In this week’s Ask Attain Fertility, fertility specialist Dr. Matthew Will answers your questions about polycystic ovary syndrome (PCOS), including drugs for PCOS and how ovarian drilling can help PCOS symptoms.
Question 1: My OB-GYN has been treating me for PCOS symptoms, and I can’t get pregnant. How do I know when it is time to see an RE for PCOS?
Dr. Will: Polycystic ovary syndrome (PCOS) is a multisystem condition that has many facets. If you are trying to get pregnant, it is important to see your OB/GYN for a preconception visit. Talk openly with your doctor, ask questions, and share your concerns.
Now, if you are not cycling regularly, you should get an evaluation to rule out other potential hormonal causes of an irregular menstrual cycle. Ovulation induction with medications such as clomiphene citrate (Clomid) is probably going to be the first line of therapy.
A reproductive endocrinologist can often help supplement the care provided by your OB/GYN. This means that your OB/GYN can take care of the initial evaluation and management of your symptoms. Then, an RE may be helpful if you have tried treatments for PCOS that have not been successful.
Question 2: What is ovarian drilling for PCOS?
Dr. Will: Ovarian drilling is a surgical procedure addressing polycystic morphology of the ovaries. Doctors began surgically treating the ovary after observing improved fertility when ovarian wedge resections were performed. For example, a woman’s menstrual cycles would often become more regular and women were able to get pregnant after the ovarian drilling procedure.
Question 3: When is ovarian drilling helpful for PCOS?
Ovarian drilling may help those with PCOS who have tried more simple fertility treatments, like ovulation induction, without success. The procedure is also an alternative to ovulation induction with injectable medications. Ovarian drilling is often appealing to some women, since it does not carry the same risks as injectable medications, such as ovarian hyperstimulation or multiple gestation.
Question 4: Do the benefits of ovarian drilling for PCOS outweigh the risks?
Dr. Will: Ovarian drilling is now performed laparoscopically and the recovery is generally much quicker than the previous open procedure. However, ovarian drilling is a surgery and it does carry some risks. Possible risks include scarring and the chance of diminished ovarian reserve. All these risks have to be weighed by you and your treatment team on an individual basis. Each person’s scenario is different so you must do what is best for your situation.
Dr. Matthew Will at Midwest Fertility Specialists is board eligible in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. He attended Medical School at Indiana University and went on to complete his Obstetrics and Gynecology Residency at the University of North Carolina. His fellowship training in Reproductive Endocrinology and Infertility was completed at the University of Michigan. Dr. Will’s professional interests include minimally invasive surgery including conventional and robotic assisted laparoscopy, assisted reproductive technology, and ovulation induction while minimizing the risk of higher order multiples. Dr. Will sees patients at the Carmel and Ft. Wayne locations. To schedule an appointment please call 1-800-218-3012.