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10 questions about PCOS and fertility

Polycystic ovary syndrome (PCOS) is the most common endocrine condition in women, affecting approximately 1 in every 10 reproductive-aged woman and as many as five million women in the US. Although the exact cause of PCOS is not well known, we know it often leads to a hormonal imbalance in your body. Women with PCOS can have:

  • elevated levels of androgens (like testosterone), which can have many effects throughout your body such as irregular menstrual cycles and increased hair growth and acne
  • insulin resistance, which relates to how your body processes glucose (sugar), our body’s main source of energy

It is important to know that PCOS is a syndrome, meaning that women can have many different symptoms and not every woman will present the same. Some women may only have a few symptoms while others may have several. Common symptoms of PCOS include:

  • irregular or no menstrual periods
  • increased hair growth
  • increased acne
  • oily skin
  • balding
  • weight gain and/or difficulty losing weight
  • abnormal metabolism of sugar known as insulin resistance
  • high blood pressure
  • elevated cholesterol levels

Because PCOS is a syndrome, women can have different signs and symptoms, and thus there is not one specific test that can be used to diagnose PCOS. Your doctor must use a compilation of tests in order to determine if you meet the criteria for PCOS and also to exclude other endocrine conditions. Testing for PCOS includes a blood draw to check for androgen levels, glucose or insulin levels, and other hormones (thyroid, prolactin, adrenal hormones). Women should also have an ultrasound to look at the ovaries to see if they meet PCOS criteria, specifically looking to count the number of small fluid-filled sacs known as follicles.

PCOS affects fertility by disrupting ovulation. Women with PCOS often have increased levels of androgens, such as testosterone, which can cause irregular or no menstrual cycles. If you are having irregular menstrual cycles or no menstrual cycles it means that you are not ovulating regularly or may not be ovulating at all. Ovulation is necessary to get pregnant. Even a small amount of weight loss can help to restore normal periods and ovulation. Ovulation can also be induced through medication.

Yes, it is important to know that PCOS can affect your general life-long health in addition to your fertility. Women with PCOS are at increased risk for several other health conditions such as obesity, insulin resistance, diabetes, high blood pressure, high cholesterol, heart disease, and uterine cancer. It is very important that you discuss how you can decrease your risks with your doctor as well as get routine screening. Screening tests help to diagnose things at an early stage when they are easiest to treat!

Diet, exercise and lifestyle modification can make a huge impact on decreasing symptoms, losing weight and restoring ovulation. Goal BMI is less than 30. If your BMI is greater than 30, the good news is that by losing as little as 5-10% of your body weight you can restore regular ovulation and significantly improve pregnancy rates. Physical activity for at least 30 minutes three times a week is a great way to start!

PCOS can affect how your body processes glucose (sugar), which is our body’s main energy source. This affects your insulin levels, can lead to insulin resistance and increases risk for developing diabetes. One of the best ways to counteract these changes is with diet:

  • eat a low-carb diet and try to mostly eat “good” carbs is key (whole grains and fruit)
  • choose things like berries that also contain antioxidants instead of sweet treats
  • imit consumption of sugary drinks
  • increase the number of veggies and protein, especially lean meats (fish, chicken)
  • eat more unsaturated vegetable oils, such as walnuts and avocado

Try and make one change at a time then build on that, instead of trying to change everything at once. Also, moderation is key – even with a “healthier diet” do not feel as if you can’t ever “treat yourself” with your favorite indulgence! 

If you are trying to get pregnant and you are not ovulating regularly each month, it is best to seek the help of a fertility doctor. By making lifestyle changes and using medication if needed, regular ovulation can usually be induced, allowing for conception to occur.

Ovulation is often stimulated through oral medications such as Letrozole or Clomid. Each of these medications are taken for 5 days at the beginning of your cycle. Intrauterine inseminations (IUI) are often done in conjunction with these medications to further improve pregnancy rates. If these medications don’t work, your fertility doctor will discuss other options that are available to try and help you conceive!

For any woman that uses a medication (Letrozole or Clomid) to help induce ovulation,it is possible that more than one egg may develop and drop into the fallopian tubes during ovulation. The risk of multiples with this type of cycle is approximately 10%. Due to this possibility, it is often best to work with a fertility specialist when taking ovulation medication to have close monitoring (with ultrasound and labs) to monitor your response to the medication. This will help to ensure additional eggs are detected so that a patient is made aware of the chance of multiples and/or discuss canceling the cycle if needed and trying again.

Medical contribution by Channing Burks Chatmon, M.D.

Dr. Channing Burks Chatmon is a reproductive endocrinologist and board-certified obstetrician and gynecologist who is passionate about supporting and guiding patients with personalized and evidence-based treatment options to fulfill their dream of having a family.

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