Does Polycystic Ovary Syndrome (PCOS) Cause Infertility?
If you’re wondering whether Polycystic Ovary Syndrome (PCOS) is the reason you are struggling to conceive, the answer could be yes. PCOS is one of the most common, but treatable, causes of infertility in women.
Reproductive Medicine Associates of Northern California (RMANorCal) physicians Dr. Scott Morin and Dr. Jonathan Kort share important information on the condition below.
What is PCOS?
PCOS is a hormonal disorder that affects up to 20 percent of reproductive age women. Because the condition affects the body’s hormonal processes, it has an effect on ovulation and fertility. Many women with PCOS have trouble conceiving naturally, but with the right treatment, chances of pregnancy are good.
In a normal menstrual cycle, the hypothalamus and pituitary release chemicals to stimulate the growth and maturation of one follicle (and the egg inside it) within the ovary. This follicle will make it to ovulation and the egg inside it will be released. Each month there are multiple other eggs within follicles that are not released, but instead are degraded and reabsorbed by the body in a process known as atresia. In women with PCOS, there are many more follicles than usual in the monthly race for ovulation, but they do not ovulate, so no egg is released, meaning it cannot meet the sperm to fertilize.
WHAT ARE THE SYMPTOMS OF PCOS?
The most common symptoms of PCOS are:
· Irregular periods or a loss of menstruation entirely
· Acne and abnormal hair growth (commonly on the face, chest, or abdomen) are commonly seen due to elevated androgen levels
· Obesity, difficulty losing or maintaining weight, and type 2 diabetes are also common
· Infertility can be a presenting symptom in couples trying to conceive
· Anxiety, depression and eating disorders are also seen in patients with PCOS
HOW IS PCOS DIAGNOSED?
Because irregular cycles are a common symptom of PCOS, a doctor taking a detailed history will ask about that woman’s menstrual cycle history and whether she has any other symptoms like acne, hair growth or difficulty losing weight.
On physical exam, the woman’s vital signs, including height, weight and a calculation of Body Mass Index (BMI) are important. A thorough examination looking for signs of elevated testosterone or insulin resistance, and to help rule out other conditions that may mimic PCOS, is also important.
A transvaginal ultrasound will help doctors see whether the patient has ovarian features of PCOS.
Then, the doctor will take blood tests to examine her levels of FSH, LH, estrogen, testosterone, AMH and to screen for insulin resistance.
HOW IS PCOS TREATED IN WOMEN WHO WANT TO CONCEIVE?
The first line of treatment for women with PCOS is lifestyle modification. Modest weight loss and increase in lean muscle mass can have huge impacts on the abnormal hormone regulation seen in women with PCOS. For many women trying to conceive, medications are needed. The goal of treatment is to correct ovulation.
A woman may be prescribed Clomid, an ovulation inducing medication that indirectly promotes the production of FSH and the growth and release of a mature egg. Another medication commonly used to induce ovulation in women with PCOS is Letrozole.
After ovulation is induced with Clomid or Letrozole, the doctor may recommend timed intercourse or intrauterine insemination (IUI). Injectable FSH with IUI can also be used in women with PCOS, but because multiple eggs are released at once, there is a higher risk of multiples so this course of treatment must be performed carefully and with close supervision.
In Vitro Fertilization (IVF) is another excellent treatment for women with PCOS and has superior success rates and a far lower chance of multiples. For women not trying to conceive, the first line of treatment is lifestyle adaptation such as weight loss, healthy eating and exercise. Birth control pills and insulin-sensitizing medication (Metformin) can also be given to improve irregular periods.
IS THERE A CURE?
There is no cure for PCOS, but with the treatments outlined above, and ongoing research into the condition, there is reason to be hopeful about the chances of conceiving. That said, once women are done childbearing, they should not ignore their PCOS, as it does predispose them to increased risk of diabetes and other metabolic conditions.
If you are struggling to get pregnant or want to learn more about PCOS, call our office at (415) 603-6999. Our patient liaisons would be happy to answer any questions you might have and can help you book a consultation with Dr. Kort or Dr. Morin in either our San Francisco or Palo Alto office..