Polycystic Ovary Syndrome (PCOS) affects 6% to 12% of women of reproductive age in the U.S. Experts believe that this number may be much higher due to the highly variable nature of the syndrome as well as the different symptoms (or the lack thereof). Whatever the case, one of the most pertinent problems of women suffering from PCOS is the difficulty in achieving pregnancy. However, with advances in our understanding of this disorder, there are many ways through which we can help PCOS women achieve pregnancy.
PCOS and Fertility: How Are They Related?
Typically, in polycystic ovarian syndrome, many fluid-filled structures called cysts are found along the outer border of the ovary, which carries immature egg follicles that couldn’t undergo ovulation. While the name of this disorder comes from these multiple cyst-like structures in the ovaries, it may not be a presentable sign in many women with this disorder.
PCOS is essentially a hormonal imbalance in women which also entails the risk of infertility due to the rise in levels of androgen (the male hormone, testosterone, that mainly develops and enhances primary and secondary sexual characteristics in men). The higher levels of androgen in blood repress in turn, ovarian hormones – progesterone and estrogen – which are needed by follicles to mature.
As the process of ovulation is interrupted due to the imbalance, there could be an onset of irregular menstrual cycles and eventual ovulatory infertility.
PCOS and fertility are correlated through a complex interplay of hormonal processes. Follicle-stimulating hormone (FSH), released by the pituitary gland during the menstrual cycle chooses which follicle in the ovary will develop and ovulate, finally releasing an egg, which can be potentially fertilized). However, the underproduction of estrogen and follicle-stimulating hormone (FSH), as well as an excess of male hormones disrupts this finely-balanced process of follicular development.
PCOS patients may hence, experience inconsistent egg maturation and ovulation, making it very challenging for them to conceive.
Long-Term Health Complications of PCOS
If left untreated or unmanaged, PCOS may lead to debilitating complications in the female body. While it can lead to infertility, as discussed above, gestational diabetes, high blood pressure during pregnancy, higher risk of miscarriage or preterm birth, non-alcoholic steatohepatitis (a severe liver inflammation caused by fat build-up in the liver), etc. are some of the long term health issues that it may cause.
Besides, it may also lead to the development of metabolic syndrome, leading to a variety of related physiological maladies that include an increased risk of heart and blood vessel (cardiovascular) diseases. This includes high blood pressure, type 2 diabetes, and abnormal cholesterol or triglyceride levels. It can also lead to depression, anxiety, and eating disorders.
How is PCOS Diagnosed?
PCOS is a difficult disorder in that it shows different symptoms in different women. In some females, it may set in with the first menstrual cycle, in others, it may start in the 20s or even 30s. Because it has a wide range of symptoms many women remain undiagnosed for a long time.
In clinical diagnosis, if a woman shows two or more of the below-mentioned signs and symptoms, then they can be diagnosed with PCOS.
1. Irregular Menstrual Cycles
PCOS is characterized by irregular or absent periods. Intervals that exceed 35 days (normal is 28-30) can cause the individual quite a lot of difficulty in conceiving, because she might not be ovulating at all or because cycle durations of varying lengths do not have a clearly demarcated fertile period.
2. Excessive Androgen Levels
Excess levels of the male hormone can cause the appearance of male characteristics like hirsutism (excessive body hair growth, especially on the chest regions and on the face), male pattern baldness, and severe acne.
3. Polycystic Ovaries
In ultrasonography, polycystic ovaries are visible. These appear bigger than normal ovaries. Fluid-filled structures are observed on the outer borders of the ovaries that are called cysts.
How RHWC Approaches PCOS Fertility Treatment to Improve Your Chances of Achieving Pregnancy
At Reproductive Health and Wellness Center, we take a 360-degree approach to designing treatment options and helping women with PCOS achieve pregnancy. We focus on a holistic way to manage the physiological issues that keep women from achieving healthy ovulatory function. Our PCOS fertility treatment takes into account lifestyle changes, medication, and specialized procedures.
