PCOS (Polycystic Ovary Syndrome) – How It Affects Your Ability to Get Pregnant
PCOS (Polycystic Ovary Syndrome) – How It Affects Your Ability to Get Pregnant
Affecting up to 1 in 10 reproductive-aged women, polycystic ovary syndrome (PCOS) is not an uncommon ovulation disorder.
In fact, 80% of patients who come to Medfem Fertility Clinic with fertility problems have underlying PCOS.
What is PCOS?
Polycystic ovarian syndrome or PCOS is a condition where eggs mature in the ovaries but are not released into the fallopian tubes – instead they remain in the ovaries and develop into cysts. This makes it impossible to successfully achieve a pregnancy. Those suffering from PCOS may experience irregular or absent periods, their ability to conceive is severely limited.
Unfortunately, irregular or absent ovulation is not the only symptom.
* Irregular menstrual cycles
* Amenorrhoea (lack of menstruation)
* Weight gain
* Excessive hair growth
* Oily skin and acne
Other symptoms of PCOS include multiple ovarian cysts, with ovaries appearing polycystic on ultrasound, and elevated male hormones (androgens) which results in excess facial and body hair growth, with a male sexual hair distribution for example on the upper lip, breasts or below the navel. PCOS may also result in hair loss.
In addition, PCOS can result in acne, oily skin and skin discoloration, as well as obesity, diabetes, hypertension, and/or elevated cholesterol.
What causes PCOS?
PCOS occurs when there is an abnormality with the secretion of the hormones FSH and LH.
FSH or Follicle Stimulating Hormone is responsible for stimulating a follicle to grow to maturity. A follicle is the fluid space in the ovary where the egg grows. Although several follicles grow each month, in a natural cycle only one becomes mature enough to ovulate its egg.
LH or Luteinizing Hormone causes a mature follicle to burst and to release the oocyte, which is called ovulation.
Both FSH and LH are secreted by the pituitary gland in the brain, and play an important role in the release of an oocyte from the ovary each month.
An abnormality in the secretion of FSH or LH results in an underdeveloped follicle developing, subsequently not bursting and therefore not releasing the oocyte.
Over time many underdeveloped follicles are formed in the ovaries, resulting in abnormal hormonal levels, specifically the ratio of LH to FSH and ‘male hormones’ being produced in the ovaries.
The causes of PCOS are directly related to excessive stress, poor dietary habits and inadequate nutrient intake.
How do I know if I have PCOS?
There are many other syndromes with similar signs and symptoms as PCOS but require different treatments.
For this reason, correctly diagnosing PCOS is essential. And correctly diagnosing PCOS is only possible through a comprehensive medical work-up to rule out other possible disease entities.
How is PCOS diagnosed?
A number of specialised blood tests as well as ultrasound technology are used to correctly diagnose PCOS.
At the commencement of a cycle – day 2 or day 3 – blood tests are conducted to test FSH, LH and male hormones, androgen, DHEAS and testosterone and reveal any abnormal hormonal levels.
In addition, blood tests are done to test insulin levels – including a fasting insulin test and a further insulin level test two hours after eating.
Furthermore, an ultrasound scan will reveal if the ovaries have a multicystic appearance.
Can I conceive if I have PCOS?
For a couple without infertility problems, the chances of conception are about 25% each month in women under 35 years of age. So even when ovulation happens, conception is not guaranteed.
When a woman is has no ovulation, she can’t get pregnant because there is no egg to be fertilised. If a woman has irregular ovulation, she has fewer chances to conceive, since she ovulates less frequently. Plus, it seems that late ovulation doesn’t produce the best quality eggs, making fertilisation less likely.
The most common reason for lack of ovulation or inadequate development of the egg is PCOS.
Also bear in mind that irregular ovulation indicates hormonal irregularities. This can lead to other fertility challenges, such as the lack of fertile cervical mucus, thinning or over-thickening of the endometrium (where the fertilised egg needs to implant), abnormally low levels of progesterone, and a shorter luteal phase.
Nevertheless, it is not impossible to conceive with PCOS. There are a range of treatments available.
The fertility specialists at Medfem Fertility Clinic have extensive experience in successfully treating women suffering from PCOS. Detailed below are some of the cutting-edge treatments used at their world-class fertility clinic.
PCOS treatments for pregnancy success
Once PCOS is diagnosed, a unique treatment protocol is designed for each patient based on her signs and symptoms.
The medical problems that are associated with PCOS include excessive levels of insulin (hyperinsulinemia, metabolic syndrome), an under-active thyroid (hypothyroisism), raised prolactin (hyper-prolactinemia) and low growth hormone levels. Each of these medical problems is treatable, with lifestyle management, medication and even surgery, if required.
In many women, losing as little as 10% of body weight and maintaining the weight loss can restore normal menstrual patterns. Abnormal insulin levels can be treated conservatively by correcting the diet, increasing physical activity and other lifestyle modifications, such as managing stress and taking Staminogro and Comegovite nutrients daily. These changes have general health benefits, and may result in a spontaneous return to normal ovulation.
In addition, it will enhance the response to medical treatment, improve your chances of conceiving and optimise pregnancy progress and success.
Abnormal insulin levels can also be treated with medication metformin (glucophage).
Patients experiencing infertility often undergo ovulation induction. Ovulation induction may be achieved with various orally ingested medications or, if needed, injectable hormones, with excellent results.
Fertility drugs such as “Clomiphene citrate” or “Letrazole” (Femara) tablets is often the first treatment option.
This medication should be prescribed by a fertility specialist able to provide ultrasonic monitoring of the ovarian response to the medication. Those with PCOS are very sensitive to these drugs and higher order multiple pregnancies are very common. In addition, ongoing monthly use has an negative effect on the ovaries, creating a ‘contraceptive effect’.
Birth control pills
Birth control pills are used to restore regular periods and to reduce the risks of developing abnormal uterine lining, as well as to reduce cosmetic effects of increased androgens, including acne and increased body hair.
Hormone injections containing FSH are very powerful and should only be administered by a specialist in fertility.
Ovulation induction may be performed using orally ingested medications or injectable medications, and is normally combined with intrauterine insemination (IUI). You can read more about IUI here.
Ovulation induction is a treatment protocol designed to increase the number of eggs that a woman ovulates in a cycle. It is most often used in women with PCOS. Ovulation induction aims to stimulate just a couple of eggs in women who are not ovulating normally.
But, because women with PCOS often react very sensitively to fertility drugs, there is a real risk of multiple follicle production and multiple pregnancies. Regular monitoring with ultrasound and hormone measurements is therefore necessary to ensure only one or two follicles are developing.
Ovarian surgery involves a laparoscopy during which a few of the small follicles are drained with a small needle to help stimulate ovulation. This is a highly specialised procedure and only performed if medical treatment fails as the ovaries can be damaged if it is not done correctly.
PCOS treatments if you’re not trying to conceive
In patients not seeking to conceive, various treatments are available which may alleviate symptoms and simultaneously reduce the risk of developing future systemic illnesses, like diabetes and heart disease.
Where to get PCOS treatment for pregnancy success
The fertility specialists at Medfem Fertility Clinic have extensive experience in treating women suffering from PCOS.
We have undertaken extensive research on PCOS throughout the years and are dedicated to providing excellence in cutting-edge care to women with the disorder.
Your next step in treating PCOS is as simple as contacting us to book an initial consultation by clicking here or contacting us telephonically on +27 (11) 463 2244.
We look forward to meeting you!