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Melanie Cole (Host):  Polycystic ovary syndrome or PCOS is one of the most common hormonal disorders among women of reproductive age. Infertility can be one of the most common symptoms of PCOS. My guest today is Dr. Alan Martinez. He is a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. First, tell us what is polycystic ovary syndrome?

Dr. Alan Martinez (Guest):  Thank you for having me today. I very much appreciate it. Polycystic ovary syndrome, or PCOS as it is called, is a condition where your body baseline has some insulin resistance and, as a result of that, it can potentially disrupt your normal menstrual period as well as create some other hormonal problems – specifically, increased male hormones--which can lead to some other symptoms as well as infertility in some cases.

Melanie:  What symptoms might a woman notice and how early would she notice? I mean, can a young woman have polycystic ovary syndrome and not know it? How would we know?      

Dr. Martinez:  Yes, women of any age can present with this, assuming they are reproductive age. Oftentimes, what happens is a woman will start her period, go through her teenage years, and, normally, you have, after two or three years, your cycle becomes very regular on a monthly schedule. For many of these patients, the most common symptom and presentation may be irregular periods. Instead of getting a monthly period, they may skip one month and then get it the next month. Or, they may even go longer without a period and have some abnormalities with breakthrough bleeding after that. That’s one of the things that most commonly presents. Second, many of these patients may actually complain of having acne. Adult acne, in and of itself, is not normal. So, that could point you in the direction of cystic ovary syndrome as well as some abnormal hair growth – so male pattern hair growth - on their chin, chest, abdomen, where a woman may need to shave or address any abnormal hair growth in those areas. Those are some of the most common symptoms.

Melanie:  Do we know what causes it? Is it hereditary? Is there a genetic component?     

Dr. Martinez:  The answer is it’s multi-factorial as many things. It can definitely run in families but the fundamental cause behind polycystic ovary syndrome is basically thought to be some underlying insulin resistance. When a woman has exposure to sugars in her diet, normally your body will respond with making insulin and it will take care of those sugars. The underlying problems that are thought to result with some problems with insulin sensitivity will also ultimately disrupt the signal of the brain going to the reproductive organs – the ovaries. After a period of time, that results in having infrequent menstrual periods as well as some of the other symptoms I’ve talked about.

Melanie:  Is it hard to diagnose?

Dr. Martinez:  No, it’s not and I think that, as infertility specialists, we’ve become better. We are very familiar with it and, in general, in the obstetrician/gynecologist the awareness has gone up over the years. If the patient presents you with these irregular cycles, difficulty getting pregnant, as well as, maybe, some adult acne or hair growth, then that can definitely perk their ears up and point them in the right direction.

Melanie:  Where fertility is concerned, how does this affect fertility and can that be overcome? Is there treatment for it?

Dr. Martinez:  That’s a very good question. About 7-10% of reproductive-aged women will have PCOS and, as a result of that, they are trying to start their family and they often present to us in the office. One of the things that it disrupts is the normal release of an egg from the ovaries. A couple is trying to conceive but if the woman is not releasing the egg, then it becomes very difficult, if not impossible. Luckily, we have medicines and we have treatment approaches that will actually address that and increase the chances that an egg is released and oftentimes they are very successful with these patients.

Melanie:  Is that the first line of defense? Are we talking about Clomid? What are you talking about when you’re talking about getting eggs to release?

Dr. Martinez:   The medication to release the eggs, as many people know, can involve oral medication such as Clomid. It can also, in some cases, involve injections of medicines actually that are stronger than the oral medications. Those are the two approaches that we use. It all depends upon the testing that the woman undergoes, her age, and the amount of ovarian reserve, and how robust her ovaries are functioning for her age.

Melanie:  If that first line of defense medication does not work, then what’s the next step?  

Dr. Martinez:  Then, sometimes we have to step up to the point of looking at fertilization. We may consider talking with the patient about in vitro fertilization. In most cases, the issue is not necessarily getting the PCOS patient to release an egg but sometimes there could also be some underlying egg development issues and that’s where the in vitro fertilization, or IVF, comes into play with that.

