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PCOS: One Size Doesn’t Fit All

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.

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, 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.

medication study for pcos

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.

SCHEDULE AN APPOINTMENT

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. 

16 Comments

  1. 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.

  2. 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?

  3. 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 ?

  4. 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

  5. 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.

  6. malia shirley

    December 22, 2016 - 8:51 am
    Reply

    For women suffering from uterine fibroids, it is important for them to know that they are not alone. I have been living with fibroids since I was 26 years old. Over the years they’ve just continue to grow and cause other concerns. I had a MRI done and the doctor said they found 4 fibroids and possibly more if they were too small for detection. My abdomen looks as if I was 14weeks pregnant. I had a myomectomy removing 4 fibroids and other treatment but all prove abortive. My problem was that the fibroid continued to grow back at an unusually rapid rate and was usually back to its original size and after one failed cycle we’re back at square one. I was lucky to have access to Herbal Medicine, This medicine strunk all my fibroid without having to grow back. I now consider myself most fortunate. Contact Dr.Leonard, his medicine may work for you too (drleonard288@gmail.com).

  7. Francesca Mcniel

    November 21, 2016 - 11:32 am
    Reply

    I actually promised myself that i will do this because i never in life thought i would be cured of PCOS because my gynecologist told me there was no cure and because of this i could not take in and get pregnant. I had PCOS (polycystic ovary syndrome) for 7 years and this was a big pain to me and my husband due to the downcast we felt for not having a child. I experienced irregular periods or no periods at all sometimes, heavy periods, i gained weight (fat). I seeked a cure from one doctor to the other used androgen, clomiphene, metformin and even travelled to different states to see other doctors to no avail. My husband got to know about Dr. Aleta via a testimony he read on the internet on how a woman got a cure and he contacted her with the contact she left. I got the herbal medication and used it for the speculated 3 months that was all i have a son who is just 8 months old. Do not give up just contact her on (aletedwin @ gmail. com) on how to get the herbal medication. Thanks and i wish you get cured soon too.

  8. 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

  9. 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

  10. 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/

  11. 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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