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Dr. Silva Explains how PCOS affects your fertility and how you can overcome it

Dr. Celso Silva discusses PCOS
Medical Contribution by Dr. Celso Silva

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 it is highly treatable and nearly every woman with PCOS should be able to get pregnant,” explains Dr. Celso Silva, Shady Grove Fertility Tampa Bay Medical Director. “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.”

pcos: cause of infertility

WHAT ARE THE SYMPTOMS OF PCOS?

PCOS affects approximately 5 to 10 percent of the population, and is most prevalent in Hispanics and African Americans. Recent studies also suggest that there is a rising rate in women of Asian descent.

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

WHAT CAUSES PCOS?

Although the specific cause of PCOS is still unknown, the condition results in hormonal imbalances that curtail or prevent ovulation—the body’s process of producing and releasing eggs from the ovary. It is common for women with PCOS to have an inappropriate production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). As a result, they experience limited follicular development (follicles are small sac-like structures within the ovaries, and each follicle contains an egg). With limited follicular development, egg development will not occur. Also as a result, women with PCOS have an increase in testosterone and other typically male hormones (androgens).

Clinically, the limited egg development may result in irregular ovulation or a complete lack of ovulation (anovulation), which can persist for months or even years. This ovulatory dysfunction is what actually causes infertility in these women. Also, when anovulation is prolonged, the endometrial tissue in the uterus can get very thick, resulting in heavy and/or irregular periods. The increase in androgens is also responsible for the excess hair growth and acne.

It also common for women with PCOS to have an insensitivity to insulin. This, many times, can predisposed them to have increased weight gain and obesity that places the patient at higher risk for diabetes and cardiovascular disease.

HOW CAN I GET TESTED FOR PCOS?

There are no specific tests for PCOS, and the condition is essentially clinically diagnosed.

Your medical team will determine if there are any physical signs of excess androgens present, as well as evidence of ovulation problems by evaluating the length and regularity of your menstrual cycles.

Some testing may also reveal common features of the condition. For example, all Shady Grove Fertility patients undergo basic fertility testing including among others blood testing and ultrasound. The ultrasound can determine if the ovaries are enlarged and contain immature resting follicles, a prominent sign of PCOS. Blood testing can reveal or confirm elevated levels of androgen (male hormones). When making a diagnosis of PCOS, it is also important to rule-out other causes of ovulatory disorders, including thyroid dysfunction.

Once your physician has a complete picture and can make the diagnosis, he or she will work with 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,” Dr. Silva states. “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 been 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 citrate (Clomid), which have been available for many decades, continue to be widely used to stimulate the development of an ovarian follicle containing an egg. Clomiphene citrate 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, additional medications can be prescribed. Metformin for example helps to make the body more sensitive to insulin, which can result in more regular ovulation.

medication study for pcos

What fertility treatments are available for PCOS?

Depending on the initial testing, a fertility specialist may recommend a patient to start ovulation induction medications (cited above) with timed intercourse or intrauterine insemination (IUI) that can be scheduled around the time of ovulation. For these treatments, it is important that the Fallopian tubes are open and the sperm counts are normal. The typical success rates with IUI is about 15 to 25 percent per cycle; a woman’s individual success rate with IUI is largely impacted by her age.

If ovulation induction with timed intercourse or IUI fail to achieve a pregnancy after a few attempts of this therapy, or if the patient also has other infertility factors such as blocked Fallopian tubes, her physician may recommend in vitro fertilization (IVF).

DO WOMEN WITH PCOS ALWAYS HAVE FERTILITY PROBLEMS?

Infertility is very common in women with PCOS. However, it is important to highlight that 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. When appropriate, being proactive about the initiation of medical therapy in these patients frequently results in a successful pregnancy. With the proper treatment, PCOS can be managed for the long-term and patients can live relatively symptom free.

To watch our On-Demand Webinar on PCOS, click here. During this free, on-demand event, viewers will learn about the symptoms of PCOS, the role they play when trying to conceive, and treatment options that are available to help women overcome their infertility caused by this condition. 

Editor’s Note: This post was originally published in June 2016 and has been updated for accuracy and comprehensiveness as of September 2018.

 

SCHEDULE AN APPOINTMENT


To learn more about PCOS or to schedule an appointment with Dr. Silva, please contact our New Patient Center at 1-877-971-7755 or click here to complete this brief online form
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17 Comments

  1. Tabi

    November 12, 2018 - 3:31 pm
    Reply

    I was diagnosed at a young age with PCOS. I was told to lose weight and things would improve. So years after being diagnosed I lost quite a bit a weight to where my periods started to come naturally each month. I have been tested to see if I ovulate but I don’t, so now I have a period each month and don’t release an egg at all. I don’t understand why I have a period at all if I’m not ovulating? Kinda of wish I never lost the weight, it was pointless.

