• Getting Pregnant
• Infertility

PCOS and Infertility: 9 Answers You Need

Polycystic ovary syndrome (PCOS) may be an unfamiliar term, but it results in an all-too-familiar problem: female infertility.

According to the U.S. Department of Health and Human Services (HHS), PCOS is the most common cause of female infertility, affecting 5 to 10 percent of girls and women of childbearing age. If you or someone you love is concerned about PCOS, here’s what you need to know about this common diagnosis.

1. What is It?

PCOS is a set of symptoms related to hormonal imbalance. With PCOS, the hormones that control a woman’s ability to ovulate (produce an egg) are out of balance. These hormones include estrogen, progesterone and in particular, androgen.

2. Why Does It Affect Ovulation?

Eggs are housed in a woman’s ovaries, and each egg is enclosed in a capsule called a follicle. Typically, each month, one follicle grows to produce a mature egg during a woman’s reproductive years. The follicle releases the egg, and then dissolves.

With PCOS, the follicle does not release the egg, and the follicle stays enlarged. This becomes a fluid-filled cyst, and over time, many of these small cysts fill the ovaries.

3. What Causes PCOS?

“No one really knows what causes PCOS,” says Kamlesh Sanghvi, MD, obstetrician/gynecologist with Northwest Ob/Gyn Inc. “We do know that there are associated major risk factors, like obesity, a tendency towards diabetes and a family history of PCOS.”

4. How Do I Know if I Have PCOS?

Many women don't know that they have PCOS until they have trouble getting pregnant. But in general, women who have it usually have at least two of these symptoms, according to the National Institutes of Health (NIH):

• Irregular menstrual periods, very heavy periods, or no periods at all
• High levels of androgens, often typified by excess body or facial hair
• Cysts (fluid-filled sacs) on one or both ovaries

Other symptoms, while not limited to PCOS, could include:

• Infertility
• Weight gain or obesity
• Pelvic pain
• Oily skin and acne
• Irregular bleeding
• Patches of thickened, dark, velvety skin (acanthosis nigricans)

Also, women who have a mother or sister with PCOS may be at higher risk.

5. Are There Any Health Risks Associated with PCOS?

Besides infertility, women with PCOS are also at higher risk for:

• Endometrial hyperplasia and endometrial cancer (the risk of endometrial cancer is three times higher in women with PCOS.)
• Obstructive sleep apnea, a disorder that leads to pauses in breathing during sleep
• Insulin resistance
• Type 2 diabetes
• Obesity
• Heart disease and high blood pressure (cardiovascular disease)
• Mood disorders

6. How is PCOS Diagnosed?

First, your doctor will want to rule out other conditions that have similar symptoms. These include:

• Excess hormone production by the adrenal glands (adrenal hyperplasia)
• Thyroid gland problems
• Excess production of the hormone prolactin by the pituitary gland (hyperprolactinemia)

Then, to confirm PCOS, your doctor will:

• Ask about your family medical history. “This is the most important part (of the doctor visit), because PCOS sometimes runs in families,” explains Dr. Sanghvi.
• Conduct a thorough physical
• Take blood samples to check the levels of androgens, cholesterol and sugar in your blood
• Do a pelvic exam or ultrasound to check your ovaries and the lining of your uterus (if your periods are irregular, the lining of your uterus may be thicker, which is a risk factor for endometrial cancer)

“Depending on your age, we might also do a biopsy of your uterine lining to make sure it is not pre-cancerous,” adds Dr. Sanghvi.

7. How is PCOS Treated?

Treatment depends on several factors, including your symptoms, your other health problems, and whether you want to get pregnant.

Options include:

• Lifestyle Changes
  Often, the first action that doctors recommend for women with PCOS is to make lifestyle changes, like losing weight through a healthier diet and more physical activity. These changes can minimize many PCOS symptoms and related conditions.
• Hormone Therapy and Medication for Ovulation
  Clomid (clomiphene) is the most common PCOS treatment; it helps with ovulation and follicle development.
  PCOS patients may also be given follicle-stimulating hormones (FSH), progesterone, or treatment to specifically affect estrogen production.
  “We use hormones to help rebuild the endometrial cycle,” says Dr. Sanghvi. “If you don’t ovulate, then the mechanism isn’t there to boost, and then break down, the endometrial lining.” If the lining builds up but doesn’t break down, Dr. Sanghvi explains, your risk for endometrial cancer increases.
• Insulin-Sensitizing Agents
  These medications make the body more responsive to insulin and keep glucose levels more stable. In women with PCOS, they may also help:
  
  • Clear up acne and reduce hair growth
  • Improve weight loss
  • Lower cholesterol levels
  • Make periods more regular
  • Slightly reduce infertility
  While not approved by the U.S. Food and Drug Administration (FDA) specifically for treating PCOS, your doctor may use insulin-sensitizing medications to help you. Talk with your doctor about any concerns you may have about these medications.
• Antiandrogens
  These medications can lower androgen levels, or even prevent the body from producing the hormone. In women with PCOS, this helps to reduce excess hair growth and clear up acne.
  Just as with insulin-sensitizing medications, antiandrogens are not approved by the FDA for the treatment of PCOS but your doctor may recommend them for you. Talk with your doctor about any concerns you may have about these medications.

8. Can I Still Get Pregnant if I Have PCOS?

Many women with PCOS can and do get pregnant. Pregnant women who have PCOS, however, are at higher risk for certain problems, such as miscarriage. If you’re planning to conceive, it’s vital that you let your doctor know so you can plan accordingly, especially since some treatments may be harmful to an unborn infant.

“No one really knows what causes PCOS,” says Kamlesh Sanghvi, MD.

9. Is There a Cure?

There is currently no cure for PCOS, and it does not go away on its own. Even after menopause, women with PCOS often continue to have high levels of androgens as well as insulin resistance. This means that the health risks associated with PCOS are lifelong. According to Dr. Sanghvi, the long-term consequences of these risks (diabetes, weight problems and cancer) are reason enough to seek medical help as soon as you suspect something is wrong.

Source: National Institutes of Health; Office on Women’s Health (U.S. Department of Health and Human Services); American Society for Reproductive Medicine; Kamlesh Sanghvi, MD, Northwest Ob/Gyn, Inc.