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  • Does PCOS affect Fertility?

    Thursday, September 24, 2020

    Polycystic Ovarian Syndrome (PCOS) is a condition marked by irregular or absent ovulation that presents as irregular menstrual cycles. It may be accompanied by symptoms associated with elevated levels of male hormones, such as testosterone, which can cause hair growth on the face and body (also known as hirsutism) and acne.

    PCOS affects 5–10 percent of women aged 15–44 years. They describe PCOS as a common and treatable cause of infertility.

    PCOS can affect a woman’s fertility in different ways:

    Ovulation problems are usually the primary cause of infertility in women with PCOS.

    Ovulation may not occur due to an increase in testosterone production or because follicles on the ovaries do not mature.

    Even if ovulation occurs, an imbalance in hormones may prevent the lining of the uterus from developing properly to allow for implantation of the mature egg.

    Due to unbalanced hormones, ovulation and menstruation can be irregular. Unpredictable menstrual cycles can also make it difficult to get pregnant and increased levels of hormones such as testosterone can affect egg quality, inhibit ovulation, lead to insulin resistance, and increase the risk disorders such as gestational diabetes.

    For those women trying to conceive a pregnancy, the first step in treatment of PCOS is lifestyle modification, including a healthy diet and exercise. The diets shown to be most successful in PCOS patients include those with lower carbohydrates, a reduced glycemic load. Recommended exercise in PCOS patients is at least 30 minutes of moderate exercise three times per week, with daily exercise being the ultimate goal.

    Women who still have infrequent ovulation despite lifestyle modifications may require fertility medications to assist with the release of an egg from the ovary.  Typical initial therapy for patients with PCOS who do not ovulate and are trying to conceive includes administration of certain fertility medications.

    For some women with PCOS, fertility tablets do not result in ovulation or pregnancy, and they require fertility injections to release an egg. Fertility injections contain the same hormone the brain releases to signal the ovary to produce eggs. Rather than producing one egg in a month, most women on fertility injections will produce two or more eggs. This treatment requires closer monitoring with transvaginal ultrasounds and several blood draws to determine the woman’s estradiol level, which is a hormone produced in the ovary.

    In some instances, women with PCOS require in vitro fertilization (IVF) to achieve a healthy pregnancy, here daily fertility injections are used to stimulate the ovaries to produce multiple eggs, which are harvested in a minor procedure. The eggs are fertilized in the lab and then a resulting embryo (fertilized egg) is transferred into the woman’s uterus. Additional embryos can be frozen for future use.

    PCOS can be problematic, but with appropriate diagnosis, lifestyle changes, and treatments, can be successfully managed.