PCOS (Polycystic Ovary Syndrome) and Fertility

PCOS key concepts

• Polycystic ovary syndrome (PCOS) is a hormonal disorder caused by the ovaries producing excessive androgen hormones that affect ovulation, often causing infertility.
• PCOS affects 8% to 13% of reproductive age women; of those with PCOS, approximately 75% will experience infertility.
• The condition can cause irregular periods, abnormal hair growth, acne and sometimes multiple small cysts to form on the ovaries, giving the condition its name.
• Treatments to address PCOS-related infertility include lifestyle changes by the patient, medications, ovulation induction, and in vitro fertilization (IVF) when other treatments fail or as initial treatment in some cases.

What is polycystic ovary syndrome?

Polycystic ovary syndrome is a hormonal disorder that affects ovulation in women of reproductive age. It is the most common cause of anovulation, or lack of regular ovulation, which may lead to infertility. It can also hamper ovulation making conception difficult. This condition affects 8%-13% of women, according to the World Health Organization.

Polycystic ovary syndrome can begin in women after they reach puberty, and some women are diagnosed in their teenage years. However, it is most often diagnosed in women in their 20s and 30s, often when they are having difficulty getting pregnant.

But PCOS is often undiagnosed, which is the case for about 70% of women worldwide with the condition. For this reason, it is important that women having trouble conceiving consult with Conceive NJ’s fertility specialist Dr. Isaac Glatstein in order to be evaluated for this condition.

Being a syndrome means PCOS is a group of problems found together. These include chronic anovulation, hyperandrogenism (elevated levels of male hormones) and cysts on the ovaries. In addition to infertility, it can cause other problematic symptoms and is associated with other long-term physical and emotional health problems.

Is PCOS holding up your family plans?

Health risks of PCOS aside from infertility

• Damage to the uterine lining (endometrium) causing thickening and abnormal bleeding.
• Metabolic syndrome that increases risk of heart disease and diabetes.
• Endometrial cancer or pre-cancerous changes.
• Obesity.
• Sleep disorders such as sleep apnea.
• Depression and anxiety.

PCOS cause & risk factors

The exact cause of PCOS is not known. The American College of Obstetricians and Gynecologists notes that it may be related to several different factors having an effect at the same time. These can be an irregular menstrual cycle, genetic factors, elevated androgen hormones and increased insulin resistance, which can lead to diabetes. A family history of PCOS and having type 2 diabetes are risk factors for a woman getting the condition.

Polycystic ovary syndrome can also cause difficulties in pregnancy. These can be increased risk of miscarriage, gestational diabetes, preeclampsia (high blood pressure during and after pregnancy) and preterm birth.

PCOS symptoms

Knowing PCOS symptoms is very helpful for women in order to identify it as a potential cause of infertility. But knowing the symptoms is also important for any woman with polycystic ovary syndrome in order to address unpleasant effects of the condition as well as preventing it from leading to other serious health problems.

Following are key PCOS symptoms.

• Infertility – PCOS is one of the most common causes of female infertility.
• Irregular periods that can be infrequent, too frequent, heavy, no periods (amenorrhea) and unpredictable periods.
• Excessive hair growth, called hirsutism, affects about 70% of women with the condition and it can occur on the chest, abdomen, face and upper thighs.
• Obesity – 4 in 5 women with PCOS are obese; unexplained weight gain is also a symptom.
• Acne that is severe or occurs after adolescence and does not respond to normal treatments.
• Patches of darkened, thick skin and oily skin.
• Skin tags.

Not all women with the condition have symptoms. Symptoms may also be so mild that they are not noticed, or attributed to a different cause.

Related reading: When To See a Fertility Specialist

Diagnosing PCOS

Conceive NJ utilizes different tests to diagnose polycystic ovary syndrome because it is a condition with multiple aspects. We have a discussion of health and reproductive history and use a combination of blood tests to evaluate hormone levels, a physical exam and an ultrasound.

Blood tests can detect high male hormone levels as well as high blood sugar and cholesterol, both indicators of the condition. Ultrasound may show enlarged ovaries and a collection of small cysts (polycystic). A physical exam can evaluate symptoms such as hirsutism and skin changes; a pelvic exam can look for other causes of abnormal bleeding the patient may be experiencing.

Conceive NJ follows the guidelines of the American Society for Reproductive Medicine in determining a diagnosis of PCOS. This requires that a woman has two of these three symptoms identified through the different forms of testing:

• Enlarged ovaries or polycystic evidence.
• Excess androgen signs like hirsutism or acne.
• Irregular, missed or heavy periods.

Related reading: Fertility Testing

PCOS treatment for infertility & symptom relief

Lifestyle changes

Our philosophy at Conceive NJ is to always recommend the least invasive and simplest treatments whenever possible. For some women with PCOS, this can be lifestyle changes they can implement themselves.

Achieving and maintaining a healthy weight is often a good course for those who are obese, which is the case for many women with PCOS. We can give guidance in weight loss, which is often a good step before undertaking other treatments.

For women not seeking to get pregnant

For women with PCOS not trying to get pregnant, hormone medication generally alleviates symptoms or reduces them. This is often through oral contraceptive pills or other forms of hormonal contraceptives that can address hair growth, help regulate periods and control acne.

Other medications can block androgen production. And metformin can reduce chances of developing metabolic syndrome and diabetes.

PCOS treatments for those experiencing infertility

Our treatments to combat infertility related to PCOS are tailored to each patient and her specific conditions. Medications can assist in improving ovulation. We can start with oral clomiphene citrate and letrozole. Metformin can also improve ovulation.

Injectable gonadotropins are helpful in stimulating egg growth. These are often used along with properly timed intercourse for pregnancy success. In addition, these can be used in conjunction with intrauterine insemination (IUI).

In some patients, minimally invasive laparoscopic ovarian surgery may be an option. However it does carry some risks of scarring and infection.

Should these not work, and in some cases where we know they are not likely to work such as when both fallopian tubes are blocked or there is also male factor infertility involved, we recommend IVF. In vitro fertilization is particularly effective for women age 35 or younger. The average success rate of live birth with IVF for women with PCOS under 35 is around 60%.

In conclusion

PCOS is a major cause of infertility in women resulting from hormone issues that affect ovulation. Aside from resulting in infertility, the condition can also cause other serious health issues.

It is often undiagnosed in women until they are having trouble conceiving and seek medical attention. Conceive NJ provides expert diagnosis through testing and offers effective treatments for women not trying to conceive and for those trying to have a child.