Polycystic Ovary Syndrome (PCOS) is the hormonal imbalance in females, producing cyst in the ovaries and making it the leading cause of infertility in females. PCOS contributes towards 75% of female infertility.

1. PCOS: FEMALE INFERTILITY
INTRODUCTION
Polycystic Ovary Syndrome (PCOS) is the hormonal imbalance in females, producing cyst in the
ovaries and making it the leading cause of infertility in females. PCOS contributes towards 75%
of female infertility.
REASON OF INFERTILITY IN PCOS
In females with PCOS, cyst formation does not allow the ovaries to release eggs. Due to this, the
eggs become unable to fertilize with the sperms. When eggs are not released properly, the
females also experience irregular menstrual cycles (anovulation). These irregular menstrual
cycles are one of the major symptoms of PCOS.
In normal menstrual cycle, a follicle (containing egg) is matured and becomes ready to ovulate.
About 14 days after ovulation, menstrual period is expected if the female is not pregnant.
In PCOS, the follicle (antral follicle) with egg is unable to develop and mature due to which
ovulation does not occur and results in irregular menstrual cycle.
Due to immature follicle, the egg becomes unable to fuse with sperm to conceive. Thus,
infertility originates in PCOS suffering females.
High levels of insulin inside body interfere in the irregularity of menstrual cycle to develop
anovulation and infertility. Insulin levels further stimulate the ovaries to produce androgens
(testosterone), which also promote infertility. In most of the women with PCOS, the pituitary
gland produces excessive amounts of luteinizing hormone (LH), which can stimulate the ovaries
to secrete androgens. This further causes infertility in PCOS females.
CONTRIBUTION OF OBESITY IN PCOS TOWARDS INFERTILITY

2. It is reported that obesity along with PCOS contributes majorly towards anovulation or infertility
in women. The elevated levels of androgens and obesity lead to increased formation of estrogen
hormone through insulin resistance. This hormone exerts a positive feedback on LH (luteinizing
hormone) secretion and negative feedback on FSH (follicle-stimulating hormone) secretion. The
increased levels of LH can lead to hyperplasia of the ovarian stroma and theca cells and
increased ovarian androgen production (testosterones), which in turn provides more substrate for
peripheral aromatization and be responsible for the chronic anovulation. Deregulation of FSH by
testosterones interferes in normal follicle growth. Thus, follicle does not mature completely and
results in anovulation.
TREATMENTS
Lifestyle modification:

3. For overweight women with PCOS who are anovulatory, diet adjustments and weight loss are
associated with recommencement of spontaneous ovulation. One of the best ways to regulate the
body weight and possibly reverse PCOS is through exercise and diet. It is considered as primary
therapy for infertility in PCOS. Weight loss alone is associated with a reduction in serum-free
testosterone concentration, which helps in ovulation and pregnancy. Weight reduction is also
associated with management of insulin levels, which contributes towards reduction in symptoms
of PCOS.
Oral contraceptive pills:
Oral contraceptive pills are reported to inhibit LH, diminish the circulating levels of androgens
and increase the levels of circulating SHBG (sex-hormone binding globulin). It is advisable to
use a low dose combination pill containing low dose of synthetic estrogen in combination with a
low-androgenic progestin. These pills control menstrual cycles, reduce male hormones
(testosterones) and help to clear acne also.

4. Insulin sensitizing agents:
Drugs initially developed to treat type 2 diabetes have been used to treat PCOS. Metformin
belongs to the group of drugs that improve insulin sensitivity by decreasing the circulating
insulin levels. As these drugs do not enhance insulin production, therefore they are free from the
risks of hypoglycaemia. Improving insulin sensitivity is associated with lowering testosterone
levels which helps to improve ovulation rates.
Fertility medications:
Women with PCOS desirous of fertility are treated mostly for anovulatory infertility. Several
medications that stimulate ovulation can help women with PCOS become pregnant. Treatment
options include:
 Clomiphene citrate (CC) is the first line treatment in women with PCOS and
anovulatory infertility. It causes increasing cervical mucus thickening and exhibits its
anti-estrogenic effect on the endometrial lining; thereby negating any benefits of
ovulation should it occur. On CC, the ovulation rate is around 70-80%. Clomiphene
citrate is used early in the menstrual cycle to increase the chances of an egg being
released by the ovary, which can then be fertilized naturally. It can be used either by itself
or in combination with other drugs (e.g. insulin sensitisers such as metformin) to increase
its effectiveness.

