Polycystic Ovary Syndrome (PCOS) & Fertility

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Andrea Fernando

By Andrea Fernando

What is Polycystic Ovary Syndrome (PCOS)?

PCOS is an acronym for Polycystic Ovary Syndrome. Polycystic ovary syndrome involves the abnormal growth of cysts on the ovaries. This results in hormonal imbalances and an inability to ovulate properly.

Normally, the ovaries produce a small amount of male sex hormones called androgens. When a woman has PCOS, the ovaries make slightly more androgens than normal.

An increase in testosterone is the key cause of the symptoms of PCOS, particularly facial hair growth, increased body mass and irregular menstruation. Most cases of PCOS are diagnosed, as it is a common cause of infertility. The body also has trouble using insulin, which causes blood sugar levels to increase. Over time, this can lead to diabetes.

Polycystic ovary and normal ovary

Who can get PCOS?

6-8% of women of reproductive age in the US are affected by PCOS. It does not seem to affect one race more than another, but is at a higher prevalence among Indigenous Australians. Most women are diagnosed with PCOS during puberty when the symptoms begin.

What are the risk factors for PCOS?

There is a genetic component to PCOS, so having a family member who has already been diagnosed increases your chances of having it. Beginning puberty early (at age 10 or below), particularly developing pubic and underarm hair at a young age is also seen to be a risk factor for PCOS. Other weak risks include obesity and low birth weight.

What are the symptoms of PCOS?

There are a few characteristic signs of polycystic ovary syndrome, and not all of them exist in every patient. Some women have polycystic ovaries on ultrasound but do not exhibit any of the clinical symptoms.

  1. Irregular menstruation
    The definition of irregular menstruation is experiencing periods at intervals less than 21 days, or greater than 35 days. If you've noticed any changes to your cycle, or don't have a set cycle, this may be irregular menstruation.
  2. Infertility
    One of the main consequences of PCOS is that the cysts on the ovaries disrupt the normal growth and maturation of eggs. This can cause infertility, as sperm cannot properly fertilize the eggs. Most women are diagnosed with PCOS after unsuccessful attempts at becoming pregnant.
  3. Hirsutism
    If you've noticed thick, dark facial hair growth, particularly around your chin, upper lip or cheeks, this is known as hirsutism. It can also be noted around other parts of your body, particularly your chest, back, thighs and buttocks.
  4. Acne
    15-20% of women with PCOS have acne, and it is usually severe and persists beyond adolescence.
  5. Overweight/obesity
    Up to 80% of women with PCOS are classified as overweight or obese, and this is also attributed to the hormonal imbalances caused by the cysts.
  6. Oily skin or excessive sweating
    All of these symptoms are due to an increased testosterone level caused by the cysts on the ovaries interrupting the normal hormonal changes.

How is PCOS diagnosed?

There are two methods for diagnosis of PCOS.

Blood tests will show high testosterone levels, and elevated levels of other hormones implicated in PCOS. This establishes the cause for the symptoms, however, raised testosterone can be due to hormonal imbalances other than PCOS, such as Cushing's Syndrome or thyroid problems.

An ultrasound can directly view the ovaries and determine whether cysts are present. Cysts are only visible in around 75% of women with PCOS, and are dependent on what time of the cycle the ultrasound is performed at.

These two tests together, along with the symptoms listed above can help to make a diagnosis of PCOS.

PCOS treatments

Depending on how PCOS is affecting your life, your doctor will adjust your treatment.

If you're having difficulty conceiving due to PCOS, the first line treatment suggested is weight loss if you are overweight.

Nutritional status and obesity have a huge impact on the ability to conceive and weight loss has been shown to be very successful in aiding conception.

Secondly, drugs that increase estrogen maybe given to increase the maturation and release of eggs. These include clomiphene and gonadotropins.

If after these pharmacological therapies are given, fertility cannot be achieved, a procedure called laparoscopic ovarian drilling can be utilized. This involves use of a laser to reduce ovary tissue, which encourages a better hormonal balance. If you aren't looking to have a baby, but are diagnosed with PCOS, treatment is mainly to remove the symptoms. The oral contraceptive pill is prescribed as a first line treatment and reduces testosterone in the body, which then reduces all of the symptoms, particularly the acne. This can take up to three months. Your doctor may also prescribe some creams to help reduce facial hair growth.

How can it be prevented?

There have not been any conclusive studies that demonstrate methods to prevent PCOS. Increased screening of females in families known to have PCOS is encouraged for early detection.

What are the consequences?

The main consequence of PCOS is infertility. Most women with PCOS are affected by infertility due to the lower rate of ovulation. As outlined above, treatments do exist to help women with PCOS conceive.

Some complications can occur during pregnancy, particularly if the mother is obese. There is an increased incidence of miscarriage in women with PCOS during pregnancy, as well as an increased rate of gestational diabetes, preterm delivery and pre-eclampsia.

Women with PCOS also have a 3 times increased risk of contracting Type 2 Diabetes in their lifetime.

Do you have PCOS? Got a question or a comment? Please let us know below.

New Join the Discussion!

