PCOS And The Role It Plays In Women’s Infertility

Polycystic ovary syndrome, commonly known as PCOS, is a hormonal disorder most commonly found in women of reproductive age. PCOS is characterised by hormonal imbalances and metabolism problems that not only affects the appearance of the woman but also impacts her overall health.

What causes PCOS?

Although the exact cause of PCOS is unknown, genetics matter: a woman is more likely to suffer from it if her mother or sisters also have it.  Other factors that may play a role include obesity, high androgen levels, and high insulin levels.

Signs and symptoms of PCOS

PCOS may show its symptoms at the time of the first menstrual cycle or may appear later in life. Having two or more of the following symptoms point to a diagnosis of PCOS:

• Irregular periods: Most commonly the first complaint is infrequent, irregular, heavy or prolonged menstrual cycles. A woman suffering from PCOS could be having fewer than 9 periods in a year – that is, more than 35 days between periods.
• Excess androgen: Androgen is a male hormone that’s found in elevated levels in those suffering from PCOS, resulting in symptoms such as acne, excessive facial and body hair, thinning of hair, and hair loss or male-pattern baldness.
• Polycystic ovaries: During a normal menstrual cycle, ovaries make and release the egg for reproduction. But in PCOS, ovaries enlarge and contain follicles that surround the eggs, preventing ovaries from functioning as they should. As a result the egg may not develop normally or is not released during ovulation.

PCOS and infertility

Most alarmingly, PCOS can affect fertility – the ability of a woman to have a child. This is due to the development of numerous fluid-filled sacs in the ovaries and failure of ovaries to regularly release eggs for reproduction.1, 3 Hormonal imbalances may also interfere with ovulation, making it difficult to get pregnant.2 Any abnormality in the menstrual cycle may also result in infertility.

Diagnosis of PCOS

In most cases, the patient’s symptoms or complaints gives the physician an indication of PCOS. So the physician looks at the thorough history of the patient and does a physical examination to check for signs of excess hair growth, insulin resistance, and acne. A pelvic examination is then done to visually and manually inspect the reproductive organs for any abnormality, including mass, growth etc. Then following diagnostic tests may then be performed:

• Blood tests: To measure hormone levels, glucose tolerance and fasting, cholesterol and triglyceride levels.
• An ultrasound: USG of the reproductive organs is done to check the appearance of the ovaries and the thickness of the lining of uterus. Sometimes a transvaginal ultrasound is done for a better view of the organs.

Treatment of PCOS

There is no cure for PCOS, but its symptoms can be managed by medication and by following a healthy diet and lifestyle routine. But for a woman who is trying to conceive, the following options may prove helpful in increasing chances of pregnancy:

• Losing weight: Healthy eating, restricting calorie intake, and regular physical activity may help in losing extra weight and regularising one’s menstrual cycle to improve fertility.
• Medicines: Doctors may prescribe medicines such as clomiphene (Clomid) that supports ovulation. Sometimes metformin is also given. Although metformin is used to treat type 2 diabetes, it may help some women with PCOS by lowering both insulin and androgen levels and by improving the ability of insulin to lower blood sugar. After continued intake for a few months, metformin may help restart ovulation and improve chances of pregnancy.
• In vitro fertilisation (IVF): In cases where medications do not work, IVF may be an option. It is a procedure by which fertilisation of egg and sperm takes place in a laboratory. The fertilised egg is then placed in the uterus of the woman to develop normally.
• Surgery: Finally, if all the above options fail to result in pregnancy, ovarian drilling is done. It is a surgical procedure in which a few holes are made in the surface of ovary either using laser or a fine needle heated with electricity. This restores ovulation in most of the cases, but only for six to eight months.

Can PCOS affect pregnancy or cause complications?

PCOS can affect pregnancy and cause complications such as the following:

• Miscarriage
• Gestational diabetes
• Preeclampsia
• Caesarean section (C-section)
• Heavy weight baby
• Baby spending more time in Intensive Care Unit

Although PCOS is the most common cause of infertility in females, it is also the most treatable cause of infertility. So, rather than feel disheartened, women with PCOS should consult a specialist for proper treatment.