PCOS is one of the most talked about infertility issues and, still, most people aren’t sure what it is and how it affects the body. Here, we go through the condition, what to know, and what to expect as far as your fertility.
PCOS (polycystic ovarian syndrome) is one of the most common endocrine disorders. It affects around 10% of reproductive-age females in the US, and its cause is still unknown. PCOS is characterized by a large number of cyst-like Follicles–each containing an egg–accumulated in the ovaries.
A normal ovary and a polycystic ovary.
This large volume of follicles is associated with a characteristic high Antral Follicle Count (AFC) and elevated Anti-Mullerian Hormone (AMH) level. Patients with PCOS also have hormonal imbalances including elevated testosterone levels. Both of these aspects of PCOS interfere with multiple body systems and can result in fertility issues, psychological issues, and other unwanted symptoms.
Unfortunately, there is no cure for PCOS, and treatment is based on your particular symptoms. Despite this wide array of symptoms, many people with PCOS still manage to conceive, but sometimes it requires the help of a reproductive endocrinologist.
People with PCOS can have physical and emotional symptoms. PCOS shows up differently from person to person, and each symptom and its severity can vary. Some of the most common physical characteristics associated with PCOS are:
excess hair growth (Hirsutism)
acne: especially if it doesn’t respond to treatment
irregular menstrual cycles: the hormone imbalances associated with PCOS can result in ovulation occurring rarely or not at all (Anovulation).
PCOS can also interfere with the body’s metabolic processes, leading to complications like Type 2 diabetes or gestational diabetes in pregnancy, high blood pressure, and heart disease.
Psychologically, PCOS is associated with anxiety and depression as well as issues around body image and appearance.
PCOS can be hard to diagnose because there isn’t one single test that confirms the diagnosis. Most of the time, PCOS is diagnosed when a patient seeks help from a doctor because they’re having trouble getting pregnant. The reproductive specialist can do a Transvaginal Ultrasound to look for the characteristic “polycystic ovaries.” Ovaries affected by PCOS have an appearance similar to a cluster of grapes (more technically, this cluster of grapes is a large number of tiny, immature antral follicles visibly clustered within each ovary). The doctor will also run lab tests like AMH, Estrogen, and Testosterone to assess hormone levels.
PCOS is secondarily diagnosed through patient-reported symptoms. It’s important to let the doctor know your normal menstrual cycle length, if you have trouble losing weight, have abnormal hair growth on your face or chest, or any pertinent medical history like diabetes, high blood pressure, or anxiety and depression.
With the incredibly intricate web of symptoms and its unknown cause, PCOS can be difficult to treat. Most often, the treatment for PCOS is to treat the symptoms individually and can be multi-layered. For instance, a doctor may prescribe one medication to control unwanted hair growth and another medication to help combat psychological symptoms.
One of the most common reasons to seek fertility treatment is irregular or absent menstrual cycles. Having irregular periods makes it virtually impossible to track when and if Ovulation is occurring during your menstrual cycle. This is a recurring problem for patients with PCOS because the syndrome is characterized by unpredictable cycles. Most often, irregular or absent menstrual cycles indicate that a person is not ovulating, which makes it difficult to get pregnant.
How do I know if I have irregular cycles?
Regular menstrual cycles happen consistently and predictably. Regular cycles, measured from the first day of one period to the first day of the next period, are 24-35 days long. Irregular menstrual cycles occur at varying lengths and are unpredictable.
Patients with PCOS struggle to conceive due to the lack of consistent, trackable ovulation, but not because of a lack of eggs available for fertilization. This gives PCOS patients a few different options for effective fertility treatment.
The good news for patients with PCOS is that, generally, even though they aren’t ovulating, they have plenty of eggs available in their ovaries. This means that patients with PCOS may have difficulty conceiving on their own, but are great candidates for low-intervention fertility treatment like Timed Intercourse (TIC) and Intrauterine Insemination.
People with PCOS are at higher risk for complications in pregnancy, like gestational hypertension, preeclampsia, and gestational diabetes.
In TIC and IUI, the patient takes an oral medication to stimulate one or more follicles to grow. In each of the follicles is an egg that is maturing as the follicle grows. When the egg reaches maturity, ovulation will either occur naturally or can be triggered using an injectable medication.
In timed intercourse, the patient times intercourse for the day of ovulation and the day after. In an IUI cycle, the patient goes into the fertility clinic for the insemination procedure.
What happens on the day of the IUI?
An IUI procedure starts with the male partner producing a sperm sample. The lab will concentrate the sample down for use in the IUI. The sample is then drawn up in a syringe with a thin plastic catheter attached. The doctor threads the catheter through the cervix and into the uterus and places the sperm there. Because the IUI is timed with ovulation, the sperm must travel only a short distance up the fallopian tube to reach the recently ovulated egg for fertilization.
If timed intercourse and IUI are not successful, PCOS patients also are good candidates for In Vitro Fertilization (IVF). Because PCOS patients have a lot of eggs, they can have success in creating multiple embryos during an IVF cycle. On the other hand, a drawback of the high egg count associated with PCOS is the higher risk for severe symptoms during and after an IVF cycle known as Ovarian Hyperstimulation Syndrome (OHSS). Your fertility specialist may be conservative with medication doses as well as very vigilant in monitoring your symptoms to try to prevent OHSS from occurring.
Polycystic ovarian syndrome is a medical condition that touches many aspects of a person’s life. Fertility is just one area patients struggle with during the diagnosis and treatment of PCOS. Knowing more about your PCOS diagnosis can empower you to take control of your health and fertility.