PCOS: One Size Doesn't Fit All

Polycystic Ovary Syndrome, or PCOS, remains the most common ovulatory disorder in women of reproductive age. Nearly one-third of all infertility diagnoses are PCOS, and, despite the myth that women with PCOS cannot get pregnant, it is an infertility diagnosis that is commonly treated successfully.

Some patients with PCOS may face many challenges and anxieties in their journey to conceive including misdiagnosis, inappropriate treatment, or weight gain. But by working with a fertility specialist who can provide the proper diagnosis and treatment options, almost anyone with PCOS can have a baby. The good news is that most PCOS patients will achieve pregnancy with changes in lifestyle and low-tech treatments. Additionally, beyond achieving a pregnancy, proper management of PCOS can have long-term health benefits.

What Does PCOS Look Like?

PCOS affects approximately 5% - 10% of the population, and is most prevalent in Hispanics, African Americans, and Caucasians while some studies suggest that there is a rising rate in women of Asian descent.

Some of the most recognizable symptoms of PCOS include acne, excess hair growth and absent or irregular menstrual cycles. While many people may consider obesity as a main symptom of the disease, approximately one-third of women with PCOS are normal weight or less.

What Causes PCOS?

PCOS is caused by hormonal imbalance of FSH to LH - commonly a 1:3 ratio is consistent with PCO although many women with PCO will have a normal ratio. Diagnosis is based more on clinical presentation rather than lab work or ultrasound.

FSH is responsible for stimulating the growth of follicles in the ovaries that contain the maturing egg. A lack of FSH for an extended period of time will cause the follicles to not mature, which then develop into the small, resting follicles within the ovary.

Increased levels of LH cause the body to produce too much estrogen and male hormones (androgens), including testosterone, which can cause the endometrial tissue in the uterus to get very thick, resulting in heavy and/or irregular periods. The increase in androgens is also responsible for the excess hair growth and acne.

Another cause of PCOS is an insensitivity to insulin which is responsible for an excess of male hormones. This, many times, results in increased weight gain and obesity that places the patient in higher risk for diabetes and cardiovascular disease.

Testing for PCOS

The difficulty in determining if a patient has PCOS is that some general practitioners may overlook some subtle signs of this hormonal condition and put too much emphasis on others.

All Shady Grove Fertility patients undergo basic fertility testing including day 3 blood testing and ultrasound. The ultrasound can determine if ovaries are enlarged and contain immature resting follicles, a prominent symptom of PCOS.

In addition to basic lab work, we review physical signs of excess androgens, as well as the quality of ovulation through the length and regularity of menstrual cycles, and then prescribe an individual treatment option based on those results.

Achieving Pregnancy & Overcoming PCOS

Changes in Lifestyle:
For overweight women suffering from PCOS, weight loss is often the first step to increasing your chances of pregnancy. The benefits of weight reduction include improving ovulatory function, better response to fertility medications, if needed, improved chances of conception, and a safer pregnancy for both the mother and baby. Studies have shown that by losing just five percent of body weight, a woman can actually restore her menstrual cycle and ovulate on her own. Weight loss has also shown to reduce other symptoms such as hair growth, acne and balding.

Medication:
Most women with PCOS will need assistance from their OB/GYN or a fertility specialist to successfully ovulate because the ovaries are not producing a follicle containing an egg each month (and sometimes no follicle is produced at all).

Oral fertility medications like clomiphene (Clomid), which have been available for more than 50 years, continue to be widely used to produce an ovarian follicle containing an egg. Clomiphene acts by blocking the action of estrogen in the brain (the hypothalamus and pituitary). As a result, there is an increased production of follicle stimulating hormone (FSH) causing the development of one or more follicles. If ovulation is still irregular, an additional medication, metformin, may be prescribed in addition to clomiphene. Metformin helps to decrease glucose production and make the body more sensitive to insulin thus leading to more regular ovulation.

Fertility Treatment:
Depending on the initial testing, a fertility specialist may recommend a patient start with timed intercourse or IUI which can then be scheduled around the development of the follicle(s), provided that the fallopian tubes are open and the sperm counts are normal. The typical success rates with IUI are about 15% – 25% per cycle with higher chances among younger women and lower chances for older women.

While many of our patients have success with the lower tech methods, several treatment cycles may be required to achieve a pregnancy and, if this process is not successful, then moving on to another treatment such as injectable medications or IVF may be necessary. At Shady Grove Fertility, patients with ovulatory disorders, including PCOS, have a 52% chance, per IVF cycle, of successfully having a baby.

Long Term Picture with PCOS

Women with PCOS have a very good prognosis for conception. Patience and dedication may be necessary to allow an adequate amount of time for lifestyle modifications to enhance fertility naturally, as well as being proactive about the appropriate amount of time to proceed with medical therapy. With the proper treatment, PCOS can be managed for the long-term and patients can live relatively symptom free.

For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.

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