The Impact of PCOS on Fertility

woman pregnant

Most women know that hormones can cause a roller coaster of symptoms each month, from bloating to cramps to mood swings. While hormone levels do change as a result of your period or pregnancy, more serious abnormalities can be a sign of underlying health issues.

One of the most common hormone-related conditions is PCOS, and it can directly impact a woman’s fertility. That’s because women with PCOS rarely ovulate on their own.

PCOS, or polycystic ovary syndrome (PCOS) affects about 15% of otherwise healthy, reproductive-aged women. The good news is, treatment is available that can increase your chances of getting pregnant.

Explaining PCOS

PCOS was first identified in 1935, but since then, we’ve learned a lot. For starters, there are a few different types of PCOS. Each type has different symptoms, and different treatment recommendations.

The most common symptoms of PCOS are irregular menstrual cycles. This could include prolonged or infrequent periods. Some women also may get acne and excess hair growth, usually because of elevated levels of androgen (male) hormones. High levels of insulin and enlarged ovaries are often found in women with PCOS.

In addition to assessing your symptoms and history, diagnosis may include labs to check your hormone levels, and an ultrasound to look for cysts on your ovaries.

Who Can Get PCOS?

The exact cause of PCOS is unknown, but the latest research shows that it may be genetic. If someone in your family was diagnosed with PCOS, there is a 40% chance you may develop it. Doctors used to believe that only obese women were at risk for PCOS, but today, we know that women at any weight can have it.

Women with PCOS are often insulin resistant, which means their bodies can’t use insulin effectively, which increases their risk for type 2 diabetes. In addition, PCOS can present similarly to type 2 diabetes, so that will need to be ruled out. Other conditions that often present like PCOS include hypothyroidism, hyperprolactinemia, some ovarian or adrenal gland tumors, congenital adrenal hyperplasia and early menopause. Many times, a diagnosis of PCOS comes about because all other possibilities were excluded.

Women with PCOS are at increased risk for pregnancy complications like gestational diabetes and preeclampsia, as well as conditions metabolic syndrome, sleep apnea, liver disease, depression, lipid abnormalities and endometrial cancer.

PCOS and Infertility

PCOS affects ovulation, which can make it more difficult to get pregnant. For women interested in enhancing their fertility, treatment for PCOS involves ovulation induction using medications like Clomiphene or Letrozole. These drugs can help with ovarian follicle growth, which then leads to regular ovulation. Both medications have risks and side effects but have been shown to be very effective. Ask your doctor which one is right for you.

For women who are obese, lifestyle changes — specifically weight loss — can help to level out hormonal abnormalities. In fact, research shows shown losing as little as 10% of their body weight can help women ovulate normally.

Beyond Fertility and PCOS

For women who are not concerned about getting pregnant, the main treatment goal is to regulate the menstrual cycle. This can help decrease their risk for endometrial hyperplasia and cancer. Hormonal contraception in the form of birth control pills, patches or a vaginal ring can help regulate a woman’s cycle quickly and effectively.

In addition, taking hormonal contraception continuously (without the usual 7-day break) can help reduce woman’s androgen levels even further. For women who can’t take estrogen-based contraceptives, progestin-only birth control can be used instead.

For women who have issues with excess hair growth and acne, anti-androgen medication can be combined with hormonal birth control. An alternative way to help regulate a woman’s periods might be medications like Metformin, which lower insulin levels.

If you’re having trouble getting pregnant and think the cause might be PCOS or another hormonal imbalance, click here to complete our patient packet. We will follow up soon to set up a consultation appointment.

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