PCOS (Polycystic Ovary Syndrome)

PCOS at a glance

• Polycystic ovary syndrome, a leading cause of female infertility, is a hormone disorder that affects about 10% of women of reproductive age.
• Though the cause is not completely known, PCOS results in high levels of androgens (male sex hormones) that disrupt the ovaries’ normal function and can lead to other problems.
• Not all women experience PCOS symptoms, but the primary ones are anovulation (chronic lack of ovulation), hyperandrogenism (high testosterone levels) and polycystic ovaries (multiple, small cysts on them).
• Polycystic ovary syndrome treatment for women trying to get pregnant usually begins with medication to induce ovulation followed by in vitro fertilization (IVF) if necessary.

What is polycystic ovary syndrome?

Polycystic ovary syndrome is a disorder of reproductive hormones that is a common cause of female infertility, affecting 5% to 10% of women of reproductive age, according to the American Society for Reproductive Medicine (ASRM). About 70%-80% of women with PCOS experience infertility, according to the National Library of Medicine (NLM). Another NLM article says that about 50% of women with PCOS don’t know they have it.

Any woman past puberty can get the syndrome (a syndrome is a collection of problems). But it usually affects women in their 20s and 30s when they discover they have PCOS after having difficulty conceiving and see their doctor.

The imbalance of hormones caused by PCOS interferes with the functioning of the ovaries, which normally release a mature egg once a month during menstruation. PCOS can affect the quality of the egg ovulated and can also prevent ovulation due to missed or irregular periods, resulting in female infertility. This can cause cysts to develop in the ovaries, hence the term polycystic, though not all women with the syndrome have this symptom.

Women with PCOS can also experience metabolic issues that affect fertility as well as their overall health and appearance. The syndrome can cause women to experience other health risks, some related to ovulation problems, such as abnormal bleeding, thickening of the uterine lining and potentially uterine cancer. Metabolic effects of polycystic ovary syndrome include high blood pressure, high cholesterol and insulin resistance that may lead to diabetes.

PCOS causes

The exact cause of polycystic ovary syndrome is unclear but research suggests it is related to factors such as an irregular menstrual cycle, insulin resistance and high levels of androgens (considered male hormones). Insulin resistance, which means a person can’t fully break down or absorb sugars in the blood, is often a factor contributing to PCOS. A woman’s family genetics can play a role in these issues.

Polycystic ovary syndrome and pregnancy

Polycystic ovary syndrome can affect female fertility and the ability to get pregnant in several ways.

• High levels of androgens can disrupt ovulation, affecting fertility.
• These effects on ovulation can cause a decrease in the production of the hormone progesterone, which plays an important role in menstrual cycles and the ability to maintain a pregnancy.
• Irregular menstruation triggered by the syndrome can lead to infertility.

How women with PCOS can get pregnant

Pregnancy is possible for those with PCOS both naturally and with our fertility treatments, which are often very successful. Because the condition is most often due to hormonal issues, women can take steps on their own to increase their chances of natural pregnancy. These include:

• Maintaining a healthy weight. Roughly 4 out of 5 women with PCOS have obesity. Making lifestyle changes to reduce weight can be beneficial (for any woman trying to conceive).
• Since PCOS affects ovulation, it is important to carefully track ovulation for optimal timed intercourse. There are many apps and methods to track ovulation, including this ovulation calculator provided by the United States Office on Women’s Health.
• Since proper blood sugar levels are important for getting pregnant, women should have their blood sugar levels checked. Proper diet and weight, as well as medications, can help in managing blood sugar levels.

If these steps are not working, fertility treatments are often necessary to overcome the issues caused by the syndrome. Studies have shown that about 80% of women treated with the drug clomiphene were able to ovulate, and half of those achieved pregnancy naturally within six months. Women with PCOS who undergo IVF have a 20%-40% chance of successful pregnancy.

PCOS symptoms

Common symptoms of polycystic ovary syndrome follow, although women won’t necessarily have each symptom. Most of the time, these symptoms will present in the late teens or early 20s. These symptoms vary from mild to severe and can be vague.

• Infertility, which is the first symptom some women notice after being unsuccessful getting pregnant.
• Irregular periods, including fewer periods, no periods (amenorrhea) and periods every 21 days or more often.
• Hirsutism (caused by excess androgens), which results in excess hair on the face, chest, abdomen and areas where men usually have hair.
• Thinning hair on the scalp, similar to male pattern baldness.
• Weight gain.
• A collection of fluid-filled sacs in the ovaries (polycystic).
• Heavy acne after adolescence that does not respond to treatment.
• Oily skin.
• Patches of thickened, darkened skin with a velvety texture, especially skin fold areas.

Diagnosing PCOS

It is important to discuss medical history and have a physical examination by a fertility specialist in order to identify PCOS symptoms and rule out those caused by other issues, such as thyroid disease. The physician may also conduct blood, insulin and glucose level tests to evaluate hormone levels. A pelvic exam can indicate if the ovaries are swollen and identify other indicators of potential PCOS.

Once our specialist has ruled out other possible causes of symptoms, the woman may receive a PCOS diagnosis if she exhibits two of the following:

• Irregular periods.
• Signs of high androgen levels, including results of blood testing, hirsutism, hair thinning and acne.
• Polycystic ovaries.

PCOS treatment

For women who do not wish to become pregnant, treatment for polycystic ovary syndrome is usually hormonal birth control pills. Women who do want to get pregnant need to pursue other treatments.

• The first treatment fertility specialists try is often oral medications to induce ovulation. These include clomiphene citrate and letrozole.
• If these do not work, we may administer injectable gonadotropins to promote egg growth and induce ovulation.
• The medication metformin may improve the body’s use of insulin and promote ovulation in some patients.
• IVF is the next treatment step for women wishing to get pregnant.

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