When women struggle with infertility, chronic anovulation is one of the most common reasons. Anovulation occurs when you skip ovulation and don’t release an egg. It accounts for about a third of visits to fertility centers, with 90% of them being due to polycystic ovary syndrome (PCOS). In the United States, PCOS affects 6% to 12% of women of childbearing age.
It’s not just a disease of the ovaries but a metabolic derangement affecting multiple systems in the body. While the exact cause of this complex condition isn’t quite clear, many aspects of it are known today.
What exactly happens in PCOS?
In a marathon, there is a clear winner, but this is not the case in PCOS. Due to hormonal imbalances, the eggs (follicles) at the start of the race are understimulated, so they all run together at varying distances and then freeze in time. Thus, when the next lot moves, there already are some eggs stranded at the start, midway, and near the finish line, but not quite there. The process repeats without the final act of ovulation.
The hypothalamus and pituitary (higher brain centers for ovulation) presume the signals to ovulate were either undelivered or unread, so they send stronger signals until it results in the characteristic hormonal imbalance of PCOS.
Due to this imbalance, overstimulation of the ovary by luteinizing hormone (LH) leads to an increase in the production of male hormones like testosterone and its derivatives. This causes acne and hair growth problems, which could present as hair thinning over the crown of the head or thickening over the legs, arms, lower half of the face, chin, jawline, neck, chest, back, and lower abdomen.
How does PCOS affect conception?
Progressive insulin resistance, largely genetic, impairs the basic machinery of ovulation. Other factors, like a processed-food or sugar-rich diet and a sedentary or high-stress lifestyle, also add to the process of inflammation. This, in turn, can set the stage for worsening of insulin resistance, leading to the so-called inflammatory PCOS.
This inflammation reduces egg quality and prevents the egg from attaining full maturity, thus inhibiting ovulation.
Here are the most frequently asked questions when it comes to a PCOS diagnosis.
What are the signs of PCOS?
Typically, the Rotterdam criteria are used to diagnose PCOS, and they require two of the following symptoms:
- Irregular or absent periods
- Increased male hormone
- Polycystic ovaries visible on ultrasound
When should you seek help?
In general, a year of regular unprotected intercourse is required before seeking help for infertility. However, you should consult your doctor earlier if there are existing comorbid factors such as:
- an elevated body mass index (BMI)
- age above 35
- impaired blood sugars
- partner with some coexisting condition
During the consultation, your doctor would check your waist/hip ratio, BMI, blood sugars, HbA1c, male hormones, and cholesterol levels and do an ultrasound to confirm your diagnosis and the severity of your condition.
For a fertility evaluation, you may be asked to undergo some fertility tests.
Are my periods heavy due to endometriosis or PCOS?
If you have PCOS, then your risk of also having endometriosis is greatly increased. Periods may be heavy in both conditions. While in PCOS the bleeding may be heavy with pain on the 1st-3rd day of the cycle, it generally improves with a better lifestyle. In endometriosis, bleeding between cycles can get worse with time if untreated. The condition is generally accompanied by painful periods, which can occur before, during, or after the menstrual cycle.
What’s the connection between hypothyroidism and PCOS?
Hypothyroidism and PCOS have a lot of overlapping features, especially in the obese type of PCOS. A detailed thyroid profile (a series of blood tests to measure how well your thyroid gland is working) is used to rule out a coexisting thyroid disease that may contribute to or complicate the clinical picture.
How PCOS may impact your fertility
Here are some factors that determine how PCOS may affect your fertility:
- Severity of your condition: How severe your PCOS was at diagnosis.
- Duration: How long you’ve had it determines the metabolic changes associated with the disease.
- Lifestyle changes: Whether you have adopted and strictly adhere to lifestyle changes and if they have improved or left your condition unchanged.
- Obesity or type 2 diabetes mellitus: They are an additional negative influence on the process of conception, especially ovulation.
- Male hormone levels: How high your male hormone levels are could determine the kind of fertility assistance you require.
- Previous medication and response: Depending on how you have responded to prior medication, the plan to assist reproduction would vary.
How to increase chances of getting pregnant with PCOS
Successful ovulation is the first step toward pregnancy. According to the ACOG diagnosis and management guidelines, ovulation induction drugs have been shown to produce ovulation in 80% of women with PCOS, of whom about 50% conceived naturally within 6 cycles of treatment.
Alternatively, gonadotropins may be used in assisted reproduction, especially if you’re resistant to ovulation induction drugs. Other drugs may be prescribed to improve overall insulin sensitivity and ovulation rates, thus increasing the chances of conception.
Your doctor may recommend IVF treatment if medications don’t help you get pregnant. Here are some of the reasons you may need to undergo IVF:
- Failure to conceive despite 6 ovulatory cycles
- Age over 35
- Comorbidities such as diabetes, hypertension, and hyperlipidemia
- Partner having contributing conditions, like a varicocele
- Genetic abnormalities
Lifestyle changes and how they affect egg quality
Incorporating these changes not only improves your quality of life with PCOS but also contributes to the quality of an oocyte:
- Eat a healthy diet: Incorporating variety, reducing the amounts of added sugars, increasing vitamins and minerals intake, and eating plenty of salads, greens, and high-fiber foods have been shown to reduce increased blood sugars and can improve egg quality.
- Exercise: Aim for at least 150 minutes weekly, with 2-3 sessions dedicated to strength training and 2-3 sessions to cardio.
- Reduce stress: Don’t fret for more than 5 minutes if it won’t matter 5 years from now.
- Limit caffeine intake: Caffeine is known to increase sugar cravings and hinder your progress.
- Alcohol and smoking: Nicotine adds about 10 years to the egg, so it’s a no-brainer that you must do without it. Heavy alcohol use has been shown to diminish the ovarian reserve and lower fecundability.
- Sleep: At least 7-8 uninterrupted hours, with a device-free time prior to falling asleep is therapeutic.
What to look out for once you’re pregnant
A PCOS pregnancy can come with its health risks, therefore it’s important to know how this condition affects pregnancy. Having a diagnosis of PCOS pre-pregnancy increases the chances of impaired blood sugars or gestational diabetes, which are toxic to the growing embryo.
Blood sugars that are not under control can affect fetal organs and cause serious congenital malformations in the brain, spine, or heart of a developing baby. High blood glucose can also increase the chance of a miscarriage or stillbirth.
If you’re careful with your sugars and diet and exercise during pregnancy, you can reduce the chances of further complications related to hypertension and the probability of becoming a type 2 diabetic, as well as aid your baby’s growth.
You may be at a higher risk of having multiple pregnancy or higher-order gestations and spontaneous miscarriages. You should report immediately to your doctor if you seem to have any spotting or bleeding.
In multiple gestations, the nausea or vomiting you experience may be much stronger than in an average pregnancy. Multiple gestations also make you more prone to having diabetes and hypertension during pregnancy.
Having PCOS doesn’t mean you can’t get pregnant, but it does mean it’s a little more complicated than just jumping in bed with your partner and getting frisky. You may require medical assistance while trying. Lifestyle changes are the way forward.