  1. Olivia Jul 29, 2016
    I visited the gynecologist this week with the history of amenorrhea for 4 months and not pregnant too. Suggested a USG pelvic scan and everything was fine with the scan. He put me on microgynon, 1 daily and M2tone 2 bd for 30 days. Will it help? I'm TTC
    1. Sarah (OC Team): It's best to check that with your Doctor Olivia, sorry. - (Jul 29, 2016)
  2. Mina Aug 06, 2016
    I have been TTC for 6 months. I treated an infection in the last 3 months. I have facial hair on my chin, but it's not thick and full as stated above. You can only tell by feeling it with your hands. Is this a sign of PCOS? More so, I took clomid cd3 to cd5, but in my life, I have never experienced dryness like this before. This is my first time. I only saw a brownish spot on my underwear, then I experienced one day of watery discharge, then the brownish spot, then dryness throughout ovulation. Could clomid cause this? I am planning to stop using it in my next cycle. I am in cd21 now and I saw whitish sticky mucus. Please what could be the reason for all this?
  3. Ic Aug 09, 2016
    Hi, I'm IC and I was diagnosed with PCOS this past November. My husband wants to have a second baby, but it failed because of PCOS. I WANT TO KNOW IF DO I HAVE A CHANCE TO BE PREGNANT AGAIN?? And how? I notice that I gain weight. Thank you.
    1. Christina (OC Team): Women with PCOS may have trouble conceiving due to the lower rate of ovulation. But there are treatments to help. You can learn more here https://www.ovulationcalculator.com/pcos/ - (Aug 10, 2016)
    2. Sean: Hello. Don't be sad if it doesn't happen fast. I have a bad case of pcos. I have had it since 2011. Since then, I've had 2 miscarriages and one beautiful baby boy. We are currently trying again. 2013 is when I began to be active. And I was on bc for two years. Anywho... keep trying. Good luck! - (Dec 01, 2016)
  4. Faith Aug 11, 2016
    I took clomid CD 3 to 7. Now I am around CD 14 and I have a 30 day cycle. I am in my fertile time, but I am dry. What can be the cause? Please help me. TTC for one year.
    1. Christina (OC Team): Not everyone notices cervical mucus. Are you tracking in other ways (BBT or OPK)? If you have concerns about whether the clomid is working, talk to your doctor. - (Aug 11, 2016)
  5. Bigmom Aug 15, 2016
    Me and my husband have been trying for 10 years now. I am on metformin, 1000mg.
    1. Christina (OC Team): Good luck! - (Aug 15, 2016)
  6. Zainab Aug 19, 2016
    Hi, I am Zee and I was diagnosed with PCOS. I have a 6yr-old baby and I have been trying to conceive for the past 3 months. Please, I need your help.
    1. Christina (OC Team): Hi Zee, Talk to your doctor about treatment for PCOS and be clear that you are trying to conceive. Also, have a look at this article for tips on getting pregnant. https://www.ovulationcalculator.com/get-pregnant/ Good luck! - (Aug 19, 2016)
  7. Shay Sep 07, 2016
    I've been TTC for 2 years. I've been diagnosed with PCOS and Endometriosis. I had the surgery done. It didn't go so well. I had them on my bladder as well. I've been on Clomid for 4 months and my progesterone levels have been over 22 each time and still nothing. What else can I do?
    1. Christina (OC Team): I'm sorry to hear the surgery did not go well. Your doctor should have some advice on next steps. The most important thing you can do when trying to conceive naturally is to track ovulation and have sex within your fertile window. Have a look at this article for more info https://www.ovulationcalculator.com/get-pregnant/ - (Sep 08, 2016)
  8. Alisha Sep 13, 2016
    Hello, I was diagnosed with PCOS and diabetes July 2015. Since then, I lost 25 pounds and just finished a 10-day clomid. I'm on CD 3-12. I'm in my fertile window, so were hoping for our baby soon.
    1. Christina (OC Team): Good luck to you! - (Sep 14, 2016)
  9. Amanda Oct 18, 2016
    I have irregular periods, a long history of non-cancerous tumors in the uterus and ovarian cysts in my family. My grandmother, both aunts and my mom all had hysterectomies. I have very painful periods sometimes. Then sometimes i dont have a period at all. Its been this way since puberty. I should get check reguarly but I dont. Diabetes also runs in my family and Bright's disease...which somehow affects the kidneys. I'm scared to know what a doctor would tell me.
  10. Rosetta Oct 20, 2016
    I think I'm already pregnant, but it's not showing up on nothing. Now I'm going to the hospital to see if this is really happening.
  11. Stacy Nov 04, 2016
    Hi guys, I have PCOS and I'm on my fourth month of clomid with no luck. I was wondering what will happen next if I don't conceive before the 6 months prescription ends? Also, are there any better positions to help sperm find the egg... thanks :)
    1. Christina (OC Team): Your doctor should discuss next steps with you after Clomid. Positions may or may not have an impact, but many suggest deep penetration for TTC as the sperm will have a slightly shorter journey. - (Nov 04, 2016)
  12. Comecko Nov 07, 2016
    I've been living in agony since 2012. I have been trying to lose weight with no luck and I suffer from cysts on my ovaries that rupture every month. It's to the point that I can't function because of how painful it is. What am I to do?
  13. Margaret Dec 14, 2016
    I have irregular periods, so it's hard to track my ovulation. I had my period starting on the 6th of December. From the 3rd day, I took 50mg of clomid for 5 days.Hoping I will conceive.
  14. Yemi Jan 05, 2017
    Hello everyone, I'm new here.
  15. Remy Jan 19, 2017
    Hi, we are trying to conceive for 2 months. I've been taking clomid and metformin (1000g). I've been starting to feel cramps from 5 dpo and pain on the left side of my stomach. I couldn't sleep on my left side. It's painful getting cramps on and off. AF is due in 3 days. Could I be pregnant? CM is creamy from 5 dpo up until now.

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