Many women do not ovulate or ovulate very irregularly. Many of these women have infertility problems. There is a special category of ovulation problems called the polycystic ovarian syndrome (PCOS or PCO). PCOS includes the following:

• Irregular menstrual periods or total lack of periods.
• Sometimes extremely heavy periods when they do occur.
• Infertility
• Hirsutism (unwanted hair in the male pattern)
• Stout build or chunky physique
• Characteristic ovarian appearance on ultrasound showing many small cysts
• Abnormal hormone blood levels

Polycystic ovarian syndrome is estimated to affect 8-10 percent of all women of reproductive age, so the total number of women affected is massive. It’s the # 1 hormonal abnormality of women, exceeding even diabetes and thyroid disease for this age group. We have recently begun to understand this disorder in much greater detail with new information that involves an unlikely hormone, insulin.

Insulin Resistance:

In the last 10 years it has become increasingly clear that the story of polycystic ovarian syndrome is really the story of insulin resistance. As most people know, insulin is the hormone made by the pancreas to control blood sugar. When the pancreas stops making insulin completely, often times in childhood, this is juvenile onset diabetes or Type I Diabetes. When the pancreas slowly decreases the production of insulin, more often in adults and more often associated with weight gain, this is Type II or adult onset diabetes. This “developed” diabetes, with its insulin resistance, has a lot to do with the way we eat and play.

An American Epidemic:

Many people are aware of how obesity in America has dramatically increased over the last 50 years. This is despite low fat diets preached by dieticians, physicians, and government sources such as the National Institute of Health. This is despite efforts to educate and to encourage exercise. This is despite many other diet fads. This is despite weight loss programs including several national paid programs such as Jenny Craig, Weight Watchers, NutriSystem, LA Weight Loss, etc. This is even despite recent emphasis on surgeries such as gastric bypass or laparoscopic band surgery.

This relates directly to a rise in insulin resistance. Besides some severe cases of PCOS, many women gradually develop an acquired insulin resistance through over eating, wrong eating (high carb diet, fast food), and lack of exercise and activity. Therefore it is not uncommon to see women who had regular menstrual cycles and were fertile when they were younger, who then begin to have irregular menstrual cycles and are no longer fertile later in life when they have gained considerable weight.

PCOS

High insulin levels in women causes a disruption in ovarian ovulation function. Worse yet, the ovaries now secrete a higher than normal amount of male hormones (called androgens), including testosterone and androstenedione. These high male hormone levels result in the excessive hair growth that is quite distressing to young women, involving the face (upper lip, chin, sideburns), neck, central chest, and lower abdomen.

Most women with severe PCOS have the onset of these symptoms when they are between 10-15 years of age, right at the time that they should be beginning normal menstrual cycles. Often times they have physical features that are very distressing to them such as being shorter and quite chunky, bothersome facial hair along with acne and oily skin. Frequently they have a family history of diabetes and sometimes other women who have the PCOS syndrome as well.

Whether or not a doctor diagnoses someone as PCOS is not the real issue; the real issue is whether that patient has insulin resistance or not. The diagnosis of insulin resistance must be made through appropriate blood tests for glucose and insulin (fasting and then repeated after a glucose challenge). While even this testing is not perfect, it will diagnose the vast majority of individuals with insulin resistance. I am doing this testing nearly everyday for women with infertility and ovulation problems, and others who are experiencing problems with difficulty losing weight, or fatigue, and sometimes in men who have sperm deficiencies. I believe that if young girls could be diagnosed in their early adolescence, treatment could then be instituted that would greatly moderate the degree of distressing hair growth, weight gain, and menstrual bleeding problems. So it is certainly not necessary to be an infertility patient in order to be seen for diagnosis and treatment.

Infertility Treatment:

The good news is that women who have ovulation problems as a cause for their infertility can be treated with medications and have good success. If they have insulin resistance, the treatment will include the use of the medication called Metformin (brand name Glucophage). This is an insulin enhancer that makes our cells much more normally responsive to the insulin molecule. Therefore, the amount of insulin in the woman’s blood stream will fall down to more normal levels and stop causing adverse ovarian function. This sometimes will be enough to allow her to ovulate without any other medications. This also may diminish the amount of male hormones and diminish hair growth. Very often, other ovulation medications will need to be used as well, such as Clomiphene (Clomid, Serophene), Letrazole (Femara), or injectable medications. The end result is that almost all of these women will be able to achieve successful pregnancies.

Dr. Eugene M. Stoelk has been treating fertility issues and reproductive health for over 20 years. In 1986, Dr. Stoelk founded the Northwest Fertility Center. For more information of fertility issues and reproductive health, visit www.drstoelkdelivers.com