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Contents - Winter 2009

Vol. 2 No. 1

Unlocking Secrets of Infertility: Research Team Uncovers Better Ways to Diagnose Polycystic Ovary Syndrome

By Ashleigh Mattern

Megan and her husband tried for years to have children. A physician herself, Megan (not her real name) thought she might have a hormonal disorder called polycystic ovary syndrome (PCOS), the leading cause of infertility in women.

But because Megan wasn’t exhibiting the usual symptoms of obesity and extra hair growth, her doctor discounted the possibility of PCOS. The disorder, which affects about six to 10 per cent of all women, interferes with egg production.

It wasn’t until Megan saw a poster about a University of Saskatchewan research study on female infertility and decided to enroll that she learned she did indeed have PCOS.

In healthy women, eggs develop inside follicles— small fluid-filled cysts—with one egg being released each month. In PCOS, more cysts collect, creating an excess of male hormones that prevents the egg’s release. The syndrome often eludes doctors because its traditional telltale signs—male-pattern hair growth and obesity—don’t always appear in women with PCOS.

Many of the more than 1.4 million Canadian women believed to have the syndrome are unaware they have it, mainly due to difficulty in diagnosing it.

In fact, most women remain unaware they have PCOS until they seek infertility treatment from a reproductive specialist. Since the syndrome increases risk of diabetes, heart disease, and even cancer, delaying diagnosis and treatment can lead to a host of health problems.

U of S researchers Roger Pierson and clinician Dr. Donna Chizen—who jointly ran the study to which Megan responded—are finding better ways to diagnose PCOS.

With help from Pierson and post-doctoral fellow Marla Lujan (who has since been recruited to Cornell University), Chizen is developing better standards for radiologists to more easily and accurately diagnose PCOS so it can be treated early to prevent such conditions as infertility, diabetes, and even cancer.

In the past, many doctors were unable to use ultrasound images to diagnose PCOS because criteria at the time were too vague to pinpoint the condition. This means that doctors couldn’t effectively distinguish between women who had the syndrome and those who did not.

Given the pervasiveness of the condition, it is no surprise that the preliminary guidelines developed by Chizen and her colleagues claimed the “Best Research Award” from the Canadian Fertility and Andrology Society last year.

These new guidelines will help doctors diagnose PCOS more quickly and accurately, but Chizen thinks as many as two in 10 women are still being affected by the syndrome because of a lack of awareness among affected women and ongoing problems with diagnosis.

“PCOS is sneaky,” says Chizen. “In many women it doesn’t show up right away with the obvious symptoms.”

“I fell into this category when I went to see my doctor,” recalls Megan. “There was this mindset that you had to have a certain appearance or be overweight—and I’m not.”

PCOS is tricky to diagnose because its symptoms may vary. Hypothetically, a woman might have the syndrome, yet be thin, ovulate regularly, and conceive. With weight gain, she might stop ovulating and five years later see the telltale sign of excessive hair. To assist doctors like Megan’s, Chizen is continuing her work to create even clearer guidelines by analyzing 3D ultrasonographic images from more than 100 volunteers to show polycystic ovaries in their various forms.

Reproductive researcher Roger Pierson is developing a computer software program that will help Chizen and other physicians use these same ultrasound images to diagnose PCOS more rapidly.

Working with U of S computer scientist Mark Emain, Pierson is using funding from the Canadian Institutes of Health Research to create a program that quickly scans and analyzes ultrasound images to give radiologists nearly instant feedback on whether ovaries are polycystic.

“The idea is that we should be able to make it easier for radiologists and family doctors to diagnose the condition so patients can be referred for proper treatment,” Pierson said.

This is the latest medical imaging breakthrough for Pierson, who in 1990 became the first scientist to record an egg being released from the ovary and in 2003 recorded follicle growth’s wave pattern. Once Pierson, Chizen, and other researchers improve PCOS diagnosis, doctors can direct affected women to appropriate treatments. Solutions range from lifestyle changes, such as better nutrition and increased exercise, to medications that regulate insulin levels or address infertility.

Megan’s story is proof that quickly diagnosing and treating the syndrome makes a real difference. After struggling with infertility for nearly five years, she was able to conceive a baby daughter without using fertility drugs a few months after receiving treatment from Chizen and the clinic.

“I’m very thankful to her and the clinic,” Megan says. “I’m not sure I would have my daughter now if I hadn’t received the treatment.”