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.

Join the Discussion!

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  1. 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.
    Reply
  2. Nikki Jan 30, 2017
    Nice side note some women with PCOS can be clomid resistant. I never ovulated on clomid. It took 5 years to get pregnant with my son after being on femara (an alternative to clomid for women with PCOS).
    I'm trying for my second baby and unsing premama fertility. It has myo-inositol and has been shown to increase ovulation with pcos
    Reply
  3. Anicka Feb 04, 2017
    I was diagnosed with PCOS 8 years ago. I have a beautiful 8-year-old girl. I'm tying for another one. I've taken clomid and had sex every day of my fertile window and on the day of ovulation, which was Jan 24-30. I've read that you get implantation bleeding. I haven't noticed that, but the cervical mucus was like egg whites 2 days before ovulation. How soon should I test for pregnancy?
    1. Christina (OC Team): You can test at 14dpo. Look for the plus sign on your calendar and you'll find the suggested date to test. Good luck! - (Feb 05, 2017)
    2. ANicka: Where do I go to see the calendar? - (Feb 06, 2017)
    3. Christina (OC Team): From your home or "Me" screen, click on the "Cycle Overview" circle to see your calendar. - (Feb 06, 2017)
    Reply
  4. ANicka Feb 06, 2017
    Thank you
    Reply
  5. Nicola Feb 16, 2017
    Hi there, my periods are bang on every month and always last 5 days. I have been with my partner for 12 years and I have never been on birth control. I never even had as much as a pregnancy scare. I had a scan done and yes there were cysts. They said there was no point in removing them because they were the type that would keep coming back, so i got my tubes checked and everything was fine. My partner also handed in a sperm sample and that came back as really good. I would love a wee baby. It's eating away at me. Help please and thanks x
    Reply

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