What are the chances of pregnancy with PCOS?

Women may suffer from many gynecological diseases, polycystic ovary syndrome is one of them. Compared with other gynecological inflammations, polycystic ovary syndrome is more complicated. The main cause of the disease is long-term endocrine disorders or long-term metabolic abnormalities in women. Women with polycystic ovary syndrome often have menstrual disorders. For example, young women may suffer from amenorrhea. The male hormone level in these patients will increase significantly, so hair and some male characteristics will appear on the body. The skin is prone to acne, large pores and other symptoms. It is worth mentioning that polycystic ovary syndrome will directly affect women's pregnancy, so what is the chance of patients with this disease getting pregnant?

First, what is the chance of pregnancy with polycystic ovary syndrome?

The ovaries have two main functions: one is ovulation, and the other is the formation of the corpus luteum in early pregnancy to maintain the stability of the embryo. If there is an abnormality in the ovaries, it can easily cause ovulation problems. Ovarian infertility accounts for about 15%-25% of infertility. With the continuous advancement of endocrine knowledge and examination technology, the diagnosis rate of infertility caused by ovarian insufficiency has increased. Understanding the causes of ovarian infertility plays an important role in both treatment and prevention.

Although the chance of pregnancy with polycystic ovary syndrome is relatively small, as long as you actively cooperate with the treatment, you can still get pregnant normally. If a woman with polycystic ovary syndrome wants to get pregnant, she must first make sure that her hormones are normal. Polycystic ovary syndrome does not necessarily lead to hormonal abnormalities. The normal manifestations of some clinical hormones do not mean that the patient does not have this problem. Some women may experience this occasionally. It's not that they don't ovulate, but there are two possibilities: infrequent ovulation or no ovulation. If ovulation is infrequent, there is a chance of pregnancy.

As long as a woman ovulates, she has the possibility of becoming pregnant. If she does not ovulate, timely treatment can be given. After treatment, the chance of conception will be greatly increased, and her wish to become a mother can be fulfilled. The probability of pregnancy in women with polycystic ovary syndrome depends on the severity of the disease. Different degrees of the disease will result in different probabilities. Generally, after treatment of polycystic ovary syndrome, the probability of pregnancy is 80%, so women should not give up treatment.

Second, ovarian factors causing ovarian infertility

1. Congenital ovarian abnormalities

Common ones include gonadal dysgenesis (Turner syndrome), 47, XXX syndrome, true hermaphroditism, and testicular feminization. None of the above are within the scope of infertility treatment, but they are also relatively common diseases.

2. Infertility caused by oophoritis

The disease can be divided into tuberculous and non-substantial ovarian parenchymal inflammation and peripheral inflammation. For inflammation, anti-inflammatory treatment should be the main treatment; for those with surrounding fibrous adhesions, laparotomy or laparoscopic adhesion lysis can be considered; for those infected with tuberculosis, anti-tuberculosis treatment should be carried out.

3. Abnormal ovarian position

Ovarian ptosis changes the anatomical position of the fallopian tube fimbria and the ovary, thus affecting the entry of the egg into the fallopian tube. Ovarian ligament shortening surgery may be considered to shorten or fix the ovarian mesentery to the posterior wall of the uterus. Adhesive uterine malposition is often caused by inflammation and endometriosis, both of which can cause infertility. Surgery or laparoscopic adhesion lysis may be considered.

4. Polycystic ovary syndrome

The incidence rate has been on the rise in recent years. Clomiphene is the first choice for treatment. For some patients, ovarian wedge resection, oophorectomy, cyst puncture and other treatments can be considered, which also have certain effects.

5. Ovarian endometriosis

In infertility caused by endometriosis, the most common cause is invasion of the ovaries by the lesions. Danazol (a derivative of 17-α-ethynyltestosterone) can be used for drug treatment; conservative surgery can be performed, and visible lesions should be removed as much as possible while preserving normal ovarian tissue. Smaller lesions can also be cauterized under laparoscopy, and mild adhesions in the pelvis can be loosened, or the contents of the endometrial cyst can be extracted through the attached needle of the laparoscopic tube.

