Polycystic ovarian syndrome or PCOS is an endocrine and reproductive disorder where there is an imbalance in reproductive hormones. Symptoms of this disorder, including abnormal hair growth, acne, irregular periods, and ovarian cysts, may appear anytime during the reproductive age and change over time.
According to the United States’ Office on Women’s Health (OWH), this health problem affects 5-10% of women aged 15-44 years or those of childbearing age. They describe PCOS as the common cause of infertility among women or the inability to carry a child. About 70-80% of women with PCOS are reported to experience infertility.
Although PCOS may occur at any age from puberty onwards, most women only find out or get diagnosed with PCOS in their 20s or 30s when they have issues getting pregnant. For other information on PCOS, read PCOS: Reducing Quality of Life in Every 10 Women.
How does PCOS affect fertility?
The hormonal imbalance occurs when the level of the female sex hormone called estrogen is too low in the body. This may also happen if the level of testosterone, a male sex hormone also produced by women in low amounts, is high. As part of a healthy menstrual cycle, matured eggs are supposed to develop and be released from the ovaries every month. However, with PCOS, the hormonal imbalance prevents the development and release of the mature egg.
Without a mature egg, the release of the egg (also called ovulation) and pregnancy cannot occur. Also, PCOS causes irregular or missed menstrual periods, which commonly lead to infertility and the development of cysts (fluid-filled sacs) in the ovaries.
In addition to egg maturation and ovulation problems, the imbalance in hormones causes difficulty in the implantation of the mature egg as the lining of the uterus does not develop also. As a result, getting pregnant also becomes difficult.
Miscarriage – Women with PCOS have three times more probability of having a miscarriage during the early months of pregnancy.
Gestational diabetes – This is a type of diabetes that only occurs in pregnant women. In most cases, it does not cause significant problems to the mother or the fetus when treated. Although treatable, women and their babies may be at higher risk of developing type 2 diabetes later in their life.
Pregnancy-induced high blood pressure – After the 20th week of pregnancy, women experience a sudden increase in blood pressure (also called preeclampsia). This may normally be treated, or else it may affect the mother’s organs and the delivery of the baby.
Preterm birth – This occurs when an infant is born before 37 weeks of pregnancy, and this may lead to many health problems.
In addition, infants born to mothers with PCOS are more likely to spend time in the neonatal ICU (intensive care unit) or die after birth.
How to address infertility if a woman has PCOS
Although PCOS often results in infertility, it is treatable and can help a woman conceive and have a healthy pregnancy. Since symptoms vary across individuals, treatment options will depend largely on whether the person wants to get pregnant or not. Other factors to consider are the patient’s age, if there are other causes of infertility, if the patient had previous treatments and the couple’s anxiety level.
Normally, birth control pills that contain artificial estrogen and progestin hormones are prescribed to relieve the symptoms and regulate the menstrual cycle, but when a person wants to get pregnant, other drugs are prescribed to induce ovulation and manage metabolic problems. These include:
Clomiphene – Primarily recommended by the American College of Obstetricians and Gynecologists, this anti-androgen drug taken at the beginning of the cycle indirectly induces egg maturation and ovulation. However, women treated with this drug most likely conceive twins or triplets.
Metformin – Although commonly used in treating diabetes, this insulin-sensitizing drug can also regulate ovulation in women with PCOS. It can be taken alone or in combination with clomiphene.
Letrozole – This drug works by slowing down estrogen production and allowing the body to produce more FSH (follicle-stimulating hormones). In some studies, letrozole was found to be more effective than clomiphene in terms of increasing ovulation and live-birth rates. However, studies of this drug on animals caused birth defects.
Gonadotropins – This hormone drug given in shots also induces ovulation. Compared to clomiphene, gonadotropins have a higher risk of multiple pregnancies. They also require frequent ultrasound and laboratory tests to know how the body responds.
Other therapeutic modalities that serve as second- or third-line treatments are ovarian drilling and in vitro fertilization. During ovarian drilling, the surgeon makes a small abdominal cut and inserts a laparoscope. A needle with electric current is then used to puncture a small portion of the ovary to lower androgen levels in the body and trigger ovulation. In vitro fertilization, on the other hand, allows fertilization of the egg outside the body by placing sperm and egg in a dish. The fertilized egg is then planted in the uterus of the woman.
Before beginning any of the treatment, your doctor should be able to rule out whether it is PCOS alone that causes your infertility or there are other causes.
Diet and exercise
Just as a healthy diet is important to anyone, doing one can help women dealing with PCOS. Specifically, a low-calorie, low-carb diet that provides all other essential nutrients can significantly improve one’s insulin sensitivity and fertility.
Experts also suggest that a minimum of 30 minutes of moderate exercise thrice a week is helpful. For those with high BMI, exercise is highly encouraged to help them lose excess weight. According to OWH, a 10% weight loss already helps overweight individuals restore their normal ovulation.
According to research, acupuncture is a safe and effective treatment for PCOS. It increases blood flow in the ovaries, reduces ovarian cysts, maintains normal blood sugar levels, and assists in weight loss.
Herbs and supplements
Although the evidence is insufficient, some studies found herbs and supplements like inositol and omega-3 fish oil to aid in PCOS problems. If a PCOS patient is considering this alternative treatment, she should speak with her doctor first since herbs and supplements might interfere with medications.
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