Some women have health conditions that make it more difficult to become pregnant.
One of these health problems is polycystic ovary syndrome (PCOS), which is one of the most common causes of infertility. Fortunately, infertility issues caused by PCOS are highly treatable, and many women with PCOS go on to have successful pregnancies.
What is PCOS?
PCOS is a common hormonal disorder in reproductive-aged women characterized by excess androgen, irregular periods, and polycystic ovaries.
The term “polycystic” describes the many small fluid-filled sacs, or cysts, that may develop on the ovaries. While these cysts are often seen with PCOS patients, it should be noted that some women with PCOS do not have cysts, while others without PCOS may develop cysts.
How common is PCOS?
PCOS affects up to 1 in every 10 women of reproductive age and is considered to be the most common endocrine disorder in women. In the United States, PCOS is estimated to affect 6% to 12% (roughly 5 million) of women of childbearing age.
PCOS symptoms
Women with PCOS can experience a range of tell-tale symptoms. Due to the production of excess androgen, or elevated levels of “male” hormones in the body, women with PCOS may develop severe acne, oily skin, thinning hair, or male-pattern baldness.
Excess hair may grow on the face, chest, back, or buttocks (hirsutism). Small pieces of skin, called skin tags, can also develop on the neck or armpits.
Some may notice darkened areas or thickened skin on the back of the neck, armpits, or under the breasts. Others may gain weight, especially around the belly area.
PCOS-related health risks
In some women with PCOS, the ovaries fail to release eggs regularly, leading to abnormal menstrual cycles including missed periods or very light periods.
Irregular ovulation and menstruation could lead to infertility and difficulty getting pregnant down the line.
With age, PCOS can be associated with other health problems such as type 2 diabetes or high cholesterol.
Causes of PCOS
The exact cause of PCOS is unknown. However, many experts believe that abnormal hormone levels, insulin resistance, and genetics play a role in PCOS.
- Hormone imbalance – Women with PCOS may have raised levels of testosterone which is typically considered a male hormone, luteinizing hormone (LH) which stimulates ovulation, and prolactin that stimulates breast glands to produce milk during pregnancy.
- Insulin resistance – When the body is resistant to the action of insulin, it tries to overcome this by making more insulin. Insulin levels then build up, resulting in higher androgen levels which prevents normal ovulation.
- Genetics – PCOS often runs in families. It’s not uncommon for someone with PCOS to find that a sister, mother, or daughter also has PCOS.
Making a PCOS diagnosis
To diagnose PCOS, your healthcare provider may first ask about your medical history and symptoms to rule out other possible causes.
A physical exam may be performed to measure blood pressure, body mass index, waist size, and to check for signs of any excess facial or body hair, acne, or skin abnormalities. Your healthcare provider may also arrange for a pelvic exam to check for enlarged ovaries.
A pelvic ultrasound which uses sound waves to create an image of your internal organs, tissues, and blood vessels may be ordered to check the size of your ovaries and whether they have any cysts. The ultrasound can also be used to examine the lining of your uterus.
Your doctor may choose to run blood tests to check your androgen hormone levels, and if they are elevated, determine whether it’s due to PCOS or another hormone-related health condition. Additional blood tests may be ordered to screen for diabetes or high cholesterol.
After taking a medical history, understanding your symptoms, and factoring in your test results, a PCOS diagnosis may be made if you meet at least 2 of the 3 following criteria:
- Androgen excess – including excessive acne, androgenic alopecia (hair loss), hirsutism, or increased testosterone.
- Ovulatory dysfunction – either oligomenorrhea (menstrual cycles ranging from greater than 35 days apart to less than 6 months apart) or amenorrhea (no menstruation for 6 to 12 months).
- Polycystic ovary – defined as at least one ovary with 12 or more follicles measuring 2 to 9 mm in diameter and/or a volume greater than 10 mL.
Treatment options for PCOS
Treatment for PCOS centers around managing the patient’s symptoms and will differ depending on whether the patient wishes to get pregnant.
- How can I get pregnant with PCOS?
Women with PCOS who wish to improve their chances of conceiving successfully are highly advised to adopt a healthier lifestyle by eating a healthy diet and increasing physical activity.
Weight loss is especially recommended for patients who are overweight. Reducing your weight by even 10% can lead to more regular menstrual cycles and help improve pregnancy chances.
Taking these steps will also help to reduce insulin resistance and significantly improve ovulation.
According to the Endocrine Society, medication such as clomiphene (Clomid) or letrozole (Femara) are recommended for infertility by inducing ovulation, with the latter showing relatively better live-birth and ovulation rates in patients with PCOS.
Metformin which is mostly used to treat type 2 diabetes can also be used with PCOS patients to induce ovulation along with other uses such as lowering insulin and blood sugar levels, decreasing cholesterol levels, and reducing heart disease risk.
However, in terms of achieving live births, research shows that clomiphene is superior to metformin among infertile PCOS women although there is a risk of multiple pregnancy with clomiphene.
In vitro fertilization (IVF), which involves fertilizing your egg with your partner’s sperm outside the body then placing it back in your uterus, is an effective way to get pregnant for women with PCOS.
This method can achieve higher pregnancy rates than medicine alone and has less risk of multiple pregnancy (e.g., twins or triplets), though the procedure can be expensive.
- How can I treat PCOS if I don’t wish to become pregnant?
For women with PCOS who don’t plan to get pregnant, treatment may involve the same lifestyle modifications described above along with hormonal contraception in the form of birth control pills, dermal patches, or vaginal rings which help to maintain regular menstrual cycles and treat acne or hirsutism due to excess androgen.
While there is some evidence that the diabetes drug metformin can improve regular menses in 50-70% of PCOS patients, oral contraceptives are shown to be more effective in regulating menstrual cycles and lowering androgen levels.
PCOS, fertility, and ovulation tests
It’s not uncommon for women who have PCOS and irregular ovulation to worry about their ability to become pregnant.
Many may be tempted to use all the help they can get, including using ovulation tests to help with pregnancy planning.
However, some women with PCOS may find that they’re unable to get accurate results from these ovulation tests.
This is because many ovulation tests work by identifying when there is an LH surge, which is supposed to indicate the beginning of ovulation and when you’re in the fertile window, but women with PCOS likely already have higher baseline levels of LH.
Without this change in LH levels as an indicator of ovulation, regular ovulation tests for women with PCOS are not the most reliable tool for pregnancy planning.
However, that’s not to say that you should abandon ovulation tests altogether if you have PCOS, but rather, that you should work with your healthcare provider to understand your results.
A healthcare provider who knows your individual medical history and symptoms will be more likely to correctly interpret the readings from your ovulation test.
Eveline.Care is a newly introduced service that connects patients with fertility professionals for a more holistic and customized fertility treatment experience. How it works is that patients who use the Eveline Digital Ovulation Predictor Kit can join Eveline.Care for access to fertility consultants who are part of the Eveline.Care Network.
Fertility professionals authorized by the patient can then evaluate fertility data shared by their patients in real time (e.g., LH levels, basal body temperature, diet, medication, symptoms, etc.).
In the case of PCOS, the Eveline.Care service can facilitate a swift diagnosis and allow patients to not only better manage their condition via virtual checkups but also improve their chances of pregnancy.
Regardless of whether you choose to adopt technology to assist you with fertility monitoring and pregnancy planning, it’s always best practice to keep your doctor informed of your health status.
Whatever route you choose, we wish you the best on your pregnancy journey!
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This article is for informational purposes only and is not meant to offer medical advice.
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Photo by Ryan Franco on Unsplash
