PCOS Treatment Guidelines: Lifestyle, Medications and Fertility Options
This blog is the second part of Dr. Laurence Jacobs’ series on Polycystic Ovary Syndrome (PCOS). In part one, he discussed the signs, symptoms and diagnostic criteria for PCOS.
In this follow-up, Dr. Jacobs outlines the latest PCOS treatment guidelines, from lifestyle modifications and metabolic therapies to fertility medications and assisted reproductive technology (ART). PCOS is a complicated disease, understand your treatment options based on your fertility goals.
About PCOS
As discussed in part I, Polycystic ovary syndrome (PCOS) is characterized by a combination of excess hair growth, ovulatory dysfunction, and polycystic ovarian morphology on vaginal ultrasound, associated with insulin resistance. Latest treatment guidelines focus on lifestyle modifications, medications, and careful fertility care, including the role of newer agents such as GLP-1 receptor agonists.
Lifestyle Modification for Preconception Health
Lifestyle intervention, overlooked by many physicians for decades, remains the cornerstone of PCOS management. Weight management, improved nutrition, and physical activity are consistently associated with improved metabolic health, ovulation, and higher pregnancy rates. Even modest weight loss of 5–10% can often restore ovulation and/or improve pregnancy rates naturally, as well as with medication/IUI and IVF treatments. Programs that offer qualified medical nutrition therapy (MNT), regular exercise training, and behavioral modification via personalized provider telehealth have excellent outcomes for preconception health (WINFertility and OvumHealth).
Medical/Surgical Therapies for Weight and Metabolic Management
Metformin continues to be used as first-line pharmacologic therapy for metabolic abnormalities, such as impaired glucose tolerance and insulin resistance in women with PCOS. The supplement Myo-Inositol has also demonstrated significant benefit in dealing with insulin resistance.
GLP-1 receptor agonists (tirzepatide, semaglutide and related agents) are a major addition in the treatment options for weight loss. These medications significantly reduce body weight, and insulin resistance in PCOS patients. Current evidence also suggests improvements in menstrual cycle regularity and ovulation. They can be helpful as an adjunct to lifestyle changes for overweight/obese women but are most effective when used in conjunction with lifestyle improvements. Careful collaborative decision making is vital, as side effects (nausea, vomiting, pancreatitis, gallbladder disease, etc.), high costs with little insurance coverage and long-term safety remain an issue. Since pregnancy safety studies are lacking, contraception should always be utilized when GLP-1s are used in women planning pregnancy in the future and stopped when attempting conception.
Bariatric surgery may be considered for women with PCOS and severe obesity who meet criteria for surgical weight management. While not specific to PCOS, weight reduction from bariatric surgery may restore ovulation and improve metabolic health.
Laparoscopic ovarian drilling, another surgical option, has a very limited role in modern infertility practices, but in the past has helped some women by reducing ovarian testosterone and other male hormones (androgens). This option is rarely used today due to costs and potential damage to ovaries leading to adhesions.
Ovulation Induction and Infertility Management
Infertility is very common in PCOS, primarily due to anovulation and/or poor egg quality.
Letrozole has become the first-line medication therapy for ovulation induction in women with PCOS and anovulation, among most Reproductive Endocrine/Infertility specialists and many Ob/Gyns. Many well-controlled randomized studies have demonstrated higher ovulation, pregnancy, and live birth rates, as well as lower multiple birth rates with letrozole compared with clomiphene citrate.
Clomiphene citrate (Clomid) remains a popular option, particularly among Ob/Gyns. Combination therapy with clomiphene plus Metformin improves ovulation and live birth rates compared to clomiphene alone.
Metformin when used alone is less effective for ovulation induction but may be considered in combination with Letrozole and/or Gonadotropin medications (Menopur, Gonal F and Follistim), when doing ovarian stimulation for ovulation induction or IVF.
Gonadotropins are second-line therapy when oral ovulation induction fails. Careful monitoring is required to minimize the risk of ovarian hyperstimulation (OHSS) and multiple pregnancies. IVF is far more effective and safer regarding multiples.
Assisted Reproductive Technology (ART) and IVF
In vitro fertilization (IVF) is often reserved for women who fail less invasive ovulation induction therapies or who have additional infertility factors such as tubal disease or male factor infertility. In PCOS, IVF requires particular caution due to the high risk of OHSS. The newest guidelines emphasize the use of GnRH antagonist protocols (Ganirelix; Cetrotide) and individualized low dose stimulation strategies with Lupron triggers to minimize this OHSS risk. Pre-treatment with metformin may also reduce OHSS risk in women still undergoing IVF with GnRH agonist protocols. As noted above, Preconception care—including optimization of weight, hormones and metabolic status—is recommended prior to doing ART.
A Comprehensive Approach to PCOS Treatment
PCOS is a complex condition requiring an individualized, comprehensive approach. Preconception health with lifestyle modification remains first-line therapy. Medication therapy has improved. Metformin and Myo-Inositol supplements maintain their roles. GLP-1 receptor agonists, with proper counseling and informed consent, represent a new option for weight loss and metabolic improvement.
