Polycystic ovarian syndrome (PCOS)

Women with PCOS are at increased risk of health problems related to obesity such as diabetes and hypertension (high blood pressure). They can hypersecrete insulin (the sugar-processing hormone) and this can make them gain weight that is very difficult to lose.

It is vital to recognise that achieving a normal Body Mass Index (BMI) will not only help them achieve a spontaneous pregnancy, but will also increase the chance of fertility treatment working.

A normal maximum BMI for a woman who is 5 foot is 10 stone. If she is 5 ft 6in the maximum is 12 stone. PCOS runs in families through the female line and so asking sisters, aunts and mums about their fertility history may be very revealing. The ideal diet for a woman with PCOS is very low in fat and high in fibre and she should combine this with an active exercise regime.

Treatments that work
Anti-oestrogens
Absent or irregular ovulation associated with PCOS should first be treated with anti-oestrogens (clomiphene or tamoxifen). With clomiphene (Clomid), treatment begins on the second day of a spontaneous or induced period at a dose of 50-100 mg per day and continues for five days. Clomiphene treatment can be started by your GP or by a hospital fertility specialist. You should be offered an ultrasound scan in your first cycle to check you are not over-responding (the chance of having twins with clomiphene therapy is raised by 10 per cent).

While ovulation occurs in about 80 per cent of women taking clomiphene, pregnancy occurs in only about 40 per cent. If pregnancy does not occur within the first six cycles of treatment, you must be checked for male factor infertility (a sperm test) and tubal factor infertility (a laparoscopy or hysterosalpingogram or HSG).

Tamoxifen is taken at a dose of 20-40mg from days two to six. Side effects of clomiphene and tamoxifen include visual disturbance (if this occurs, treatment should be stopped immediately), multiple pregnancy, abdominal distension, ovarian cysts, hot flushes, dizziness and nausea.

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