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This article reviewed current research data regarding the infertility workup of couples where the woman also suffered from polycystic ovary syndrome (PCOS).
PCOS is a common condition affecting between 5-10% of women. An important feature of PCOS is the lack of ovulation, associated with irregular menstruation, which may lead to infertility.
The clinical workup for couples in which the woman has PCOS generally involves the evaluation of both partners for other fertility issues. In men, the first test involves screening for male-related infertility with a sperm analysis, to determine the number of sperm cells, their appearance and movement patterns. In women with PCOS, blood tests are performed to determine the levels of several hormones that play a role in female fertility and to evaluate ovarian reserve (available egg reservoir). Additional imaging tests are often done to assess the fallopian tubes and uterus, such as hysterosalpingography (HSG). HSG involves introducing a contrast dye into the uterus that can be well seen using an X-ray. Sometimes, laparoscopy (a minimally invasive surgery done through small incisions with the help of a video camera) may be used to check for tubal abnormalities.
If abnormalities that would interfere with fertilization (other than PCOS) are not found, the first line of treatment is to induce ovulation using the drug clomiphene citrate (CC). If CC treatment fails, second line involves gonadotropins (hormones that induce ovulation), or surgery.
Based on results of 9 previously published trials, researchers found that in couples starting first-line CC treatment, male infertility (in addition to female infertility) was present in 4-10% of cases. Semen analysis was however not reliable in predicting pregnancy outcomes. Tubal evaluation revealed that 4% of women starting CC therapy had blockages in both fallopian tubes (bilateral) – a condition that makes spontaneous pregnancy impossible. In women referred to second line treatment, bilateral tubal blockage was reported in 8% of women. There is limited data about the frequency of male infertility among these couples.
Published By :
Fertility and Sterility
Date :
Jul 01, 2013