For infertility treatments, letrozole is clearly the first-line option for ovulation induction. Clomiphene, metformin (alone), and gonadotropins are occasionally used. IVF is very effective but requires careful strategies to minimize OHSS risk. Single frozen embryo transfers greatly reduce the risk of multiples. (1-2% identical, if embryo splits).
Expert Care for PCOS
Dr. Jacobs has helped women manage their PCOS for more than 40 years and was formerly the Director of the PCOS Center of Excellence. He understands firsthand how medications, supplements and lifestyle modifications can profoundly impact the health and fertility of PCOS patients.
If you think you may have PCOS or are struggling with symptoms, Dr. Jacobs and our team can help with the correct diagnosis and treatment options. Click here to schedule a consultation.
To understand more about PCOS, read part one of this blog discussing symptoms and diagnosis.
PCOS Awareness Month: Signs, Diagnosis and Treatment Options
Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal conditions affecting 1 out of 10 women of reproductive age. Yet, it often goes undiagnosed because the signs and symptoms can be subtle and inconsistent. In this blog, Dr. Laurence Jacobs shares important information about how to know if you have PCOS and how different lifestyle and treatment approaches can improve your health.
Understanding PCOS
A common misconception is that all women with PCOS experience irregular periods, excess hair growth, ovarian cysts or weight gain. However, not every woman with PCOS has all of these symptoms. Because there is no single test to diagnose PCOS, some doctors may miss the correct diagnosis, especially in young women, by only treating irregular periods with birth control pills.
Signs and Symptoms of PCOS
PCOS may present differently from woman to woman, but symptoms often include:
- Irregular or absent periods
- Infrequent or absent ovulation
- Infertility
- Hirsutism (excessive hair growth) of face, chest or abdomen; acne
- Weight gain or obesity
- Insulin resistance
How is PCOS Diagnosed?
Women must have two out of three of the following diagnostic criteria:
- History of irregular or absent menstrual cycles and/or no ovulation since puberty
- Hirsutism and/or high blood levels of male hormones: Testosterone and Androgens
- Vaginal ultrasound evidence of polycystic ovaries (20 or more follicles in one or both ovaries)
It is also important to note:
-Other endocrine issues, such as various thyroid and adrenal diseases, must be ruled out as their symptoms can mimic signs of PCOS.
-Ultrasound diagnostic criteria no longer applies to teenage girls.
Key Considerations
- Not all PCOS patients are overweight (Classical PCOS). Some may have what is known as Lean PCOS.
- Women with PCOS often experience irregular periods and infertility due to lack of ovulation and/or egg quality.
- Insulin resistance is common in PCOS patients. This means their bodies do not respond to glucose properly. In order to maintain normal blood glucose levels, the pancreas produces excessive insulin, which then increases fat storage and disrupts hormone levels. This leads to symptoms such as irregular periods, obesity, infertility and excess hair growth.
Lifestyle and Treatment Approaches
The good news is that addressing insulin resistance can help restore normal ovarian function. Research shows that lifestyle and medical strategies can improve fertility and overall health in women with PCOS:
- Nutrition: A balanced, lower-carb diet can help regulate blood sugar and hormone levels.
- Exercise: Regular activity supports insulin sensitivity and weight management.
- Supplements: Vitamins like Inositol may help regulate insulin resistance and menstrual cycles.
- Medications: Insulin-sensitizing medications such as Metformin are often used to improve ovulation and restore hormone balance. The beneficial use of GLP-1 agonist medications, such as Semaglutide (Ozempic or Wegovy) and Tirzepatide (Zepbound) along with proper nutrition and lifestyle changes will be discussed in part 2 of this PCOS blog.
- Weight reduction: Even a weight loss of 5–10% can enhance fertility, improve natural ovulation and increase success rates with fertility treatments, including IVF.
Expert Care for PCOS
Dr. Jacobs has helped women manage their PCOS for more than 40 years and was formerly the Director of the PCOS Center of Excellence. He understands firsthand how medications, supplements and lifestyle modifications can profoundly impact the health and fertility of PCOS patients.
If you think you may have PCOS or are struggling with symptoms, Dr. Jacobs and our team can help with the correct diagnosis and treatment options. Click here to schedule a consultation.
Stay tuned for part two of this PCOS blog which will discuss management and treatment options for those PCOS patients dealing with infertility issues.
Abdominal Cerclage and IVF: How We Overcame Recurrent Pregnancy Loss
Amanda and Paul’s journey to parenthood was anything but simple. In this blog post, Amanda shares her six-year journey through IVF, pregnancy loss, abdominal cerclage and finally, the joy of welcoming her son Dimitri.
Our Dream of Starting a Family
My husband, Paul, and I always knew we wanted kids. We always talked about having two but were open to the idea of three. I never suspected anything was wrong because my cycles were pretty regular, and I had no signs or symptoms of any issues.
We got married in the summer of 2018 and were anxious to start trying. After several months of negative tests, I talked to my OBGYN, and he put me on Clomid. I took Clomid for about six months, and after that didn’t work, we started to explore other options and began working with a fertility clinic. We started the IVF process in November 2019 and finally had our first retrieval in March 2020. When the lockdown mandate was ordered, we were too far into the cycle to cancel, so we were able to proceed with the retrieval.
