With nearly one-third of all infertility diagnoses in women, polycystic ovary syndrome, or PCOS, is the most common ovulatory disorder in women of reproductive age.
While myths persist that women with PCOS cannot get pregnant, the reality is that PCOS is highly treatable and nearly every women with PCOS should be able to get pregnant. In fact, many women will experience increases in fertility through lifestyle changes and modest weight loss. Others will find success with basic infertility treatments and medications. And for those that need additional help conceiving, in vitro fertilization (IVF) is a highly effective form of treatment for women with PCOS.
WHAT ARE THE SYMPTOMS OF PCOS?
PCOS affects approximately 5 to 10 percent 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 underweight.
WHAT CAUSES PCOS?
Polycystic ovary syndrome (PCOS) is caused by hormonal imbalances that curtail or prevent ovulation—the body’s process of producing and releasing eggs from the ovary. Essentially, women with PCOS have an inappropriate production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). As a result, they experience limited egg development and an increase in testosterone and other typically male hormones (androgens).
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 prevent the follicles from maturing, keeping them as 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 at higher risk for diabetes and cardiovascular disease.
HOW CAN I GET TESTED FOR PCOS?
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 testing, your medical team will determine if there are any physical signs of excess androgens present, as well as the quality of ovulation through the length and regularity of your menstrual cycles. Once your physician has a complete picture and can make a diagnosis, he or she will work you to create an individualized treatment plan.
CAN DIET AND EXERCISE HELP WOMEN with PCOS CONCEIVE?
For overweight women with PCOS, weight loss is often the first step to increasing your chances of pregnancy. The benefits of weight reduction include improved ovulatory function, improved chances of conception, a safer pregnancy for both the mother and baby, and—if needed—better response to fertility medications. Studies have shown that by losing just 5 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.
WHAT MEDICATIONS ARE PRESCRIBED FOR PCOS?
For women with PCOS who are actively trying to conceive, it is advised to consult with your OB/GYN or a fertility specialist, since many women with PCOS are not ovulating. Your physician can prescribe medication to help stimulate ovulation.
Oral fertility medications like clomiphene (Clomid or Serophene), which have been available for many decades, 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. Metformin helps to decrease glucose production and make the body more sensitive to insulin, thus leading to more regular ovulation.
It is only recommended to stay on a medication-only protocol for three to four cycles, after which, chances of this protocol resulting in a pregnancy decrease.
What fertility treatments are available for PCOS?
Depending on the initial testing, a fertility specialist may recommend a patient start with timed intercourse or intrauterine insemination (IUI) (with medications to induce ovulation)n that can 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 to 25 percent per cycle; a woman’s individual success rate with IUI is largely impacted by her age.
If after a few attempts with IUI, or if the patient is presenting with other factors, such as blocked Fallopian tubes, her physician may recommend in vitro fertilization (IVF).
DO WOMEN WITH PCOS ALWAYS HAVE FERTILITY PROBLEMS?
Women with PCOS have a very good chance at 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.
Editor’s Note: This post was originally published in September 2011 and has been updated for accuracy and comprehensiveness as of June 2016.
To learn more about polycystic ovary syndrome or to schedule a new patient consult please call our New Patient Center at 1-877-971-7755.