5.  Letrozole (an aromatase inhibiter) is indicated as an effective agent for induction of
ovulation in women with PCOS. This drug slows the estrogen production and causes the
body to make more follicle-stimulating hormone (FSH), a hormone needed for ovulation.
Letrozole is as effective as clomiphene in causing ovulation.
 Gonadotrophins are hormones involved in regulating ovulation by managing follicle-
stimulating hormone (FSH), luteinising hormone (LH), human chorionic gonadotrophin
(hCG). The medication is injected and the ovary carefully monitored by ultrasound to
avoid over stimulation. These can also be used for treating infertility where women have
not responded to clomiphene citrate.
Furocyst (fenugreek seed extract) treatment
It has been demonstrated by clinical studies that the bioactive components present in fenugreek
seedextract – Furocyst contributes majorly towards the management of PCOS and induction of
fertility. These bioactive components target insulin resistance to normalize the resultant
overproduction of testosterones. It was also observed during the clinical study that Furocyst
maintained regularity in menstrual cycle in PCOS women on completion of the treatment and
women also got pregnant. It is known in PCOS that hormone levels such as luteinizing hormone
(LH) and follicle stimulating hormone (FSH) levels are reduced which is also one of the reasons
behind infertility. But Furocyst treatment showed significant increase in LH and FSH levels in
the women. Thus, the study concluded that Furocyst was efficacious in ameliorating PCOS.
According to Chaudhary S et al., insulin resistance plays important role in the reproductive
dysfunction in women. They reported that PCOS women have insulin resistance, which gives
rise to infertility in them. According to their study, reduction in insulin resistance causes
improved action of androgen on target tissues that offers the possibility of improvement in the
physical stigmata of androgen excess leading to correction of the reproductive dysfunction and
prevention of metabolic derangements. Fenugreek seedextract – Furocyst has been reported

6. to target insulin resistance, which might contribute in the prevention of infertility in PCOS
women.
In a randomized, double-blinded and placebo-controlled trial of fenugreek seed extract
conducted by Bashtian MH et al., it was observed that fenugreek maintained the regularity in
menstrual cycle in PCOS women. Pregnancies were also observed after the fenugreek seed
extract treatment. They also showed that fenugreek had significantly positive effect on the
insulin resistance.
Furocyst is an innovative product (extracted and developed through a novel & innovative U.S.
patented process) involving separations of active ingredients from the natural plant without
affecting chemical properties of the active fractions. No chemicals are used. It is a natural and
promising dietary supplement for the management of Polycystic Ovary Syndrome (PCOS).
REFERENCES
 http://www.advancedfertility.com/pcos.htm
 https://jeanhailes.org.au/health-a-z/pcos/fertility-management-treatment
 https://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/infertility.aspx
 http://202.120.143.134/Download/c250ac8a652942551493de542064-299708120125.pdf
 http://womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-
syndrome.html
 https://www.arcfertility.com/polycystic-ovarian-syndrome-insulin-resistance/
 http://ijpr.sbmu.ac.ir/pdf_1296_3b0a5cb275247dc60c246cac1b579bda.html
 http://www.pmrc.org.pk/Insulin%20Resistance,PJMR-2012%20_2_,p63-65.pdf
 http://www.fasebj.org/content/29/1_Supplement/936.7?related-
urls=yes&legid=fasebj;29/1_Supplement/936.7
 http://furocyst.com/