By the fall of 2020, we were ready for our first transfer. It worked—or so we thought. The embryo stopped growing and resulted in a loss. We decided to move forward with another transfer toward the end of 2020. That one also worked, and I was released from my IVF clinic at six weeks. A few weeks later, I went in for an ultrasound and was told there was no longer a heartbeat. Because we were still in the midst of COVID, I was alone. The ultrasound tech was the only person in the room. She was so kind—she hugged me and cried with me. It was something I’ll never forget. I had my first D&C right before Christmas.
Finding Dr. Miller and a New Plan
After talking to a friend who was already with Dr. Miller, she recommended that I switch doctors. The one I was with didn’t want to change anything in my protocol, and it was time for a change. We started the process of switching over to Dr. Miller and moved our remaining embryos. I had a phone consultation with him in early 2021, and we began the necessary genetic testing for both my husband and me. Everything came back completely normal, so we were still at a loss as to why we couldn’t get pregnant.
We had our first transfer with Dr. Miller at the end of July 2021. We got pregnant! Everything looked good—until it didn’t. This pregnancy also ended in a loss and required another surgery. We had another consultation with Dr. Miller, and he suggested a trial cycle. We started it and had to push the transfer date back one day. I also had some inflammation due to endometriosis. Around that time, Dr. Miller spoke to Dr. Jubiz, who suggested I have an endometrial scratch before the next transfer.
An endometrial scratch is created when a small catheter is inserted into the uterus, then moved back and forth and rotated in order to cause some disruption to the uterine lining. It may be helpful in women with recurrent implantation failure by increasing endometrial receptivity. Once I got the all-clear from Dr. Miller, we prepped for the next transfer. I had the endometrial scratch in the cycle prior, and the transfer was done on April 29, 2022.
This transfer would prove to be both the most successful and the most gut-wrenching. After all the surgeries, retrievals, and losses, I wasn’t hopeful. My husband remained positive and supportive—my rock. I tried to stay open-minded, but after almost two years of heartbreak, I was losing hope. To my surprise, this transfer worked! My beta numbers were the highest they’d ever been, and we made it to another OB ultrasound. Our baby boy was growing and developing perfectly! It was surreal to finally start believing I was truly pregnant. We relaxed a little and began dreaming of the day we’d bring our baby home.
Everything was going perfectly. We finally got to announce our pregnancy on July 20, 2022—our fourth wedding anniversary. He was healthy and growing beautifully. Then my husband and I both got COVID.
We scheduled our gender reveal for August 6, 2022. It was hot, and our cake melted—but it was a perfect day. Our family found out we were having a boy. We had known from genetic testing, but we still wanted to share the moment with them.
A few days later, I noticed more discharge than normal. Research suggested it was fine, so I didn’t worry. But on August 13th, I went to the bathroom, pushed, and heard a loud pop. It sounded like a gasket breaking. I checked but saw nothing unusual. Later, as I turned on the couch, I felt a gush of liquid. I ran to the kitchen, and it was pouring out of me. I called my husband—he was in disbelief. I called my OBGYN, who suggested I lie down and elevate my feet since I wasn’t bleeding. Moments after I hung up, I started gushing blood. I got into the bathtub, and my husband rushed home. We went to the ER.
After hours of waiting, we were told my water had broken. While the baby still had a heartbeat, he wouldn’t survive. I was 18 weeks pregnant. We were given the option to go to a hospital equipped for babies born at 18 weeks, but the outcome would be the same. We went home, and I prayed harder than I ever had that he would make it to 22 weeks. I played lullabies and told him I loved him.
The next day, I began cramping. We rushed to the hospital. Everything escalated quickly. Our son was born sleeping about 45 minutes after we arrived. It was the hardest moment of my life. The hospital staff gave us as much time as we needed with him before saying goodbye.
Discovering the Need for an Abdominal Cerclage
When we were ready, I called Dr. Miller to get back on the schedule. About a month later, we created a new plan. Dr. Miller was kind and compassionate. I asked him not to give up on us, and he promised he wouldn’t. We also met with a Maternal Fetal Medicine doctor and discussed a cerclage This is a small stitch to close the cervix. Initially, I thought a vaginal cerclage was best, but Dr. Miller strongly recommended an abdominal cerclage.
An abdominal cerclage is a surgical procedure where a strong stitch is placed around the cervix through the abdomen to help keep it closed during pregnancy. It’s most often recommended for women with cervical insufficiency, a condition where the cervix opens too early, which can cause pregnancy loss or preterm birth. By reinforcing the cervix, the cerclage gives the pregnancy a better chance to continue safely.
When an abdominal cerclage is placed prior to pregnancy, it avoids the risks associated with a vaginal cerclage, such as infection or an inability to place the cerclage due to cervical thinning. It has a success rate of about 98%. Paul and I knew this was the right choice. We had it placed in early 2023.
We did another endometrial scratch, this time two cycles before the next transfer. That transfer didn’t take. I started spiraling, truly believing I might never be pregnant again.
Hope After Heartache: A Successful Transfer
We still had four embryos left. We proceeded with another scratch the month before our next transfer in August 2023. I wasn’t hopeful. But we were pregnant again. Instead of joy, I felt dread. Our first beta was decent, not great, but it continued to rise. We made it to another OB ultrasound at the Naperville office. I couldn’t bring myself to get excited. My heart was guarded. I told myself that if we lost this one, at least I wouldn’t be attached.
