DEAR DR. DONOHUE: I am in need of any information on how a woman with polycystic ovary syndrome can become pregnant. This information is for my 29-year-old niece, now living in Hungary, who is desperate to have a child. She is under the care of a gynecologist who is also a fertility specialist. She feels the doctors in North America are more advanced and would like a second opinion. — M.H.

ANSWER: Polycystic ovary syndrome, PCOS, has come a long way since Drs. Irving Stein and Michael Leventhal first described it in 1935. Their criteria for making the diagnosis were obesity, loss of menstrual periods, enlarged ovaries studded with many cysts and infertility. Now the diagnosis rests on demonstrating an overproduction of male hormones (hyperandrogenism). The consequences of that are many. Periods decrease or stop. Ovulation stops. Acne, facial hair and loss of scalp hair are other signs. Infertility is common. Obesity is frequently present. Insulin resistance — the inability of insulin to control blood sugar — is another important sign of the syndrome. A woman might have no visible signs of the illness but still have it. She might be like your niece, whose greatest problem is the inability to become pregnant.

Since your niece is interested in having a child, I will talk only of the treatment for infertility.

If your niece is overweight, weight loss is the first approach in her quest to become pregnant. If that isn’t her problem, medicines often can induce pregnancy. Clomiphene (Clomid) jump-starts the secretion of hormones that are a prerequisite for ovulation and pregnancy. Has she tried it? Sometimes it’s combined with metformin, a diabetes medicines that resolves the issue of insulin-resistance and its influence on infertility. Metformin, in fact, sometimes is prescribed as a single medicine for this problem.

Since she is seeing a fertility specialist, she has probably discussed in-vitro fertilization. If she hasn’t, she might want to broach that treatment.

Your niece needs not be leery of medical practice in Hungary. Hungarian doctors are respected throughout the world. Important medical discoveries were made there.

DEAR DR. DONOHUE: I have never seen you write about scar tissue. My life has been greatly affected by it. I have had to have two colon resections because of scar tissue in my abdomen. All of this was due to a car accident. You can die from scar tissue. I wonder about people who have unnecessary surgeries. It must be a problem for them. — G.M.

ANSWER: I’ve written about adhesions. They’re the scar tissue you are talking about. They’re thin or thick broad bands of scar tissue that spring up in the abdomen after trauma, including the trauma of surgery. Your auto accident prompted their formation. Abdominal surgery — because organs are displaced or blood seeps into the abdominal cavity or tissues are jostled during the operation — fosters the growth of adhesions. They can wrap around the intestines and obstruct the passage of food through them. If the obstruction is complete, then surgery is usually the best way to free the obstructed intestine.

Laparoscopic surgery, when possible, lessens the chance of adhesion formation. A viewing scope is inserted into the abdominal cavity through a small incision, and instruments are passed through equally small incisions. Less trauma results. Often, this process is used for removing adhesions.

DEAR DR. DONOHUE: What are the results so far with PinPointe laser treatment for toenail fungus? I want to have it done, but insurance won’t cover it. Is it worth the gamble for me? — D.F.

ANSWER: With PinPointe FootLaser treatment, a laser beam is directed in such a way that it is supposed to eliminate the toenail fungus without hurting surrounding tissue.

This a fairly new procedure. The number of expert-reviewed reports is few. The Food and Drug Administration has not given a seal of approval to it yet. Personally, since it is expensive and is new, I would wait until more information is available to support its effectiveness and safety.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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