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Health & Wellness

PCOS and Fertility

We speak with Dr. Jane Frederick To Learn About The Dangers Of PCOS, and the challenges of Trying To Conceive with PCOS
by KK
5 Sep 2019

UPDATED: 3 Nov 2022

ORIGINALLY PUBLISHED: 5 Sep 2019

September is Polycystic Ovary Syndrome (PCOS) awareness month. (PCOS) is one of the most common hormonal disorders impacting people with ovaries, affecting approximately 1 in 10 people of childbearing age, yet it is being reported that it can take doctors an average of two years to diagnose. It is also one of the biggest causes of infertility affecting an estimated 5 million people people in the U.S, alone.

We spoke with Dr. Jane Frederick, an internationally noted fertility reproductive endocrinologist, about PCOS, the dangers of PCOS, and trying to conceive with PCOS. We were grateful to connect and learn more about this syndrome, and  put forward a few questions from our members. This article will focus mainly on the impact PCOS can have on fertility.

 What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome, known commonly as PCOS, refers to a hormone disorder affecting 3-10% of people with ovaries. Considered a leading cause of infertility, PCOS reduces the ability of the ovaries to mature and release eggs into the uterus. Other symptoms of PCOS include the creation of polycystic ovaries, characterised by multiple cysts and small follicles; chronic anovulation, or an inability to ovulate; and hormonal imbalance, including high levels of the hormone androgen.

Though PCOS affects a relatively high percentage of people, the cause is unknown and can be found in children as young as 11 years old. People with PCOS are more likely to have a child with the disease. Some signs can be recognised early on, such as irregularities in menstrual cycles; the presence of acne and hair growth in the face and chest; and obesity, particularly in the midsection as well as hormonal imbalance. Health problems often associated with the disorder include a high risk for miscarriage and long-term medical problems, such as diabetes, cardiovascular disease, and uterine cancer.

What are the symptoms of PCOS?

It’s important to note that if you have PCOS you might only experience a few of these symptoms if any at all. The important thing is that if you are experiencing any, it’s always best to get checked out at the GP.

Common symptoms of PCOS include:

  • Irregular periods or no periods at all
  • Difficulty getting pregnant (because of irregular ovulation or failure to ovulate)
  • Excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
  • Weight gain
  • Thinning hair and hair loss from the head
  • Oily skin or acne

Can PCOS Cause Infertility or Difficulty Conceiving?

Some people may not realise they have Polycystic Ovaries until they try to conceive. If you’ve been trying to conceive naturally for over a year, you should speak to your doctor about getting tested for PCOS. Some strategies, such as losing weight, healthy eating, and in certain cases, medications, can increase your chances for getting pregnant. Your doctor can help to recommend the best course of action for you. 

People with PCOS frequently suffer from chronic anovulation, a condition that can cause them to go through fewer than eight menstrual cycles each year; frequently, they skip their periods altogether. Furthermore, the hormonal imbalance associated with PCOS can result in symptoms ranging from an excess of oestrogen or androgen, to decreased levels of progesterone (another hormone important to the menstrual cycle) and resistance to insulin.

What Happens with PCOS During Pregnancy and What Are the Dangers?

People with PCOS who become pregnant may experience more health problems than the general population including:

  • High blood sugar levels, which can lead to diabetes
  • Pregnancy-induced high blood pressure
  • Miscarriage
  • Premature delivery
  • Pre-eclampsia (signs of which include high blood pressure, and protein traces in the urine)
  • Macrosomia (a newborn with an excessive birth weight)

Insulin resistance reduces the insulin sensitivity of your cell walls. Glucose has to pass through the cells walls to be converted to energy. Insulin assists in this process. When the cell walls have become desensitised to insulin by insulin resistance, this vital process can break down. Glucose cannot get into the cell, and remains in the bloodstream, causing elevated blood sugar levels. This process can lead to weight gain and obesity.

All of these serious problems are yet more evidence that it is extremely important to address PCOS and make the lifestyle changes necessary to manage it. This can help to prevent the health issues that can compromise long-term wellness for both parent and child during and after pregnancy

What Should PCOS Patients Do About the Condition During Pregnancy? After Pregnancy Are There Any Special Considerations for People with PCOS?

Metformin (Glucophage) is a drug often prescribed for people with PCOS who are trying to get pregnant, and who are in the early stages of pregnancy. Metformin improves the cell’s response to insulin and helps move glucose into the cell. As a result, the body will not be required to make as much insulin and helps to balance the hormones in PCOS. Weight loss through exercise and changes in diet and lifestyle can also be effective in treatment for PCOS. People should seek out a specialist who can provide nutritional and exercise guidelines to enhance their weight loss success. 

How Can PCOS Be Treated?

Infertility experts usually rule out other causes of anovulation and hyperandrogenism (an excess of certain hormones) before diagnosing PCOS and establishing a treatment approach for the disorder. 

Management of PCOS requires a treatment program focused on four individual areas: encouraging fertility (if this is important to the person with PCOS); restoring regular menstrual cycles while preventing disorders of the endometrium (uterine lining); treating the symptoms of acne and abnormal hair growth, and lowering insulin levels. 

Research shows that diet and exercise can go far in reducing the obesity associated with PCOS and, as a result, restore normal ovulation and menstruation cycles. Experts recommend diets in which carbohydrates largely come from fruits, vegetables, and whole grains. If not done through weight loss, balancing insulin levels often requires medication, such as the type 2 diabetes drug metformin. 

Infertility specialists typically treat hormonal symptoms, in particular, the excessive level of androgen, by prescribing low-dose oral contraceptives. This approach would reduce acne and hair growth. In cases of excessive or distressing hirsutism, an anti-androgen drug can be prescribed. 

To increase fertility, PCOS patients can undergo a number of conservative treatments, such as fertility drugs like Clomid to help ovulation and achieve a successful pregnancy. The important message aspiring parents should know is that PCOS is a very treatable disorder, and people can seek out infertility specialists for help for diagnosis and treatment.

If you are struggling with PCOS or any associated symptoms, speak to your medical practitioner for advice.