But another week passed, and the baby was thriving—already a day ahead in growth. The heartbeat was strong. We graduated and saw my OBGYN that same week. We agreed I’d see him or the MFM every other week to ease my anxiety. At 18 weeks, the anxiety was intense, but thankfully, I had an appointment. Our son was growing, moving, and the cerclage was holding strong. We passed 18 weeks, then 20 weeks, then reached viability. I felt a wave of relief. Before I knew it, it was time for my baby shower. I was 37 weeks—the cerclage had done its job.
Because I have an abdominal cerclage, I could only deliver via C-section unless it was removed. To protect the stitch, my OBGYN scheduled a C-section at exactly 38 weeks: May 1st.
But our son had other plans.
Welcoming Our Rainbow Baby
On Sunday, April 28, 2024, after dinner, I started having contractions. After about 12 in an hour, I called my doctor. He said, “That’s it—we’re having a baby.”
Our beautiful baby boy, Demetrios Bartho, was born at 37 weeks and 5 days, weighing 9 lbs 1 oz and measuring 22 inches long, on April 29, 2024, at 4:38 a.m. What we had prayed for and hoped for over nearly six years was finally a reality. He was—and is—absolutely perfect.
We recently celebrated his first birthday and are now beginning a sibling cycle.
A Message to Others Facing Loss
Without Dr. Miller’s knowledge, persistence, and innovative care, we probably would not have our beautiful son today. If you’ve experienced loss due to an incompetent cervix, I highly recommend finding a qualified doctor capable of placing an abdominal cerclage. It was—and is—a life saver.
We will be forever grateful to Dr. Miller and his staff, my OBGYN Dr. Tom Kazmierczak, and the MFM doctors at Duly.
-Paul, Amanda, and Demetrios (Dimitri)
The Importance of Single Embryo Transfer in Modern IVF
Dr. Charles E. Miller has practiced fertility medicine for more than 35 years, witnessing firsthand how technology and standards of care have evolved. One of the most significant shifts in modern IVF is the move toward Single Embryo Transfer (SET) as the recommended best practice. In this blog, Dr. Miller explains the change and how it benefits patients today.
Background
When Dr. Miller first opened his IVF clinic in Naperville, Illinois in September 2001, the common practice was to transfer multiple embryos at one time. Two embryos would typically be transferred in hopes of increasing the chances of a successful pregnancy. Dr. Miller’s practice was successful, and the clinic soon earned the reputation of the “Twin Capital.” Because this was the standard at the time, patients going through treatment accepted it and sometimes even favored the practice, “embracing the idea of being ‘one and done’ in terms of family building” as put by Dr. Miller. However, sometimes multiple embryo transfers came with complications, or resulted in triplet pregnancies.
Hidden risks with multiple embryos transfers
In addition to the occasional triplet pregnancy, Dr. Miller noted that once per quarter, his patients would deliver prematurely. Most of the twin pregnancies would be delivered nearly at full term (36-38 weeks) but premature deliveries were usually due to cervical incompetence, where the cervix dilates too early. According to Dr. Miller, “the risk of delivery prior to 32 weeks was 2% for singleton pregnancies, 8% for twins, and 26% for triplets (i).” Even with healthy pregnancies and births, children were left with long-term health impacts like cerebral palsy, profound developmental delays, and severe sensory and motor disabilities. Other risks associated with multiples include:
- Preterm birth
- Low birth weight
- Higher rates of Neonatal Intensive Care Unit (NICU) admission
- Maternal complications
How technology changed the game
Thanks to advancements in the embryology lab, including cryopreservation techniques and having the ability to select a genetically normal embryo, via Preimplantation Genetic Testing for Aneuploidy (PGT-A), SET is the optimal method of transfer. Dr. Miller no longer performs two-embryo transfers, only SET, and has delivery rates of over 65%.
Why is SET the recommended approach?
The values of SET extend beyond its clinical outcomes. Not only is it more cost-effective with saved NICU visits, but it also reduces the emotional strain that can come with a high-risk pregnancy. Elevated stress from pregnancy with multiples is well documented, Dr. Miller citing a study in which “22% of mothers of multiples had Parenting Stress Index scores in the severe range, compared to 5% of mothers with singleton pregnancies conceived via IVF and 9% with singleton pregnancies conceived naturally (ii).” By shifting to SET, clinics and patients can experience reduced risks from multiple pregnancies and reach their family building goals more safely.
i Practice Committee of American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril. 2012 Apr;97(4):825-34.
ii. Glazebrook C, et al. Parenting stress in first-time mothers of twins and triplets conceived after in vitro fertilization. Fertil Steril. 2004 Mar;81(3):505-11.
What to Expect at Your First Fertility Consultation with Dr. Jacobs
Starting your fertility journey can feel scary and intimidating, yet also hopeful. Knowing what to expect can help ease anxiety and make you feel more comfortable before beginning this process.
With more than 45 years of experience, Dr. Laurence Jacobs has guided thousands of families through their fertility consultations. Here’s what to expect when you schedule yours:
First Steps:
You and your partner (if applicable) should plan to attend the first consultation together; it usually lasts about an hour.