6. Ovarian tumor

Ovarian cysts are sometimes associated with infertility, and multiple follicular cysts that secrete too much estrogen can cause persistent anovulation. Ovarian solid tumors such as various hormone-secreting tumors, granulosa cell tumors that secrete female hormones, and ovarian cystic cell tumors. Symptoms of female masculinization, such as testicular blastoma, adrenocortical tumor, and hilar cell tumor, which secrete male hormones, are all associated with infertility. Except for ovarian tumors with a tendency to become malignant, normal ovarian tissue should be preserved as much as possible when the tumor is removed.

Third, differential diagnosis

1. Cushing syndrome

There are various causes of adrenal hyperfunction. Typical manifestations include moon face, buffalo hump, centripetal obesity, purple skin striae, hirsutism, acne, hypertension, osteoporosis, impaired glucose tolerance, skin pigmentation, and often accompanied by virilization. Laboratory tests showed that the normal circadian rhythm of plasma cortisol was lost and urinary free cortisol was increased. The overnight low-dose dexamethasone suppression test is a simple method to screen for this disease. If cortisol decreases by 50% (L) after medication, Cushing's syndrome can be ruled out. If cortisol is >390nmol/L and there are no factors that cause false positives, it may be Cushing's syndrome.

2. Congenital adrenal hyperplasia (CAH)

It is an autosomal recessive genetic disease. The most common are congenital 21-hydroxylase and 11β-hydroxylase deficiencies. Such patients cannot synthesize glucocorticoids, the pituitary ACTH loses inhibition, and the adrenal cortex hyperplasia causes the accumulation of pre-enzyme metabolites - 17α-hydroxyprogesterone, 17α-hydroxypregnenolone and their metabolite pregnentriol, and increased androgen secretion. The patient's chromosomes are 46, XX, the gonads are ovaries, and the internal reproductive organs are uterus and fallopian tubes. However, due to the effect of excessive androgen, the external genitalia and secondary sexual characteristics have varying degrees of masculinization. Because the fetus has been affected by excessive androgen, abnormal genital development has already occurred at birth. A small number of patients have late-onset adrenal hyperplasia, and clinical manifestations are often delayed until after puberty, which may manifest as slowly progressive hirsutism, infrequent menstruation, and no obvious genital deformities. Laboratory tests show elevated serum T and A levels (T>2.8nmol/L, A>9.5nmol/L), serum cortisol levels are mostly normal, and 17α-hydroxyprogesterone is elevated (>9.1nmol/L). However, the basal level of 17α-hydroxyprogesterone in late-onset patients may be within the normal range, but its level is significantly higher than normal after the ACTH stimulation test, which is of greatest diagnostic value.

3. Ovarian masculinizing tumor

Such tumors include testicular blastoma, hilar cell tumor, lipoid cell tumor, granulosa cell tumor, and theca cell tumor. It usually occurs between the ages of 30 and 50. The patient had normal menstruation and fertility before the onset of the disease, but after the onset of the disease, he developed obvious masculinization, amenorrhea and infertility. Laboratory tests show elevated androgen levels, mainly T and A (T>7nmol/L, A>21nmol/L), and the androgen secretion of most tumors is neither regulated by ACTH nor gonadotropin. B-ultrasound is a better way to examine this disease, and CT or MRI can also assist in diagnosis.

4. Adrenal tumors

Both benign and malignant tumors of the adrenal cortex can lead to increased androgen production. The growth and secretion functions of the tumor are autonomous and are not controlled by pituitary ACTH or inhibited by exogenous glucocorticoids. Adrenal carcinomas generally do not respond to exogenous ACTH stimulation, but adenomas sometimes do. The patient's hirsutism and virilization symptoms develop rapidly, accompanied by systemic metabolic abnormalities caused by excessive secretion of glucocorticoids or mineralocorticoids. CT or MRI is very sensitive for adrenal tumors and can localize and demonstrate contralateral adrenal atrophy.