Reproduction and Fertility

Fertility Treatments

Polycystic Ovarian Syndrome (PCOS)

PCOS is a common endocrine disorder, especially among women in the Mediterranean region. It was named polycystic because of the morphology of the ovaries that is characteristic in this syndrome. The ovaries do not have many cysts, as the name implies, but many small arrested follicles which are distributed in the periphery of the ovary. These are remnants of the unruptured follicles of previous cycles.

Apart from the characteristic sonographic picture of PCOS ovaries, in order to have the syndrome you need to also have:

  • Oligo ovulation and / or anovulation ( i.e. irregular periods)
  • Hyperadrogenemia (symptoms from excess androgens, like more facial or body hair, acne etc.)

What are the symptoms of PCOS?

– Irregular periods, delay of periods or no periods at all

– Excessive hair growth (Hirsutism).

– Tendency for weight gain.

– Infertility in more severe cases of PCOS with long periods of anovulation (i.e. no periods)

– Oily skin and Acne.

– Hair thinning or hair loss from the head.

Women with PCOS are at increased risk for developing high cholesterol and diabetes at later stages of life.

What is the cause of PCOS?

It is related to abnormal hormonal levels but the exact cause behind this has not been pinpointed. It definitely has a genetic component to it because it often runs in families.

Women with PCOS show different levels of insulin resistance (the cells are partially resistant to the action of insulin) which forces the body to produce more insulin, hyperinsulinemia. This also enhances the increase in androgens levels.

Being overweight or obese also causes insulin resistance. That is why women with PCOS have significant amelioration of their symptoms when they lose weight.

Can I cure PCOS?

There is no cure for PCOS, only treatment of the symptoms.

Medications can treat the symptoms as long as you take them but when you stop the medications, the symptoms will return because the underlying condition still exists.

Oral contraceptives are the most common modality of PCOS treatment. The body senses the exogenous hormones from the OCPS and stops producing hormones from the ovaries, thus reducing the excess androgens and abnormal levels of hormones. This is an exogenous way to control a normal hormonal state, which as soon as you stop taking the OCP, the underlying condition takes over again.

We usually first recommend lifestyle changes that don’t have the long term side effects of oral contraceptives. Regular exercise (especially aerobic), loss of weight and eating healthy are lifestyle changes that ameliorate the symptoms of PCOS.

Excessive hair growth in unwanted areas can be dealt with hormonal therapy or destruction of the hair follicle with laser or electrolysis, etc.

Can I get pregnant if I have PCOS?

Most women with PCOS will get pregnant on their own, without any medical help.

In severe cases of PCOS the help of a fertility specialist might be required to achieve a pregnancy.

Premature or Delayed puberty

Premature puberty

Premature or Precocious puberty occurs when a child’s body begins to change into that of an adult too soon. If that happens before the age of 8 in girls or the age of 9 for boys, it is considered premature puberty.

The cause of precocious puberty is often not found.

Children with precocious puberty will have shorter stature as adults because the growth spurt occurs at an earlier stage.

Medications usually will be given to delay the process of puberty.

If parents notice signs of precocious puberty like early breast growth and menarche in girls, facial hair and deepening of the voice in boys and pubic and underarm hair in both genders they should contact a reproductive endocrinologist.

Delayed puberty

If the onset of pubertal changes is delayed or never occurs.

There are many causes of delayed puberty but most are idiopathic and without any clinical implications.

If the parents notice no breast development by 13 y.o in girls and no testicular enlargement by the age of 13y.o they should contact their doctor.

Virilizing disorders

Virilization is a condition where a female develops male pattern hair growth and other masculine physical traits as a result of excessive androgens.

There are many causes of virilization like congenital adrenal hyperplasia, PCOS, anabolic steroids, adrenal tumors and more.

Symptoms of virilization include excess facial hair, acne, deepening of voice, increased muscle mass, increased sex drive. The uterus becomes smaller, the clitoris enlarges and menstruation can stop.

If some of these symptoms are noticed, it should be properly evaluated by a doctor in order to provide the appropriate therapy.

Premature Menopause

The average age for menopause is 51 years old. If menopause occurs before the age of 40 then it is considered premature.

What are the causes?

The causes can be genetic, illness, or iatrogenic (from surgical procedures like removal of the ovaries or depletion of their follicles by radiation or chemotherapy).

What are the symptoms?

The symptoms are the same as those experienced in normal menopause, initially:

  • Irregular or delayed menses.
  • Hot flashes

And at later stages:

  • Vaginal dryness
  • Decreased sex drive
  • Sleep disorders
  • Mood swings or mild depression.

What are the long term sequelae?

  • Osteoporosis
  • Colon Cancer
  • Cardiovascular disease

How is it diagnosed?

The diagnosis is based on the clinical findings, sonographic findings and confirmed with blood tests like FSH, estradiol and AMH (Anti Mullerian Hormone) measurements.

How can we treat or prevent premature menopause?

It cannot be prevented but the symptoms can be treated. Especially when the menopause is premature we usually administer HRT (Hormone Replacement Therapy) because the health and psychological benefits outweigh the possible side effects.


Defined as having no menses for more than 12 months. The months or years leading to menopause are described as perimenopause.

What are the symptoms of Menopause?

  • Hot flashes
  • Night sweats
  • Sleep disorders
  • Decreased libido
  • Headaches
  • Vaginal dryness
  • Mood swings
  • Palpitations
  • Joint stiffness

The most common symptoms are hot flashes and vaginal dryness, as many as 75% experience hot flashes.

Long term effects of menopause can be osteoporosis and cardiovascular disease among others.

What is the therapy for menopausal symptoms?

HRT is an efficient therapy since it replaces the hormones that are depleted (estrogens and progesterone). Nowadays we tend to give HRT only in selected cases and for a shorter duration of time since it has been shown that long term HRT can increase the risk for venous thromboembolism, cardiovascular problems and breast cancer.

Local estrogens or lubricants can efficiently alleviate vaginal dryness symptoms and dyspareunia.

Healthy balanced diet and exercise can improve certain symptoms

Weight bearing exercise and Calcium and vit.D supplementation can prevent osteoporosis.