What We’ll Review:
- Medical records and history, menstrual cycle, past surgeries or complications
- Lifestyle factors and any medical issues (for you or your partner)
After that, we’ll outline the infertility workup to determine why pregnancy isn’t happening. This includes:
- Hormone blood tests
- Diagnostic ultrasounds
- X-rays
- Semen analysis
5 Key Fertility Factors We Evaluate (you may have more than one)
1. Male Factor
- Semen analysis
- Sperm function test, including strict morphology, to identify if there is any difficulty in being able to fertilize an egg
2️. Ovarian Reserve (Egg Supply)
- On cycle days 2-4, you will come into the office so we can check your hormone levels, including AMH, which helps assess your egg supply.
- We’ll also do an antral follicle count transvaginal ultrasound to measure how many egg sacs (follicles) are present. The sonographer will count the antral follicles on both ovaries, looking for them to be 2-10 mm in diameter. The more follicles the better!
3️. Ovulation Evaluation
- Ovulation predictor kits, which look for a rise in a hormone called LH that tells us when you’re about to ovulate
- Ultrasound to check egg sac (follicle) size
- Follow-up progesterone test about a week later to confirm ovulation and assess if you have produced enough progesterone to be able to build up the lining of the uterus to get it ready for a pregnancy
4️. Uterine and Tubal Factors
- HSG, an X-ray using contrast dye, to view the uterus and fallopian tubes or a saline sonogram to check for fibroids, adhesions or polyps
- We also flush the fallopian tubes (part of the HSG) to make sure the fluid goes through the tubes so we know if the tubes look healthy and are functioning properly.
5. Pelvic Factors
- Check for adhesions from endometriosis, pelvic inflammatory disease or past surgeries
- Assessment for fibroids that could impact fertility
Next Steps:
After your workup (typically completed in a few weeks), we’ll schedule a follow-up appointment to review results, discuss medications and consider options like IUI or IVF if necessary. We’ll also recommend lifestyle changes to help support your fertility.
Ready to schedule?
Call us at 630-428-2229 or fill out this request form to get started.
About Dr. Laurence Jacobs
Dr. Laurence Jacobs is a Mayo Clinic fellowship-trained Reproductive Endocrinologist with over 45 years of experience helping thousands of families build their dreams through personalized fertility care.
Board-certified in Obstetrics and Gynecology, Dr. Jacobs brings deep expertise in IVF, PCOS, male and female infertility and second opinions for complex cases. After decades in leadership and practice, he is proud to provide consultations at Charles E. Miller, MD & Associates | CCRM Fertility’s Naperville office. Known for his compassionate approach and trusted by both patients and peers, Dr. Jacobs has been recognized nationally as a Top Infertility Doctor and consistently honored for his patient-centered care.
How Endometriosis Affects Fertility: Causes, Symptoms, Diagnosis and Treatment
We spoke with Dr. Laurence Jacobs, a reproductive endocrinologist with over 30 years of experience, to explore how endometriosis impacts fertility and how to recognize the signs of this often misunderstood condition.
How Does Endometriosis Affect Fertility?
Endometriosis can make it much more difficult to get pregnant. In fact, 20-50% of all infertile women have endometriosis, making it a prevalent issue in reproductive health.
One of the main ways endometriosis affects fertility is through scar tissue formation. When endometrial tissue grows outside the uterus, it can create scar tissue, adhesions and inflammation around the ovaries and fallopian tubes. This can often distort the normal anatomy of the pelvis, making it harder for the fallopian tubes to move over to the ovary and pick up the egg during ovulation.
Endometriosis can also interfere with ovulation. Endometriomas, which are cysts formed by endometriosis growing deep within the ovaries, can disrupt ovulation by affecting both the development and/or release of eggs. Additionally, some research suggests endometriosis can negatively affect the egg quality due to the inflammatory environment it creates within the pelvis.
Another concern is embryo implantation. The inflammation caused by the endometriosis can make it more difficult for the embryo to successfully implant within the uterine endometrial lining, leading to infertility or recurrent pregnancy loss.
The severity of endometriosis plays a significant role in its impact on fertility.
- Stages 3 or 4 (more advanced endometriosis) involve severe adhesions and endometriomas, which can have a major impact.
- Stages 1 or 2 (milder cases) may only involve small implants of endometriosis, which can still affect fertility but to a lesser degree.
The stage, severity and location of lesions and implants all play a significant role in how endometriosis affects fertility.
How Can You Tell If You Have Endometriosis?
The most common symptoms of endometriosis include:
- Pelvic pain
- Moderate to severe menstrual cramps
- Pain during sexual intercourse
Although some women with endometriosis have no symptoms at all. A pelvic exam can sometimes reveal signs of endometriosis, such as hard nodules at the bottom of the pelvis.
Ultrasound is another useful tool for identifying endometriosis. Endometriosis growing very deep inside the ovaries, can form a cyst called an endometrioma and these cysts can be seen on ultrasound. However, most smaller implants of endometriosis cannot be seen on ultrasound. Ultrasound can only detect advanced stage 3 or 4 endometriosis, while smaller implants and adhesions seen in Stage 1 or 2 may not be visible.
