Polycystic ovarian syndrome (PCOS) affects approximately 10 million women around the world. PCOS is one of the most common causes of infertility amongst women who are unable to ovulate. If you and your partner have been affected by PCOS and are unable to get pregnant, do know that the both of you are not alone in this journey.
This article was written to help you understand how PCOS affects infertility, and what you and your partner can do to successfully conceive.
What is PCOS?
PCOS is a condition whereby the body does not make enough hormones that are needed for ovulation to happen. Under normal circumstances, a mature egg is released from the ovary during ovulation. The mature egg can then be fertilized by sperm in order for a woman to get pregnant.
However, when a woman is affected by PCOS, ovulation does not happen. Hence without an egg being released, it is not possible for a woman to get pregnant. Instead, numerous small cysts develop in the ovaries. These cysts are one of the reasons why this condition is known as polycystic ovarian syndrome.
Estrogen and progesterone are the important hormones that help regulate a woman's menstrual cycle and also the ovulation process. Androgens such as testosterone on the other hand, are commonly known as male sex hormones. They are naturally present in females but in very low amounts. However, in women with PCOS, the ovarian cysts mentioned above stimulates abnormal levels of androgen, hence disrupting the ovulation process.
Despite the term polycystic in its name, some women with PCOS do not actually develop cysts in their ovaries. What was consistently observed was that women with PCOS were found to have excess amounts of androgens in their bodies.
Signs and symptoms of PCOS
The signs and symptoms of PCOS differ from one woman to another. It is important that we do not self-diagnose ourselves with PCOS just because we are experiencing one of the symptoms below. However, they do provide us with clues when something is not right in our bodies. Some of the common symptoms of PCOS may include:
- Irregular periods, or no period at all
- Excessive hair growth, especially in the facial and body area
- Male-pattern baldness
- Dark patches of skin on their body
Causes of PCOS
Up til today, the exact cause of PCOS is not yet known. However, PCOS seems to run in the family. This means that if your mother or sisters have PCOS, there is a chance that you might get it too.
PCOS seems to be linked to insulin resistance too. The exact cause of insulin resistance in PCOS is also unknown. However, insulin resistance causes an accumulation of insulin in your body, which then contributes to the increase in the levels of androgens. This worsens the symptoms that are already present in PCOS women.
How is PCOS diagnosed?
If you have symptoms of PCOS, such as irregular periods, excessive hair growth, and obesity, it is best to consult your healthcare provider. Your doctor will find out more about your symptoms and medical history, in order to understand if you are affected by PCOS.
Blood tests can then be done to identify androgen levels in your body. If the readings are higher than a pre-specified level, your doctor may suspect that you have PCOS.
Ultrasound may also be done to determine the size of your ovaries and to see if there are multiple cysts in your ovaries.
Your doctor can then make a diagnosis of PCOS if any two of the following criteria are present:
- Irregular or skipped menses (oligo-ovulation or anovulation)
- High levels of androgens, as determined by blood tests (hyperandrogenism)
- Presence of many small cysts in the ovaries, as seen in ultrasound (polycystic ovaries)
How does PCOS affect infertility?
Women with PCOS experience infertility mainly because there is irregular ovulation. This makes it harder for fertilization between the sperm and egg to happen.
In some women with PCOS, there is no ovulation at all. This means that it is not possible to get pregnant without medical intervention, because fertilization cannot happen without a mature egg being released by the ovaries.
The ovaries may not able to produce and release mature eggs because of the low levels of female hormones that are required for these processes to occur.
PCOS infertility treatment
Some women with PCOS may find it difficult to get pregnant. The good news is that there are many treatment options available to help couples to overcome this problem:
Medications to induce ovulation
Women with PCOS affected by infertility could be given ovulation induction medications. These medications will regulate your menstrual cycle and induce your ovary to release viable eggs that could be fertilized. Ovulation induction medications may include:
- clomiphene citrate
- exogenous gonadotropins
Do discuss your treatment options with your fertility doctor to understand which type of medication is best suited for you.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is another fertility treatment option that your doctor may suggest to you. IUI involves injecting sperm directly into the uterus at the right time, which is around the time of ovulation. This helps to increase the chances of fertilization.
The IUI process begins with ovulation induction, in which specific medications are used to trigger ovulation (the release of egg from the ovaries). The insemination process (injecting sperm into the woman’s reproductive tract) is done during ovulation, in order for fertilization to occur.
In vitro Fertilization (IVF)
In vitro fertilization (IVF) is another fertility treatment option for women with PCOS. During the IVF process, a woman takes hormonal medication to stimulate the development of eggs in her ovaries. This is followed by a procedure to collect the eggs from the ovaries, once they have matured.
Viable egg cells are then fertilized with sperm in the laboratory. The fertilized egg, also known as an embryo can then be transferred back into the woman’s uterus. The embryo could either be a frozen or a fresh embryo. The transferred embryo would implant to the walls of a woman’s uterus, and continue developing into a baby. Once implanted, the development process of the baby occurs naturally, just like in a normal pregnancy.
Compared to IUI, IVF may be more costly. However, the chances of becoming pregnant is much higher with IVF as the quality of the eggs, and subsequently the embryos can be determine before they are transferred back into the womb for implantation.
The main lifestyle changes that are recommended for women with PCOS who are trying to get pregnant revolve around weight loss. Weight loss can improve the ovulation cycle and metabolism in women with PCOS.
Weight loss can be effectively achieved via the following methods:
Women with PCOS are encouraged to maintain a healthy and balanced diet. Balanced low-calorie diets or low-fat diets are recommended for weight loss.
Processed food should also be cut down, if possible, as they tend to contain high amounts of calories or sugar. Examples of processed food include fast food, processed meat, sugary drinks, and much more.
Again there is no one stop diet plan that will help a woman with PCOS to lose weight. When in doubt, always practice moderation, and learn to listen to your bodies' cues. This helps to ensure that you are still able to enjoy eating, while achieving your goal of maintaining a healthy weight.
Exercise can also help in reducing weight in women with PCOS. Exercise prevents muscle and bone mass reduction that may occur during weight loss. Some of the recommended exercises for weight loss include a combination of aerobic and resistance exercise.
Infertility caused by PCOS can be a really challenging journey for women and their partners who are trying to have a baby. However, no matter how difficult your experience has been, do take heart that there are many solutions out there.
If you and your partner have been actively trying over the past one year without contraceptives, but are still unable to get pregnant, perhaps it's time to seek professional help from fertility doctors. With the variety of treatment options available today, such as IUI and IVF, women with PCOS can still be optimistic about their chances of getting pregnant. The important thing is to seek help early, if needed.
We wish you all the best in your journey of building a family of your own.