Nearly ten million women worldwide suffer from Polycystic Ovarian Syndrome (PCOS), making it one of the leading causes of infertility.
With numbers like those, it should be an easily understood diagnosis, but it’s not.
Reproductive Medicine Associates of Philadelphia’s Dr. William Schlaff provides some insight on PCOS and gives hope to those who have it and want to conceive.
What is Polycystic Ovarian Syndrome (PCOS)?
PCOS is a complex hormonal disorder characterized by irregular menstrual cycles or the failure to ovulate entirely, increased level of androgens (male hormones), and the presence of many immature follicles in the ovary (often times referred to as cysts, but are not cysts) that do not grow to the point of ovulation.
While women with PCOS often times have trouble conceiving naturally, many are successful with a little bit of help from a reproductive endocrinologist.
Women diagnosed with PCOS typically have infrequent and/or irregular menstrual cycles because they are not actually ovulating. But what causes the hormonal disruption and why do the follicles fail to grow normally?
During a normal menstrual cycle, the pituitary gland, hypothalamus and ovary work together to stimulate the growth of tiny fluid-filled sacs on the ovaries called follicles. Each follicle holds one tiny, immature egg.
Once a month, one follicle matures enough to be able to release an egg, while the remaining immature follicles degrade in a process called atresia. This cycle repeats monthly slowly diminishing the amount of eggs each ovary holds until the woman reaches menopause.
In women with PCOS, this process is altered: the follicles begin to grow, but none ever mature or release an egg, leading to the persistent existence of many small follicles.
As a result, no egg ever matures, ovulation does not occur, and there is little to no chance of natural pregnancy because the sperm does not have anything to fertilize each month.
While the exact cause of PCOS is still debated in the scientific community, genetics and lifestyle can be underlying factors that contribute to the diagnosis.
What are the symptoms of PCOS?
There are three recognizable symptoms of PCOS:
- Irregular menstrual cycles
- Excessive facial hair growth and acne
How is PCOS diagnosed?
It’s important to note that not all women who have menstrual irregularity have PCOS. In order to be diagnosed properly, there are three specific qualifying criteria that a woman must meet:
- Multiple small, immature follicles on the ovaries as seen on an ultrasound
- Irregular menstrual cycles
- Elevated levels of androgens (male hormones) in blood or clinical evidence of increased androgens (mostly increased hair growth).
When beginning the diagnostic process, the physician will record the patient’s medical history, noting how often she menstruates and calculating her body mass index (BMI) to determine if she’s obese. The doctor will also perform a transvaginal ultrasound to check for multiple immature follicles on the ovaries.
A series of bloodwork will help the doctor make the final diagnosis, specifically looking at certain hormone levels. The hormones FSH (Follicle Stimulating Hormone), LH (Luteinizing Hormone) and AMH (Anti Mullerian Hormone) all play an important role in ovulation, and sometimes their levels help doctors understand the state of a woman’s fertility.
The most important of these hormones for a PCOS diagnosis is AMH, because it is a hormone secreted from a woman’s follicles as they mature. Because women with PCOS have many more follicles that are maturing (albeit improperly) than a woman without PCOS, their AMH count will be higher than normal, and alert doctors to the woman’s condition. For example, an AMH level below 3ng/m is seen as healthy during a normal cycle; an elevated AMH level of 4 ng/m or higher can be a marker of PCOS.
Once a doctor makes a PCOS diagnosis, treatment is available for patients trying to conceive.
How is PCOS-related infertility treated?
When a patient trying to conceive is diagnosed with PCOS, the first recommendation is lifestyle change, because one of the symptoms of PCOS is obesity. Consuming a well-rounded diet and bringing body weight down to a healthy level can often times assist in regulating the abnormal hormones and, correcting erratic ovulation.
For some women, doctors will prescribe oral medications like Letrozol or Clomid to induce ovulation, and recommend timed intercourse or Intrauterine Insemination (IUI) to increase the chances of conceiving. For women who don’t find success this way, In Vitro Fertilization (IVF) can be successful. IVF has high success rates for women who suffer from PCOS.
Is there a cure for PCOS?
For those women who have developed PCOS on the basis of excess weight, the diagnosis can be reversed. Maintaining a healthy weight and overall healthy lifestyle is the most productive way to offset the symptoms of PCOS. In the cases where genetics play a role, there is no cure, but treating the symptoms can result in pregnancy.
For women past their childbearing years, it is still important to seek treatment for PCOS, since the lack of ovulation can result in a buildup of uterine lining, leading to periodic heavy menstruation and, in rare cases, uterine cancer.