PCOS treatment for a couple who want a baby aims to help the ovaries release an egg, which doctors call ovulation. If you searched for "pcos ka ilaj", this guide explains what the NHS and other medical organisations say about the options, and what to expect if you come to Mother & Child International Hospital (MCI) in Mirpur.
What is PCOS, and why is it now also called PMOS?
PCOS stands for polycystic ovary syndrome. The NHS now uses a new name, polyendocrine metabolic ovarian syndrome (PMOS), and says it "used to be called" PCOS. The American Society for Reproductive Medicine (ASRM) has endorsed the new name, which it says reflects the condition's complex hormonal and metabolic impacts. This guide uses the older name, PCOS.
The NHS describes it as a hormone condition that can affect hair growth, periods, fertility and mood. The NHS says the cause is unknown, and that you are more likely to have it if a close relative has it or if you have an Asian background, and Leeds Teaching Hospitals NHS Trust says it is more common in some ethnic groups, including south Asians.
Common signs listed by the NHS are:
- irregular or infrequent periods
- excess hair growth, or hair loss
- weight gain or difficulty losing weight
- difficulty getting pregnant
- mental health problems, such as depression or anxiety
- oily skin and acne
- tiredness
- thick, dark skin patches on the neck or armpits
Symptoms can be mild or severe, and some women have none.
A scan that shows "polycystic ovaries" does not by itself mean you have PCOS. Leeds Teaching Hospitals explains that polycystic ovaries describes how the ovaries look on an ultrasound scan. PCOS is diagnosed when two of these three features are present, once other causes have been ruled out: signs or blood tests showing high testosterone, irregular or absent periods, and polycystic ovaries on a scan.
Can you get pregnant with PCOS?
Yes, it is possible, but it can be harder. The NHS says PMOS can sometimes cause problems getting pregnant, usually because the ovaries do not release an egg each month. Leeds Teaching Hospitals adds that if your cycle is irregular, ovulation is also irregular or absent, and it will take longer to get pregnant.
The Royal College of Obstetricians and Gynaecologists (RCOG) notes that you may still become pregnant even if you do not have periods.
What is the treatment for PCOS if you want a baby?
The right treatment depends on your tests and your doctor's assessment.
Reaching a healthy weight
Leeds Teaching Hospitals says that being overweight or underweight reduces the chance of pregnancy, and asks patients to reach a healthy weight through diet and exercise before starting treatment. It is still important to get your symptoms checked by a doctor. ASRM says that for women who are overweight, losing weight can improve ovulation and fertility. RCOG says you only have to lose a small amount of weight to make a difference to your symptoms and your health.
Tablets to help you ovulate
The NHS names clomifene, a medicine used to improve fertility. Leeds Teaching Hospitals says two tablets, letrozole and clomifene, can regulate your cycle and start ovulation. ASRM says letrozole can be particularly helpful for women with this condition. Do not start these tablets on your own; your doctor decides whether they suit you.
Injections and surgery
If tablets do not work, Leeds Teaching Hospitals lists daily hormone injections containing a drug called FSH, or laparoscopic ("keyhole") ovarian drilling, as alternatives. The NHS says drilling uses heat or laser to remove tissue on the ovaries and may help release more eggs. ASRM says women with this condition must be watched very carefully when injected fertility medicines are used. These are not medicines to start on your own.
IVF
IVF ("test tube baby" treatment) is where eggs are fertilised in a laboratory and an embryo is put in the womb. Leeds Teaching Hospitals says you can move on to IVF if treatment to start ovulation is not successful, and ASRM says IVF may help if other treatments do not work.
What about metformin?
Metformin is a type 2 diabetes medicine. ASRM says it can improve ovulation. Leeds Teaching Hospitals says large studies have suggested improvement in the menstrual cycle and ovulation, but that there is no good evidence it improves the chance of having a baby, and that it tends to recommend metformin if there is a proven problem with high glucose (blood sugar) levels. Ask your doctor, and do not start it on your own.
Birth control pills
ASRM lists birth control pills as a treatment for women who are not trying to conceive. They can regulate periods and reduce excess hair and acne, but they also prevent pregnancy. The NHS says you may be offered the pill or progestogen tablets before starting IVF, to help the doctor start your fertility medicine at the right time. Follow your doctor's advice.
What are the risks during treatment and pregnancy?
Ovarian hyperstimulation syndrome (OHSS). When you have fertility medicine to stimulate ovulation, the NHS says there is a small chance of too many eggs developing in the ovaries, which can become large and painful. MedlinePlus lists having PCOS as a risk factor.
Diabetes in pregnancy. RCOG says women with PCOS are at higher risk of developing diabetes in pregnancy, and says that in the UK they are offered a blood test for it between 24 and 28 weeks. Ask your doctor about this test.
Other risks of IVF. The NHS also lists multiple pregnancy (having more than one baby, which can carry risks for the parent and babies) and ectopic pregnancy.
Long-term health. The NHS says the condition can sometimes increase the risk of type 2 diabetes, high blood pressure, cardiovascular disease (heart and blood vessel disease), non-alcoholic fatty liver disease and womb cancer. It advises regular check-ups.
When to see a doctor
See a doctor if you think you may have PCOS or if your symptoms are affecting your everyday life, work or relationships, as the NHS advises. Also see a doctor if you have not had a period for over 4 months: RCOG says it is important to have a period every 3 to 4 months, and Leeds Teaching Hospitals says at least this often, to reduce the risk of the womb lining becoming too thick, and RCOG says you may need hormone tablets to make you have a period. Do not take them on your own.
If you are having, or have had, fertility medicine to stimulate ovulation or IVF, including if you are now pregnant, follow the NHS advice below.
Contact your fertility clinic or the doctor treating you as soon as possible (in the UK, your clinic or NHS 111) if you have:
- pain and bloating in your tummy
- feeling and being sick
- feeling faint
- coughing up blood
- vaginal bleeding or a brown watery discharge
- pain or discomfort when going for a poo or wee
Call an ambulance or go to the nearest hospital emergency department immediately (in the UK, call 999 or go to A&E), and do not drive yourself, if you have:
- difficulty breathing
- pain in your chest or upper back
- being very thirsty and peeing less than usual (dehydration)
- swelling in any part of your body
- tummy pain, low down on one side
- pain in the tip of your shoulder
The NHS says these could be severe symptoms of OHSS or of an ectopic pregnancy (a pregnancy growing outside the womb).
What to expect at MCI
At MCI, the first consultation, the ultrasound scan and the semen analysis are free, so both partners can start there. Our fertility tests page explains the tests. Treatment depends on a doctor's assessment at the consultation. MCI offers fertility tests for women and men, IUI, IVF, ICSI, and freezing of embryos, eggs and sperm, using only the couple's own eggs and sperm. See our treatments.
For patients in Pakistan, IVF or ICSI costs Rs 80,000 from consultation to embryo transfer. Medicines are separate and usually cost Rs 50,000 to 70,000. Our treatment prices are on our costs page.
The hospital is in Chitterpari, Mirpur, about 2½ hours by car from Islamabad and about 4 hours from Lahore; these are estimates and can be longer in traffic. You can start with a video consultation. To book, contact us on WhatsApp or by email.