How Is Endometriosis Diagnosed?
Symptoms and signs of endometriosis and even ultrasounds can make one suspicious of endometriosis, but the only way to definitively diagnose the condition is through laparoscopy. A laparoscopy is a minimally invasive procedure that allows a surgeon to look inside the pelvis using a laparoscope, which is a thin, telescopic rod with a video camera on the end. Not only can laparoscopy surgery confirm endometriosis, but the procedure can treat it as well.
Why does surgical expertise matter?
Because advanced endometriosis (Stage 3 or 4) often involves severe adhesions affecting the ovaries, intestines, bladder and ureter, it is highly recommended that the laparoscopy be performed by a skilled reproductive surgeon rather than a general gynecologist.
- A skilled reproductive surgeon can both diagnose and remove endometriosis in one procedure.
- You don’t want to undergo surgery just for diagnosis, only to need a second procedure for treatment.
- A less experienced surgeon may leave some endometriosis behind or be unable to treat complex adhesions.
New Advances in Endometriosis Testing
In the last seven years, innovative diagnostic measures have been developed to help determine if a woman with no symptoms or ultrasound evidence might have endometriosis. It also helps physicians decide who would be a good candidate to undergo laparoscopy.
Back in the 1980s and 1990s, it was standard procedure that everyone with infertility undergo laparoscopy, but now we try to be much more selective. The ReceptivaDX test, an endometrial biopsy performed in the office, checking or sampling the uterine lining, measures a protein called BCL6, a marker usually associated with endometrial uterine inflammation and potentially silent endometriosis.
An abnormal biopsy result usually means there is endometriosis or inflammation in the pelvis. This biopsy can be very helpful for women who have no symptoms, evidence of endometriosis on ultrasound or unexplained fertility.
Seeking Expert Care
If you think you might have endometriosis, it is imperative to seek out an experienced reproductive surgeon specialized in treating advanced endometriosis. In my opinion, Dr. Charles Miller, Dr. Kirsten Sasaki, and Dr. Molly McKenna are among the best reproductive surgeons for endometriosis treatment in the Midwest. Their expertise ensures that patients receive the highest level of care for both diagnosis and treatment, improving their chances of achieving a successful pregnancy.
Request a consultation or call 630-428-2229 to schedule.
Patient Story- Kayla
For many couples, the dream of starting a family is filled with excitement and anticipation. But for Kayla and her husband, that dream turned into a struggle with infertility. Just when they thought they had reached the end of the road, a second opinion with Dr. Miller changed everything. This is their story and the journey to two little boys that made it all worth it.
Like most couples, we dreamt of starting a family filled with laughter, love and the pitter-patter of little feet. However, as months turned into years, that dream seemed to drift further and further from our grasp. What began as hopeful anticipation soon gave way to the harsh reality of infertility. Month after month, we watched as the lines on pregnancy tests remained stubbornly blank, each negative result a painful reminder of our unfulfilled longing. Faced with the heartbreaking prospect of infertility, we embarked on the difficult journey of fertility treatments.
With our hearts full of hope, we began our fertility journey. We spent a year at our initial fertility clinic before finding Dr. Miller. Within that first year, we underwent numerous tests yielding frustratingly normal results and a series of treatments that encompassed Clomid, IUI and eventually IVF. Our first IVF round yielded 11 embryos. With eager anticipation, we underwent a fresh transfer and subsequent frozen transfers, clinging to the belief that each embryo held the key to our future family. However, amidst our prayers and unwavering determination, we encountered the bitter sting of disappointment in the form of only one chemical pregnancy.
Despite our best efforts, the road to parenthood seemed full of overwhelming obstacles. Faced with the crushing blow of yet another failed attempt, our doctor delivered the devastating news that there was nothing more he could do for us. With our hearts shattered, we made the decision to seek a second opinion.
When we first met Dr. Miller, we felt defeated and hopeless. However, we were determined to leave no stone unturned before exploring other alternatives. Seeking a second opinion turned out to be a pivotal moment in our journey to parenthood, leading us to the greatest gifts of our lives. Through three rounds of IVF under Dr. Miller’s guidance, we experienced a rollercoaster of emotions, each cycle marked by its own unique challenges and triumphs.
In our first round, despite our renewed hope, we faced yet another heart-wrenching setback with another chemical pregnancy.
After years of tirelessly chasing the elusive dream of parenthood, we found ourselves on the brink of surrender. We had spent years going through countless treatments and tests to only find ourselves right back where we started on our journey to parenthood. Despite the pain and disappointment, we made the courageous decision to give it one last chance.
Our second round of IVF with Dr. Miller was a life changing moment in our journey, etched in our hearts as a turning point that brought light to the darkest days. We were initially filled with hope as 12 embryos seemed to be thriving. However, the day of our fresh transfer, our hopes were crushed when we learned that only one embryo had survived. Little did we know, that single embryo would become our greatest blessing, our precious son Theodore.
We became pregnant in January 2020, just before the world was engulfed by the chaos of the Covid-19 pandemic. We felt extraordinarily blessed. In a time of uncertainty and fear, our joy was immeasurable as we welcomed the news of our pregnancy. It was a reminder that amidst the darkness, miracles still happen, filling our hearts with hope and gratitude for the precious gift of new life.
