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Does Polycystic Ovary Syndrome (PCOS) Affect Your Fertility?
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age. Approximately 5-10% of young women are affected, often experiencing challenges with conception. Common symptoms include irregular menstrual cycles, excessive hair growth, acne, and ovaries with multiple small cysts.
PCOS and Its Impact on Fertility
PCOS hampers fertility because women with the condition often do not ovulate regularly. This irregular ovulation is due to an overproduction of estrogen by the ovaries. The lack of regular ovulation leads to irregular menstrual periods and elevated levels of hormones like testosterone, which can compromise egg quality, inhibit ovulation, cause insulin resistance, and increase the risk of gestational diabetes.
Pregnancy with PCOS
Although it's not impossible for women with PCOS to conceive naturally, many may need assistance from a fertility specialist.
Treatment Options for PCOS-related Infertility
For women attempting to conceive, the initial treatment for PCOS typically involves lifestyle changes, such as adopting a healthy diet and regular exercise. Diets that are low in carbohydrates and have a reduced glycemic load are often most effective. The recommended exercise regimen includes at least 30 minutes of moderate exercise three times a week, with the ultimate goal being daily exercise.
Women who continue to experience irregular ovulation despite lifestyle modifications may need fertility medications to stimulate egg release. The initial therapy usually involves selective estrogen receptor modulators. If these medications are ineffective, fertility injections (e.g., Follistim®, Gonal-F®, Bravelle®, and Menopur®) may be necessary. These injections contain hormones that signal the ovaries to produce eggs, often resulting in the production of multiple eggs per cycle. This treatment requires careful monitoring with transvaginal ultrasounds and blood tests to measure estradiol levels, and carries a higher risk of multiple births.
In some cases, in vitro fertilization (IVF) may be required. This process involves daily fertility injections to stimulate the ovaries, followed by the retrieval of multiple eggs in a minor procedure. These eggs are then fertilized in the lab, and an embryo is transferred into the woman's uterus. Any additional embryos can be frozen for future use.
Health Risks Associated with PCOS
Insulin resistance is a common issue in women with PCOS and can be identified through a blood test. If insulin resistance is present, treatment with metformin (Glucophage) may be recommended.
Hyperlipidemia, or high levels of cholesterol and/or triglycerides, is another potential concern and can be detected with a fasting blood test. This condition is crucial to monitor, as it can lead to cardiovascular disease later in life.
Women with PCOS are also at an increased risk for endometrial (uterine) cancer due to consistently high levels of circulating estrogens. Irregular menstrual cycles can cause overgrowth of the uterine lining, which may lead to malignancy.
Additionally, there are indications of an elevated risk of ovarian torsion, a condition where the ovary twists, in women with PCOS.
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