What is Polycystic Ovary Syndrome (PCOS)?
Polycystic Ovary Syndrome or PCOS is one of the most common hormonal endocrine disorders in women. Approximately 5-10% of young women have it, and yet we don’t really know why. In general, PCOS means that women with it grow bigger ovaries with many small cysts. These cysts are generally not dangerous but often lead to severe hormone imbalances which can cause infertility.
Many women unknowingly struggle with PCOS for years, and only when they have difficulty conceiving and seek fertility assistance do they learn it is the reason for many of their symptoms. It’s estimated that more than fifty-percent of PCOS cases remain undiagnosed.
There is some degree of heredity with PCOS. Some studies have found that if a mother has PCOS, there is a 50% chance that her daughter will have it as well.
PCOS and Fertility Problems:
During a normal cycle, a woman develops many follicles which contain eggs. Around day 14 of her cycle when one of the eggs is appropriately developed, a woman ovulates, or releases the egg.
Women with PCOS often develop many small, antral follicles with eggs in them, however, the eggs fail to mature properly so they are never ovulated. Most women with PCOS do not ovulate or don’t ovulate regularly. This is known as anovulation, and it makes it difficult to get pregnant without fertility treatment.
PCOS is one of the leading causes of infertility among women, and is estimated to be responsible for around 70% of infertility issues in women who have difficulty ovulating. It affects nearly 10 percent of women before they hit menopause. Post-menopausal women can also suffer from PCOS.
Symptoms of PCOS:
PCOS cannot be diagnosed with one test alone, and symptoms often vary from woman to woman. Additional warning signs include:
- PMS or pelvic pain
- Irregular periods
- Heavy or absent periods
- Weight gain
- Increased hair growth on face, back or chest
- Sleep apnea
- Thinning hair/baldness
- Elevated cholesterol
- High blood pressure
- Type II Diabetes
Many women with PCOS are overweight and have difficulty with weight control, although you can be lean and still have PCOS.
Women with PCOS frequently have higher levels of insulin in their blood than normal. Researchers believe that the overproduction of this hormone causes women’s bodies to respond by producing excessive amounts of the male hormone androgen. In a healthy body, the ovaries make a tiny amount of androgen, but with PCOS, they start producing too much. This can cause you to stop ovulating, have irregular periods, grow excessive facial and body hair, acne, and can negatively impact egg quality. PCOS also makes it difficult to sustain a healthy body weight. That is why proper diet is critical to those who suffer from PCOS.
While there is no known cure for PCOS, it is possible to manage its symptoms medically and through lifestyle modifications and medications focused on managing individual concerns of yours
Conceiving with PCOS:
The good news is that your chances of getting pregnant with PCOS using fertility treatments that combine various levels of medications and fertility treatments. Since many women with PCOS do not ovulate regularly, they generally require ovulation induction in order to get pregnant.
Common medications used to help one conceive with PCOS include:
- Letrozole (Femara): Originally developed as a breast cancer medication, letrozole is the most often the best choice to stimulate ovulation for those with PCOS. It works by increasing the amount of FSH the pituitary gland secretes.
- Clomiphene (Clomid): An anti-estrogen medication that is often used for timed intercourse and IUI cycles though it is rarely used at CNY Fertility as a female fertility medication. If you’re OBGYN or fertility specialist is prescribing Clomid, you may want to ask about Letrozole.
- Metformin (Glucophage, Fortamet, others): An oral medication for type two diabetes helps improve insulin resistance and lower insulin levels. Though it may not seem related to infertility, metformin has been shown to help tremendously for those with PCOS.
- Gonadotropins: Injectable medications usually encountered after multiple failed IUIs. Can be used with both IUI and IVF cycles.
Common fertility treatments for those with PCOS:
- ovulation induction: ovulation induction is usually the first medical intervention someone that is trying to get pregnant with PCOS encounters. Ovulation induction involves taking medications (like letrozole and sometimes a trigger shot) to help stimulate ovulation. Couples are then instructed to engage in timed intercourse.
- Intrauterine Insemination (IUI): Also known as artificial insemination, IUIs typically use similar medications to ovulation induction (but can also use gonadotropins) and have the advantage of inserting the sperm inside the uterus making the journey the sperm must travel much shorter.
- In Vitro Fertilization (IVF): IVF is the gold standard of fertility medicine offering the highest success rates per treatment cycle when using one’s own eggs. The eggs are removed from the woman’s ovaries, fertilized, grown in a lab, and 3-5 days later transferred back into the woman’s uterus or frozen for a subsequent Frozen Embryo Transfer. There are many different medication protocols that go along with IVF.
- Donor Egg/Sperm: Most people with PCOS do not turn to Donor Eggs or Donor Sperm until they have either failed multiple IVF cycles, are of advanced maternal age or have a semen analysis showing azoospermia.
While CNY Fertility Specialises in assisting reproduction, women with PCOS also have many other symptoms that are often managed by their OBGYN or other medical professionals.
To help regulate the menstrual cycle:
- Birth control: birth control pills/patches/vaginal rings that contain both estrogen and progestin help decrease androgen and regulate estrogen production. Regulating hormones can help lower the risk of endometrial cancer, correct abnormal bleeding, and control hair growth and acne.
- Progestin: Progestin therapy can help regulate periods and protect against endometrial cancer. It does not improve androgen levels and will not prevent pregnancy.
To help regulate and reduce excessive hair growth:
- Birth control: as mentioned, birth control medications decrease androgen production which can cause excessive hair growth.
- Spironolactone (Aldactone): blocks the effects of androgens on the skin. Known to cause birth defects, so one must also be using effective contraceptives and thus is not recommended if pregnant or trying to conceive.
- Eflornithine (Vaniqa): a cream used to slow facial hair growth.
- Electrolysis: a tiny needle inserted into hair follicles to deliver an electronic pulse that damages the follicle.