After experiencing the immense joy of welcoming our first son into the world, we knew in our hearts that we wanted to expand our family and give him a sibling. Returning to Dr. Miller, we embarked on another round of IVF. Starting from scratch without any frozen embryos. This time, our efforts blessed us with eight precious embryos, one of which would become our beloved son, Cameron.
Our journey to parenthood was marked by highs and lows, hope and heartbreak, yet it led us to the most precious gift of all- our two sons. Their arrivals into our lives was nothing short of miraculous. Despite the challenges we faced along the way, we are forever grateful for modern medicine and our doctors, nurses and countless others who played a role in making our dreams a reality. They have given us the greatest gifts of all time, and for that, we will be eternally grateful.
-Kayla
Patient Story- Chloe- Asherman's Syndrome
Today we are featuring Chloe’s patient journey with intrauterine adhesions. According to Dr. Miller, these adhesions are one of the hardest things to deal with in infertility. Chloe sought Dr. Miller’s help after a pregnancy loss and being diagnosed with Asherman’s syndrome, a condition where adhesions form inside the uterus. Dr. Miller performed surgery to remove the adhesions and Chloe participated in a clinical trial aimed to prevent the return of these adhesions. The surgery was successful and Chloe recently welcomed her daughter, Charlotte. We are so happy to have played a part in helping Chloe become a mother.
Check out Chloe’s story:
In September 2021 we found out that we were pregnant with our first baby and we were over the moon. Fast forward to January 2022 and we lost our little boy when I was 23 weeks pregnant. We were distraught and didn’t know what to do. On top of losing our baby I was then diagnosed with Asherman's Syndrome. According to the Cleveland Clinic, Asherman’s syndrome is an acquired condition where scar tissue (adhesions) form inside your uterus. The scar tissue can build up, decreasing the amount of open space inside your uterus. Women with Asherman’s syndrome may experience light or no periods, pelvic pain or infertility.
We weren’t very educated on this syndrome at the time, but later on found out that it would be difficult to get pregnant with Asherman's syndrome. I was told that I would need a hysteroscopy to get rid of these adhesions. A hysteroscopy is a procedure in which a surgeon inserts a thin, lighted telescope to see inside the uterus. Adhesions can be removed at this time.
I knew that I wanted to make sure I had the best doctor performing this procedure since my ability to have kids depended on it. I learned about Dr. Miller from my husband's cousin, who is a nurse in Park Ridge. At the end of 2022 I scheduled an appointment. Dr. Miller ended up performing the hysteroscopy and lysis of adhesions in March 2023. I took part in a clinical trial to get rid of my adhesions. The trial looked at the effect of a soft gel-like material, called Juveena™ Hydrogel, inserted into the uterus after the removal of adhesions to reduce the formation of adhesions again.
After my procedure the nurse told me that my adhesions were some of the worst she had ever seen. However, they felt like they had gotten all of them. I had a follow up a few months later where I was told everything looked good and I was ready to try for another baby.
In November 2023 I found out that I was pregnant again. My husband and I were very excited, but also nervous after everything we had previously gone through. Dr. Miller and his team were great from the moment I told them that I was pregnant. They got me in for a visit right away and started monitoring me until they felt I was in the safe zone.
In June we welcomed a sweet little girl named Charlotte into the world. We are so in love with our baby and so thankful to Dr. Miller and his team. If it wasn’t for him I truly don’t believe we would have Charlotte. I know if I have any issues in the future Dr. Miller would be the first person I would reach out to.
May 10 is Dr. Miller Day!
Did you know May 10th is Dr. Miller Day? Neither did we, until our patient, Jamie, shared that she created this special day to remember her fertility journey, the support she received from her “village” and of course the doctor who helped her become a mom!
Jamie writes:
Our fertility journey started as most do, with a lot of hope and a lot of disappointing negative pregnancy tests. During my initial testing, I found out I had 2 fibroids and one was very large. Although I kept asking about the large one, I was told by 3 different doctors that they weren’t an issue and was encouraged to start IUI or IVF.
Although reluctant, we started planning on how and when to move forward. Through that process, we started applying for grants. While looking at the grant application, I started reading into how it would be scored. In the fine print, I noticed certain types of fibroids would disqualify us from the grant, and that is because they can make IVF less successful. This made me, once again, question my fibroid. I told my husband that I wanted to find an expert opinion to rule out the fibroid causing my fertility issues before beginning any treatment. I started to research fibroid experts, and one name kept coming up again and again in my search, Dr. Charles Miller.
In April 2022, during my consultation with Dr. Miller, I expected to hear, once again, that the fibroid was “fine.” Dr. Miller recommended surgery, and on May 10th, 2022 he successfully removed both fibroids. We spent the next few months healing, trying to enjoy life, appreciating what we have, and planning our next steps to bring home a baby of our own.
In August 2022, I returned to Dr. Miller’s office, and he told me that things healed well and we could start trying again. During that same month, I was on pins and needles hoping to hear that we got the IVF cycle grant. However, less than three weeks after my follow-up visit with Dr. Miller, our jaws dropped when we got our positive pregnancy test! It was clear that the fibroid was what had been causing my infertility, and if we hadn’t done our research and sought out Dr. Miller’s expertise, we would have spent thousands on IVF without any success.
