Ovulation induction (OI)
During this treatment, ovulation is stimulated / induced with hormones to increase the chance of natural conception.
PCOS is a common hormonal condition that affects around 5–10% of women.
We understand the impact PCOS can have on your fertility and offer specialised treatments to support you in your wish to have a child.
A new name for PCOS
It was recently decided internationally to gradually replace the name PCOS (polycystic ovary syndrome) with PMOS (polyendocrine metabolic ovarian syndrome). The new name better reflects the broad hormonal and metabolic features of the condition. Would you like to read more about this name change? Read our blog: PCOS becomes PMOS: what does the new name mean?
With PCOS, several follicles in the ovaries do not mature fully, which leads to an absence of ovulation and irregular menstrual cycles. This can make it more difficult to get pregnant naturally.
Causes
The exact cause of PCOS is unknown, but hormonal imbalances and a hereditary predisposition play a role. There is often a raised insulin level and an imbalance in sex hormones. Being overweight can make the symptoms worse, but women with a healthy weight can also develop PCOS. Losing 10% of your body weight can already help to improve your cycle.
PCOS can affect fertility through:
When there is irregular ovulation or absent ovulation (anovulation) and/or irregular or absent periods.
When an ultrasound scan shows that you have polycystic ovaries (more than 12 follicles per ovary).
Being overweight with PCOS often goes hand in hand with insulin resistance, which means that your body is less sensitive to insulin. As a result, extra insulin is produced, which disrupts your metabolism and increases the risk of type 2 diabetes. Women with impaired glucose metabolism at a young age are more likely to develop diabetes between the ages of 40 and 50.
Weight loss can significantly reduce this risk. Regular monitoring of blood sugar levels is important, especially in women who are overweight. A healthy lifestyle, a balanced diet and, if necessary, medication can help to prevent or treat insulin resistance and diabetes.
Raised levels of androgens (male hormones) can show up as excessive hair growth, acne or hair loss.
A healthy weight is crucial for both your fertility and a safe pregnancy. If you are overweight, losing weight is often the first step before fertility treatment. Sometimes the menstrual cycle recovers on its own through weight loss, and if medication is needed, it works better once you have adopted a healthier lifestyle.
Losing weight not only increases the chance of a natural pregnancy, but also improves the success rate of fertility treatments. A healthy weight also reduces the risk of complications such as miscarriage or gestational diabetes. During a consultation, we discuss how you can improve your lifestyle, for example with the help of the MijnFerticoach programme, and whether professional support would be helpful.
With PCOS, medication can help to induce ovulation and increase the chance of pregnancy.
There are two treatment options:
Ovulation induction with tablets
We stimulate ovulation with tablets, which you take from day 3 to day 7 of your cycle. This anti-oestrogen medication causes the pituitary gland to produce extra FSH, allowing an egg to mature. Around 80% of women ovulate as a result and 50% become pregnant. There is a small chance of a multiple pregnancy.
FSH injections
If tablets do not work well enough, FSH can be given by injection. These hormones stimulate the ovaries directly. The dose is built up carefully to prevent excessive follicle growth. With this treatment, 90% of women ovulate and around 50% become pregnant. If repeated stimulation is not successful and too many follicles keep growing, IVF may be a possible next step.
In some cases, surgery may be needed, for example to make a number of small superficial holes in the ovaries by electrocautery (LEO: laparoscopic electrocoagulation of the ovaries). The aim is to bring about a change in hormone production in the ovary. If surgery is needed, we will refer you to a specialist centre¹.
¹Via Zorgwijzer you can find an overview of centres that perform LEO procedures.
