key benefits of this treatment
Reducing the concentration of androgens brings numerous benefits:
- Spontaneous ovulation returns in 80% of patients, while the pregnancy rate reaches 70%;
- Acne and increased hair growth are reduced;
- The hormonal balance in the body improves significantly.
The most important advantage of this method is its long-term effect — one intervention provides permanent results, without the need for repetition, unlike other therapies that are often shorter.
A treatment for treating PCOS for women who do not want to become pregnant
Laparoscopic "ovarian drilling" is not only for women who want to get pregnant. This method is for anyone who wants to:
- Improve quality of life
- Permanently reduce PCOS symptoms in an all-natural way
In vitro fertilization (IVF) in women with polycystic ovary syndrome
In vitro fertilization in women with polycystic ovary syndrome is performed when pregnancy does not occur after ovulation stimulation with letrozole and clomiphene citrate tablets, laparoscopic drilling, and when there is some additional infertility factor.
The principle of in vitro fertilization is the same as in women without PCOS, with the fact that the risk of ovarian hyperstimulation syndrome is increased and an individual approach to therapy is required.
Fertilization in the laboratory can be done by standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), depending on the male factor and previous procedures.
There is also a method called in vitro maturation (IVM) where immature eggs are retrieved and then matured in the laboratory. This reduces the risk of hyperstimulation syndrome (OHSS), but this method has weaker results than the standard IVF method.
Expert advice: frequently asked questions
Answered by: Milan Milenković, MD, PhD
Is it possible to get pregnant with PCOS?
Pregnancy is absolutely possible and women with PCOS with medical treatment have the same chance of conceiving as other women. The chance of pregnancy decreases with age.
Can PCOS go away in menopause?
Polycystic ovary syndrome does not disappear in menopause, only the focus shifts from reproductive health to metabolic and endocrine disorders. Women with PCOS have an increased risk at menopause for type 2 diabetes, dyslipidemia, and cardiovascular disease such as endometrial cancer.
What does laparoscopic treatment of polycystic ovaries mean?
Laparoscopic treatment of PCOS is a method where the ovary is punctured in 5-10 places at a depth of 5 mm with a needle connected to a monopolar energy source. The method is known as laparoscopic "ovarian drilling". In this way, the number of ovarian cells that produce androgenic hormones is reduced. By reducing the level of androgenic hormones, there is regulation of ovulation, reduction of acne and increased hairiness.
Is there a genetic predisposition to PCOS?
PCOS is basically a condition with a genetic predisposition that changes in relation to environmental and lifestyle factors.
What is the difference between polycystic ovary syndrome and polycystic ovaries?
Polycystic ovary syndrome is defined when two of the following three criteria are present:
- irregular menstrual cycle;
- increased level of androgenic hormones or clinical symptoms such as acne and increased hairiness;
- polycystic appearance of an ovary on ultrasound, that is, more than 20 antral follicles on one ovary.
If there are only an increased number of antral follicles visible on ultrasound examination, the diagnosis of polycystic ovary syndrome cannot be made. Some women have a physiologically increased number of follicles without endocrinological and metabolic disorders, and this appearance of the ovaries is defined as polycystic ovarian morphology (PCOM).
The term polycystic ovary itself is not adequate, since antral follicles are not cysts.
If you have additional questions, please feel free to contact us.
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