On April 17, 2023 our miracle baby girl, Fontana, was delivered via c-section. We cannot thank Dr. Miller enough for taking his time to listen to our concerns, truly evaluating the fibroid and its impact, and for his flawless surgery. Without Dr. Miller, we wouldn’t have had a first birthday to celebrate last month.
This Friday we will celebrate our second Dr. Miller Day. This year we took the time to reflect and appreciate those who were a part of our village by writing cards to family, friends, and those strangers who supported us during our darkest days of infertility. Each person is represented by a house, and when we put them all together, it was empowering to see just how many people helped us along the way. No two infertility journeys are the same, but for those still in the trenches, trust your gut and advocate for yourself.
Patient Story- SJ
SJ has been a patient of ours since 2012. After years of trying at another clinic, she underwent surgery with Dr. Miller, and then made the difficult decision to use donor eggs. In 2013, SJ and her husband welcomed twins! However, their family was not complete, and they welcomed another son last year! SJ understands the complexities of using donor eggs but hopes her journey brings awareness and inspiration to others in similar situations.
If you would like to learn more about our donor egg program, please contact Lindsey Bartscher (lbartscher at drcharlesmiller.com). Special thanks to SJ and her husband for sharing their inspiring story.
Our journey to build our family was a long one, but we are happy to say we are on the "other side" of infertility thanks to Dr. Miller and his wonderful staff!
We started trying to conceive in May 2009 when I was 29 years old. Both of our parents had conceived easily, and we were both healthy, so we didn't expect to have any problems. Unfortunately, after a year of negative cycles, we started seeing a fertility doctor in June 2010. Despite all our tests looking normal, we did four IUIs that all failed. When we finally got to the point of doing IVF, we just expected it would work. Our first IVF cycle, I got pregnant and for the first time ever saw two pink lines! Even though my hcg numbers were low, I thought just the fact that I'd finally seen a positive pregnancy test meant things might work out. We lost the pregnancy around 5.5 weeks and quickly moved into a frozen embryo transfer (FET). That cycle failed, and we did two more IVF retrieval cycles and fresh transfers that both failed. After our third failed IVF cycle, my original fertility doctor suggested that we may need to use donor eggs. I was not ready to move forward with donor eggs then, so we tried one more IVF cycle with our original doctor. When that cycle failed, our doctor suggested not only donor eggs but donor sperm. We asked our doctor if he would be willing to perform further testing and a laparoscopy to test for endometriosis, since my sister had recently been diagnosed with it. When he refused, we decided it was time to switch clinics.
I had a friend who was able to get pregnant after a procedure Dr. Miller performed, so based on her recommendation and a lot of research, we decided Dr. Miller's office was the right place for us to continue our journey. Dr. Miller was completely on the same page as us and understood that before we did donor eggs or donor sperm or another IVF, we wanted to be 100% sure we had tested for any potential issues like endometriosis or immune issues that could affect implantation of an embryo. Our motto was "no regrets," so we wanted to make sure we had no regrets about our decisions on this fertility journey. Dr. Miller performed a laparoscopy after finding mild endometriosis, and he discovered I had homozygous MTHFR, both issues he thought could affect IVF success. We tried one more IUI cycle and one IVF cycle with Dr. Miller. After our first IVF cycle with Dr. Miller, he told me I had "soft" eggs and recommended donor eggs. He said he did not think we needed donor sperm, but he showed us the statistics on donor eggs and explained how such a cycle would work. Dr. Miller's Donor Egg IVF Coordinator also gave us a lot of information on donor egg agencies and counselors.
After taking a few months to regroup and make sure we were ready, we decided to move forward with donor eggs in August 2012. Dr. Miller also added Lovenox and Medrol to my cycle due to my MTHFR and repeated IVF failures. We found an amazing donor egg agency (Graceful Conceptions) and moved forward with a fresh donor egg cycle in December 2012. The difference between our donor egg cycle and my egg cycles was night and day! We had so many more embryos to work with that we did with my cycles, and they were all top quality! We transferred two embryos on December 18th and were able to freeze five more high graded embryos. And right before Christmas I got two beautiful pink lines on a pregnancy test! It was the BEST Christmas gift we could ever imagine! We found out two weeks later that we were expecting not only one but TWO babies!
Our twins were born healthy in 2013, and we kept our frozen embryos for several years. Eventually, in 2022, we decided to try and expand our family. We knew it might take a few tries, but we got lucky and had success on our second frozen embryo transfer in May 2022.
We know some people are not comfortable with donor eggs, but Dr. Miller made us feel so comfortable about it, and he reminded me that with donor eggs I would still be carrying my children. We know our three beautiful children would never have been possible without donor eggs or Dr. Miller. We are forever grateful we decided to switch clinics back in 2012, and we are thankful Dr. Miller was so straightforward about donor eggs being our best chance of having a baby and building our family. We explained to our kids that donor eggs are just part of their story and something that makes them special, and they will always know how much they were wanted and loved! We hope our story gives other couples hope, especially when faced with failed IVF cycles. "Success" looks different for everyone, but we are blessed and grateful that our donor, Dr. Miller and science have made our family possible!
-SJ