What is PCOS?

PCOS is a complex hormonal disorder that affects women of reproductive age. The World Health Organization (WHO) estimates that up to 4% of the entire female population is touched by it (that’s over 110 million women) but the numbers might be much higher. The reason for this is the multitude of symptoms this condition presents itself with and a lack of consensus regarding diagnosis criteria, that make it highly underdiagnosed. 

The condition is characterized mainly by cycles of irregular periods and the presence of high levels of androgens, which are sometimes called male hormones. One of the main features of PCOS is the presence of several small follicles in the ovaries (antral follicles), hence the name “polycystic ovaries.” 

The cause of PCOS isn’t fully understood, but genetics and excess insulin seem to be major factors. PCOS can have profound effects on a woman’s endocrine, reproductive, and metabolic systems, leading to various symptoms such as: 

  • Irregular or absent periods, anovulatory cycles 
  • Excessive hair growth on the face and body 
  • Acne 
  • Weight gain (being overweight increases the risk of getting PCOS) 
  • Thinning hair and hair loss 
  • Darkening of the skin, particularly along neck creases, in the groin, and underneath breasts 
  • Skin tags in these areas 
  • Infertility 
  • High AMH levels 
  • High LH levels, with abnormal LH:FSH ratio. 
  • Multiple follicles in the ovaries, sometimes with an ultrasound aspect of “string of pearls” 

How is PCOS Diagnosed?

The diagnostic process involves a comprehensive review of a patient’s medical history, a physical examination, and various tests including blood tests to measure hormone levels, glucose tolerance test to check how your body responds to sugar, and pelvic exam or transvaginal ultrasound to look for cysts on your ovaries. 

The diagnosis of PCOS is made when at least two out of the following three criteria are met: 

  1. Irregular periods and lack of ovulation 
  1. Excess of male hormones (Testosterone, DHEA) 
  1. Polycystic ovaries visible on ultrasound 

Early diagnosis and intervention are crucial due to the implications on a woman’s long-term health beyond fertility. Yet, data shows us that diagnosis is often delayed, with women sometimes seeing more than 3 doctors before being diagnosed with PCOS. 

Can I Get Pregnant with PCOS?

The ability to conceive naturally with PCOS varies from person to person, with many women experiencing difficulty getting pregnant. Irregular ovulation or outright absence of periods can make conceiving more challenging, and if one ovulates, the quality of the eggs might be compromised. 

Cycle tracking is essential when trying to conceive, and the fact that many PCOS patients have high LH levels throughout their cycle makes the classical ovulation tests unreliable. Some women rely on cervical mucus monitoring, others on basal body temperature. When conception fails to occur, it’s best to make an appointment with a fertility specialist and discuss treatment options. 

However, it’s important to note that not all women with PCOS are infertile. Some women may still ovulate occasionally or irregularly, making it possible to conceive naturally, especially with the intervention of ovulation-inducing medications and changes in lifestyle and diet to manage insulin resistance and weight. 

For those who struggle more significantly with infertility, specially tailored treatment plans and fertility procedures, such as in-vitro fertilization (IVF), can be pursued with high success rates. 

Is there a Treatment for PCOS?

The primary goal of treatment is to manage symptoms and improve overall and long-term health. Common treatment approaches include: 

Lifestyle Modification 

Eating a healthy diet and maintaining a regular exercise routine can help control weight, which is often a significant factor for women with PCOS. Studies show that by losing 10% of their body weight, pregnancy and live birth rates improved considerably in overweight patients.  Combining a healthy lifestyle with a tailored exercise plan can also help to regulate periods and improve chances of conception. 

Medical Management 

  • Birth Control Pills: Can help regulate menstrual cycles and reduce abnormal hair growth. 
  • Diabetes Medications: Such as metformin may be prescribed to lower insulin, which in turn can help regulate periods, lower androgen levels, and improve the chances of ovulation. 
  • Fertility Medications: Women who are trying to get pregnant may benefit from the use of medications to stimulate ovulation. When ovulation stimulation and intercourse fail to succeed, it’s maybe time to consider assisted reproduction techniques like IVF. 

Other Interventions

Nowadays, invasive interventions such as ovarian drilling, are not longer recommended.  

Women with PCOS should work closely with their healthcare providers to create a comprehensive and personalized treatment plan. 

Understanding how PCOS affects natural conception is the first step in proactive fertility management. By staying informed and following up with their health providers, women with PCOS can take effective steps toward achieving their dream of parenthood.  

Remember, each case of PCOS is unique, and with the right combination of lifestyle changes and treatment, many women with PCOS can conceive and have a healthy child. 

At ART Fertility Clinics, we strive to make your dream of parenthood come true. 

Book an appointment with one of our specialists today and let us be part of your family’s journey.