Understanding PCOS and Infertility

Polycystic ovary syndrome (PCOS), sometimes known as polycystic ovarian disease (PCOD), is one of the most common hormonal disorders among women in their childbearing years, according to RESOLVE, the National Infertility Association. It’s responsible for as many as one third of infertility diagnoses.Many women with PCOS wonder if they will ever be able to get pregnant and carry a baby to term. The good news is most women with PCOS will eventually be able to have a baby, if they receive treatment.

What is PCOS?

Women with PCOS have at least two of these three features: irregular periods; excess androgens, which are male sex hormones; and polycystic ovaries on ultrasound. Irregular periods happen because a woman isn’t ovulating regularly. The extra androgens can cause acne on the face, back or chest and excess facial and body hair, in the places where a man would have it. The polycystic ovaries which give the syndrome its name are actually follicles on the ovaries which don’t develop and ripen because of the hormonal imbalances. They give the ovaries a lumpy, cystic appearance on an ultrasound.PCOS is thought to be caused by a number of different factors, including genetics and obesity. Obesity is a chicken-and-egg question in PCOS. It’s not known if obesity causes PCOS or PCOS causes obesity, but 50 to 60 percent of women with the condition are obese. Women with PCOS are also predisposed to develop insulin resistance and type II diabetes. Tests for PCOS are performed as part of a fertility workup by a reproductive endocrinologist. Blood tests will be performed to assess your levels of FSH (follicle stimulating hormone) and LH (luteinizing hormone) to see if they are out of balance and preventing you from ovulating and androgens, such as testosterone, will be measured. Your doctor will also order an ultrasound to see if your ovaries are enlarged and lumpy, signs of PCOS and may test you for insulin resistance if PCOS is suspected.

Infertility Treatment for PCOS

PCOS can’t be cured, but the symptoms can be controlled and, in many cases, fertility can be restored. Lifestyle changes can be effective treatment for PCOS. Losing as little as 5 to 10 percent of your weight may be enough to restore ovulation and your menstrual cycle. Losing weight also will make fertility medications work better if they are needed and will help you have a healthier pregnancy. Weight loss has also been shown to reduce some of the other symptoms of PCOS such as excess facial and body hair (hirsutism) and acne. Losing the pounds takes time and patience, but it can pay off in improved fertility and overall health.Your fertility specialist will develop a treatment plan to help you ovulate. Fertility medications like Clomid or Serophene (clomiphene citrate) or Femara (letrozole) are often used to stimulate ovulation by blocking production of estrogen and allowing increased production of FSH which results in stimulation of development of the ovarian follicles and ultimately in ovulation.. These medications increase your chances of a multiple pregnancy and may require monitoring with ultrasounds. Your doctor may prescribe metformin as well to decrease insulin resistance and reduce androgens in your body. If clomiphene or letrozole does not work after several cycles, or you do not ovulate in response to the medication, the reproductive endocrinologist may recommend IVF. In IVF treatment, your ovaries are stimulated with injections of fertility drugs to produce multiple eggs, which are then fertilized in the lab. One or two of the healthiest embryos are then transferred to your uterus to implant and grow. The good news with PCOS or PCOD is that in the majority of cases the question is which infertility treatment will work, not whether one will work. Especially if you are under 35, your chances of success are good. In all cases it’s important to see a fertility specialist and get the treatment that’s right for you.