The first steps that an individual must take are on a personal level – by making small, but significant, tweaks in lifestyle habits. These include getting on a healthy diet, taking prescribed medication, and being physically active through an exercise regimen.
We also advise that our patients keep track of their ovulation and menstrual cycles through a calendar or an app. This will help us target the specific days for fertility treatment and also understand the severity of menstrual imbalances.
The next thing to do is to aim for a healthy weight. Research has found that in women with PCOS who are also struggling with weight gain issues, even a modest (5%-10%) weight loss can significantly boost their fertility. By following a balanced diet and a regular exercise regimen, we aim to achieve a reduction in BMI.
The next important thing is to maintain healthy blood sugar levels. A PCOS-affected individual is more prone to being pre-diabetic. Keeping daily stressors at bay is keybecause a person who is actively stressing over something, may release an abnormal amount of the stress hormone cortisol which, owing to its nature, reduces the uptake of insulin by cells, and increases the amount of glucose in the blood. This insulin resistance can have a cyclical effect on the body.
Getting sufficient sleep (7 to 8 hours at night), is also vital to keep the circadian rhythm and biochemical cycles functioning perfectly. The body also gets sufficient time to recoup and repair the wear and tear from daily activities and maintain homeostasis.
Apart from lifestyle changes, we also prescribe certain fertility medications. However, it is not advisable to take these medicines without consulting with your physician or fertility expert. These are prescribed on a case-by-case basis.
Prescription drugs that can help PCOS women increase their chances of conceiving are –
- Metformin or Glucophage – to maintain insulin balance
- Clomid (clomiphene citrate) – to help regulate estrogen levels
- Birth control pills – to maintain healthy levels of female hormones (before beginning fertility treatment)
- Female hormones like FSH and LH – to stimulate ovulation
Some specialized procedures help in inducing ovulation and achieving pregnancy through expert intervention. These are usually mildly invasive techniques with a good success rate.
Induction of Ovulation
The first line of medical therapy for achieving pregnancy in PCOS women is ovulation induction (OI) using medications. Apart from medication to induce ovulation, there is also a surgical procedure called ovarian drilling. Even though ovarian drilling is not always essential, studies have shown that up to 50% of patients are capable of conceiving within the first year following the procedure.
IUI or Artificial Insemination
Artificial insemination, also known as intrauterine insemination, is the second line of medical therapy. This procedure entails injecting a prepared sperm sample from either the spouse or a donor into the female’s uterus at or shortly before ovulation. IUI must be done in conjunction with ovulation induction (OI) if the individual has irregular menstrual cycles; otherwise, it can be done during a typical menstrual cycle.
In-vitro fertilization (IVF)
An advanced assisted reproductive technology, it is a slightly more intrusive technique that may be required if the individual with PCOS struggles to conceive despite the first two medical treatments.
There are five essential phases in an IVF therapy cycle:
- With the use of reproductive medications, the ovaries are stimulated to create many eggs
- The eggs are extracted by an ultrasound-guided surgical procedure under mild sedation
- The embryo is formed in the lab by combining the sperm and egg, from the respective donors.
- The embryo is then transferred into the woman’s uterus so that it can get implanted there and continue to develop into a fetus
- An ultrasound is performed again, at around six to seven weeks into the pregnancy, to confirm that the pregnancy is indeed clinically verified.
Coping with infertility is a huge challenge. Even more challenging is coping with infertility brought on by a condition like PCOS that can harm the female body in more ways than one. However, a proper diagnosis and the formulation of a well-rounded approach to tackle the disorder are key to reducing the effects and risks associated with the disorder and eventually increasing fertility.
At Reproductive Health and Wellness Center, we start by understanding the unique biology of our patients and then customizing the treatment regimen to increase the chances of success.
To experience our world class services in a boutique setting, contact our fertility specialist today.