Innovations in the Treatment of PCOS (Polycystic Ovary Syndrome)

PCOS (Polycystic Ovary Syndrome) is a common hormonal disorder in Turkey. It is extremely important because, clinically, it causes an ovulation problem that can lead to infertility. First of all, it is necessary to establish the diagnosis and to inform the patient in detail. PCOS is divided into different subgroups within itself, and the treatment options for these subgroups are also different.

There are significant differences compared with other patient groups in ovulation treatment, IUI treatment, and IVF (In Vitro Fertilization) treatment. Although treatment response and pregnancy chances are high, the treatment details are very important. For high success, an individualized treatment option must be determined properly, and a high chance of pregnancy should be offered without causing side effects or complications.

In all treatments to be applied in PCOS, the individual response threshold is important. Below this threshold, no response is obtained, while above it, excessive response and serious health problems related to this may occur, and at times these problems can be life-threatening. The treatment threshold may vary for each patient and even between different treatments in the same patient. In summary, PCOS treatment is a serious issue that requires expertise.

When no response is obtained from ovulation treatment and IUI treatment, or when pregnancy cannot be achieved, IVF treatment comes to the fore.

In IVF treatment, Prof. Dr. Aygül Demirol, who has achieved a very important first in Turkey, has been successfully performing the IVM, that is, drug-free IVF technique, for many years. IVM treatment is an option that must be offered carefully and only to the appropriate patient group, with a pregnancy chance ranging between 30–35%. In IVM treatment, the side effects of hormone therapy are not observed. However, for various indications, it is not suitable for all patient groups. There are many cases in which normal IVF treatment, that is, conventional treatments applied with hormonal stimulation, must be used. We can list this group as follows: cases in which IVM is not preferred according to the ultrasonographic appearance of the ovaries, cases with previous unsuccessful IVF attempts, and cases in which, after evaluating other details specific to the couple, IVF treatment with hormonal stimulation should primarily be given. It should also be emphasized that, compared with IVM, IVF treatment with hormonal stimulation has a higher success rate of around 40–50%.

In IVF treatment for PCOS cases, the patient must be evaluated in detail. It is extremely important to adjust the dose and type of hormones according to age, hormonal characteristics, weight, and ovarian features on ultrasound. Determining the threshold value at which the case will respond is of vital importance. In this way, the desired number and quality of eggs can be obtained, and thus high fertilization rates and high pregnancy rates are achieved. In addition, embryos remain after transfer for freezing. In some cases, even if the hormone treatment applied is organized very meticulously, ovarian hyperstimulation syndrome, that is, abdominal distension, fluid accumulation in the body, and in advanced cases, life-threatening systemic conditions may occur, affecting the respiratory system, kidneys, and coagulation system.

The systemic causes leading to serious complications have been investigated and specific treatment methods targeting the cause have been developed. It has been determined that ovarian hyperstimulation syndrome, that is, hyperstimulation, is related to the renin–angiotensin system, which we call the kidney and urinary tract system, via the calcium system, and by primarily treating the system that would lead to complications, the problem has been almost completely eliminated. In other words, in IVF treatments with hormonal stimulation, in PCOS group cases and in cases similar to PCOS that will respond highly to treatment, treatment side effects and complications have been reduced to almost 0%. Thus, both high pregnancy rates have been achieved and side effects have been eliminated. In the treatment applied, both the hormone doses and forms are planned very carefully, and at the same time the treatment is closely monitored and the timing of egg collection is precisely planned accordingly. In the newly developed treatment, depending on the characteristics of the case, a special calcium-containing serum treatment is administered under medical supervision before egg collection, at the time of egg collection, and afterwards. This treatment method has been successfully applied in many cases and has attracted great attention after being published in a respected scientific journal.