  2. PCOD

    September 30, 2018 - 6:10 pm
    Reply

    Great Blog post. I read properly about causes of PCOS and tests for PCOS. you have explained point to point about symptoms of PCOS in this blog post . Thank you very much for sharing.

  3. jasa pembuatan website

    September 17, 2018 - 9:06 pm
    Reply

    like your blog so much! I also have pcos and I know how it feels. I’ve been in treatment for years. Unfortunately it brought zero result. I’m currently pregnant with twins from donor egg.

  4. sharadashekar

    May 11, 2018 - 1:48 pm
    Reply

    Nowadays PCOS is a common problem for women. Which basically accorded by mainly weight gain, hormonal imbalances, food habits. You have explained very well about PCOS. Thank you for such a beautiful blog. Causes of female infertility diagram which explained very well. I have PCOS since 7 years being married. We are trying to conceive… But it’s not happing with PCOS but now i come to know. Thank you for this useful information.

  5. Alice

    May 3, 2017 - 1:42 am
    Reply

    I was diagnosed by 2 doctors with PCOS based on my hormone levels in my blood work. I never had irregular periods, infertility, hirsutism. I was underweight until I hit my forties. I do get ovarian cysts but not a lot of them. I went to the doctor because my hair is thinning. I am 54 but I still get my period. I wonder if the doctors misdiagnosed me. My mother wasn’t infertile but she had some of the symptoms and she did get type 2 diabetes and uterine cancer. Does it run in the family?

  6. Charlotte

    February 13, 2017 - 8:14 pm
    Reply

    Hello Shady Grove

    I have been considering contacting a clinic such as yourselves, but I feel in a negative space as I’m not sure what a clinic such as yourselves could do for us as we are at a dead end.

    I was diagnosed with PCOS at 26. I am now 36. We have been trying for a baby for 8 years. I have pretty much had all the treatment available to me in the UK. Clomid etc. ..I was on metformin for about 5 years. I stopped taking it 2 years ago, as I don’t want to be on it forever.

    I have had IVF 3 times, and everytime I had a 2 day transfer. After my 2nd round of ivf I had a 3d scan and nothing was found. I had terrible cramps (still have these ) and after investigation – had a laparoscopy which concluded that I have endometriosis. This was delt with (scrapped/ removed)…

    The 3rd ivf cycle , a year after the laparoscopy, was again a 2 day transfer the only little bit of light was that x 1 egg made it to blacecyst but was not good enough to freeze.

    My conclusion, is that it does not seem like any of my embroyos have been good enough quality as they all (bar 1 on the 3rd cycle) made it to blacecyst. I have had to go with a 2 day transfer everytime.

    If we have ivf again, we do not want to go down the same route, when everytime – I have pretty much had the same result. What treatment or how would you do things differently at your clinic ?

  7. nicole alex

    February 11, 2017 - 8:59 pm
    Reply

    I was married at 32 and immediately tried to get pregnant. When I was unable to conceive I had blood tests for fertility and was told that I had an FSH (follicle stimulating hormone) of 54 and would not be able to have children. Even though the doctors knew that I had been diagnosed with Hashimoto’s thyroiditis since age 25, no one bothered to check my thyroid levels. my TSH was measured at .001. My Synthroid dosage was lowered. a friend advise me to contact a spiritualist who help with fertility with her medicine, i collected her contact an explain my situation to her she prepared for me a herbal medicine which i took as describe I by her. became pregnant very quickly, I had a successful pregnancy. I have my baby august 2014. to get pregnant at age 35 with my 2nd child in september 2016, thank you mama , this is her email contact if you require her help nativeiyabasira@yahoo.com

  8. ghazal

    December 23, 2016 - 3:09 pm
    Reply

    recently my 18 years old daughter diagnosed pcos .high testosterone and follicular cyst in left ovary,hirsutism,no irrugular period and weight 130 lbs.i really worried about her that in future when she can conceive or pregnant after marriage.