Melanie:  Is there any risk to the actual pregnancy itself? Does it make it more difficult to maintain a pregnancy if you have PCOS?

Dr. Martinez:  No. Overall, there is no evidence of any increased miscarriages with this condition. Mainly, it’s a pre-conception issue. It does, however, overall affect a woman moving forward in life. They have a higher chance of developing pre-diabetes and ultimately diabetes. There is some evidence that it may affect cardiovascular disease rates. So, those are some things we have to counsel our patients whenever we see them in the office and say, “You need to be plugged in with your provider. You need to get some annual exams. You need to check your sugars by a physician every few years and really pay attention to your menstrual frequency.”

Melanie:  When women have been told they have PCOS and they’ve got symptoms, birth control might be used as a way as you mention to control acne and hair loss--some of those things. If they’ve been on birth control then how do you counsel them about the difference between actually using the birth control to control those symptoms and then being able to get pregnant?

Dr. Martinez:  Unfortunately, those two aren’t mutually exclusive. We have to address their desire for conceiving at that particular time. Birth control pills will actually, in many cases, one--it will regulate the patient’s cycle. Two, it may help out with some of the elevated male hormones – so the hair growth and the acne, it can help out with that. But, when we want to conceive we, obviously, have to take them off of those medicines. It may be quality of life issue and proper counseling to say, “You may have an increase in acne. You may have some more hair growth come back if we take you off birth control pills but, if our main goal is to try to get you to conceive at this time, then this is the route we need to go. We need to stop the oral contraceptives and then, we need to move forward with the fertility treatments.” Most of the time, the patients are very receptive because their desire to have a baby outweighs some of those other issues.

Melanie:  In the last few minutes, give your best advice to women and things that they might notice that would signal that they should get in and see somebody and be diagnosed for PCOS and what you tell them about the hope to get pregnant if they are somebody who suffers from polycystic ovary syndrome.

Dr. Martinez:  The main thing is actually to keep tabs and a record of your menstrual history. If you go two or three months without a period, then for other reasons besides just being diagnosed with polycystic ovary syndrome, you should contact your obstetrician/gynecologist and go in for a visit. You would need to be evaluated and we need to make sure, as long as you’re not on any medications such as oral contraceptives, that you are having regular periods for your own health. I counsel them that maintaining a healthy lifestyle, a healthy diet, keeping in tune with their own bodies. If they have any of these symptoms that develop or they’ve plagued them throughout their life – acne, abnormal hair growth – then there are treatments that are available. It’s just oftentimes that people become so used to dealing with these problems that they just consider it a way of life. If my patients are educated, if the general obstetrician/gynecologists are educated, then we can have these patients evaluated in the proper manner and then we can best take care of them. Lastly, with the fertility, the nice thing is that with polycystic ovary syndrome, in many cases, we can be very successful with stimulation of the ovaries taking over the body’s normal process of developing eggs. We have a good chance of actually being successful with fertility treatments. That is a good take home point for the patients. I don’t want them to feel like they’re in despair but, in many cases, we can be very successful.

Melanie:  In just the last minute, tell us about your team at the Reproductive Science Center of New Jersey.

Dr. Martinez:  Here at the Reproductive Science Center of New Jersey, we specialize in evaluation of many reproductive endocrinology conditions surrounding infertility and overall health. Polycystic ovary syndrome is one of them. We are a full service fertility treatment center. We offer our care in an intimate setting and a very personalized setting. We’re here to help out patients, whether it’s quality of life or whether it’s for the purposes of starting their own family. We want to make ourselves available and we hope that we will continue to be successful with this and we have been.

Melanie:  Thank you so much for being with us. It’s really great information. You’re listening to Fertility Talk with Reproductive Science Center of New Jersey and for more information you can go to FertilityNJ.com. That’s FertilityNJ.com. This is Melanie Cole. Thanks so much for listening.