  9. Jasmin

    September 22, 2016 - 8:55 pm
    Reply

    Hi
    I am a 28 years old. As far as I know, my period wasn’t regulate very well, so I could have it for one month, and then have it again after 3 or 5 months. 3 months ago, my OB said that I clinically have PCOS and prescribed for me Metformin, which is really being so helpful in regulating and having a period every month. Today, I get my lab results. they confirmed me having PCOS. All the lab results came back normal (testosterone was normal). My question is, I have been trying with metformin for the last 3 months to conceive, but nothing yet. Should I just wait and continue or ask the OB to prescribe clomid, w/out metformin to increase my chances? Thank you

  10. lana

    June 5, 2016 - 2:36 pm
    Reply

    I like your blog so much! I also have pcos and I know how it feels. I’ve been in treatment for years. Unfortunately it brought zero result. I’m currently pregnant with twins from donor egg. We had this procedure in Ukrainian clinic biotexcom. I should say now I have no feeling my babies are not mine genetically. To be honest I had some doubts. I didn’t know how I feel about the procedure… I thought maybe I should wait and try something else and it will help me to get pregnant. But we’d found out that the likelihood of having our own children was practically zero. So ivf with donor egg was our last and only one option. I have a very ‘modern’ family with step parents/brothers/sisters, half siblings and step nieces and nephews etc. Genetics really means nothing to me. People who raise and love you are your true family. In the beginning my dh wasn’t fully on board. We had some very serious arguments about the procedure. But when he found out I was pregnant everything in him changed! The babies I’m carrying are our children and will always be ours. It’s such a hard decision to make, I know. Only you will ever know if it’s right for you or not as it’s not right for some people. I look at it like at usual treatment of infertility. Doctors just help you a little bit. And then you carry/ give birth/ raise – do what usual parents do. We still haven’t decided whether or not we’ll ever tell the babies about the donor. But we’re definitely not telling anyone else how we came to be pregnant. It’s only our bussiness. I don’t see something super special in it so everyone should know. These babies are mine. I really feel it and I don’t make myself to do so. Girls I wish you all the best and good luck xx

  11. suveni

    January 28, 2016 - 8:47 am
    Reply

    Solution to PCOS Problem -Insulin Resistance

    For the majority of women with poly-cystic ovary syndrome, a primary cause of symptoms is the presence of a medical condition called “insulin resistance”. Insulin resistance simply means your cells are “resistant” to or are under-responding to the hormone insulin. Therefore, insulin cannot efficiently tell the cells to store blood sugar or perform a multitude of other tasks. The result is that the entire body is thrown into a state of imbalance and distress, leading to weight gain, belly fat, ovulation problems, mood disorders, and skin and hair issues.
    http://furocyst.com/insulin-resistance-solution-to-pcos-problem/

  12. Parul

    January 21, 2016 - 6:42 am
    Reply

    Hi,

    I am a 28years old women and was diagnosed with PCOS about 4months back. All my reports were normal except FSH/LH ratio which was 1:5. I am 5.2 and weigh 53 kgs.
    We are planning a baby and have started trying just a month back, but I am not getting periods on my own, I have to take deviry for every period. Does this mean I am not ovulating at all and need medication.

    Please help,
    Parul

    • suveni

      January 28, 2016 - 8:45 am
      Reply

      Solution to PCOS Problem -Insulin Resistance

      For the majority of women with poly-cystic ovary syndrome, a primary cause of symptoms is the presence of a medical condition called “insulin resistance”. Insulin resistance simply means your cells are “resistant” to or are under-responding to the hormone insulin. Therefore, insulin cannot efficiently tell the cells to store blood sugar or perform a multitude of other tasks. The result is that the entire body is thrown into a state of imbalance and distress, leading to weight gain, belly fat, ovulation problems, mood disorders, and skin and hair issues.
      For more visit – http://furocyst.com/insulin-resistance-solution-to-pcos-problem/

    • Iwanttwins

      May 29, 2016 - 7:27 pm
      Reply

      In response to your question about ovulating while having PCOS. I’ve also been diagnosed with PCOS 3 months back& was prescribed medroxyprogesterone (generic provera). That Rx induced my period after taking (1) x 10 days starting April 1, AF came on the 9th day, but I still took my last pill on day 10. My OB recommended that I order ovulation& pregnancy strips from amazon to catch the right time TTC, unfortunately my ovulation tests are all positive, due to my PCOS LH surge being out if wack.I have normal hormonal levels, however, I have multiple cysts on both ovaries. I go for my follow-up next week, hopefully I’ll get prescribed clomid or metformin to induce ovulation, I hope this helps& good luck to you!

    • Shady Grove Fertility

      June 2, 2016 - 1:35 pm
      Reply

      Hi Parul – For many women with PCOS, medication is used to stimulate ovulation. Often times this is enough to get your system going and you are able to conceive. For others, additional intervention may be needed. Please contact our new patient center at 877-971-7755 to discuss your options.

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