How Polycystic Ovary Syndrome (PCOS) Affects Fertility and How to Manage It?

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a medical condition affecting hormone levels in women, which can lead to potential metabolic problems. While it can influence the health and functionality of the ovaries, it doesn't necessarily lead to infertility.

Infertility and PCOS

Infertility rates are notably high among women with polycystic ovaries. Many of these women face challenges when attempting to become pregnant and often require medical interventions to enhance their chances of conceiving.

Polycystic ovary syndrome (PCOS) affects women differently. While some may occasionally ovulate, others may not ovulate at all. Ovulation is crucial for conception, since it is during this process that a mature egg is released and can be fertilised by sperm.

Recognising PCOS Symptoms 

PCOS symptoms can manifest differently from person to person. Some women may notice these symptoms around their first menstrual period, while others may only discover they have PCOS when they face challenges such as weight gain or difficulty conceiving.

Common PCOS symptoms

• Irregular Periods: PCOS often leads to irregular menstrual cycles. The lack of ovulation prevents the uterine lining from shedding each month, resulting in women with PCOS having fewer than eight periods a year or sometimes none.
• Heavy Bleeding: Due to the prolonged build-up of the uterine lining, when menstruation does occur, it can be heavier than normal.
• Excessive Hair Growth: More than 70 per cent of women with PCOS experience increased hair growth on their face and body, a condition known as hirsutism. This excess hair can appear on the back, belly, and chest. 
• Acne: Elevated levels of male hormones in PCOS can lead to oilier skin and frequent breakouts, typically affecting areas like the face, chest, and upper back.
• Male Pattern Baldness: Hair may thin and even fall out on the scalp due to the hormonal imbalances associated with PCOS.
• Skin Changes: Dark patches of skin can develop in body creases, such as the neck, groyne, and under the breasts.
• Headaches: Hormonal fluctuations can sometimes trigger headaches in women with PCOS.

Diagnosing PCOS

Diagnosing Polycystic Ovary Syndrome (PCOS) involves a series of assessments.

Initial Evaluation

When an individual consults a healthcare provider with concerns related to PCOS, the diagnostic process typically begins with a discussion. The healthcare provider will consider various aspects of the individual's health, including:

• Symptoms: The patient will be asked about the symptoms they've been experiencing, such as irregular menstrual periods, excess hair growth, acne, and any recent weight changes.
• Medications and Medical History: The healthcare provider will inquire about the patient's medications and any pre-existing medical conditions.
• Menstrual History: A detailed history is crucial, as irregular periods are a common symptom of PCOS.
• Physical Examination: During a physical examination, the healthcare provider will look for signs of excess hair growth, insulin resistance, and acne, which are frequently associated with PCOS.

Diagnostic Tests

Following the initial evaluation, the healthcare provider may recommend specific diagnostic tests to confirm or rule out PCOS. These tests include:

Transvaginal or Abdominal Ultrasound

Transvaginal and abdominal ultrasound imaging is commonly used to assess the ovaries. It can reveal the presence of cysts or follicles on the ovaries, a hallmark of PCOS. This, however, is not the sole diagnostic criterion, as some women with PCOS do not have visible cysts.

Blood Tests

• Hormone Levels: Blood tests are performed to measure hormone levels, including:
  • Follicle-Stimulating Hormone (FSH)
  • Luteinizing Hormone (LH)
  • Testosterone
  • Sex Hormone-Binding Globulin (SHBG)
  • Prolactin
  • Thyroid hormones (TSH, T3, T4)
  • Anti-Mullerian Hormone (AMH)
• Glucose and Insulin Levels: Measuring fasting glucose and insulin levels can help identify insulin resistance, which is common in PCOS. 
• Lipid Profile: Assessing cholesterol and triglyceride levels can determine the risk of cardiovascular complications associated with PCOS.

Menstrual and Ovulation Assessment

Irregular menstrual cycles could be a symptom of PCOS. Your healthcare provider may ask for a menstrual diary or use tests such as progesterone challenge tests to assess ovulation and menstrual regularity.

Additional Testing

In some cases, additional tests like a 2-hour Oral Glucose Tolerance Test (OGTT) may be performed to assess glucose metabolism and insulin resistance. This is especially important in women with features of metabolic syndrome.

Endometrial Biopsy

In cases where PCOS is associated with prolonged or heavy periods, an endometrial biopsy may be recommended to rule out endometrial hyperplasia or other uterine abnormalities.

Further Testing

If a diagnosis of PCOS is confirmed, the healthcare provider can suggest additional tests to monitor and manage potential complications. These can include:

• Mental Health Screening: Given PCOS's emotional and psychological impact, screening for conditions like depression and anxiety is essential to provide comprehensive care.
• Screening for Sleep Apnea: Obstructive sleep apnea is more prevalent in individuals with PCOS. Screening and management of sleep disorders can help improve overall well-being.
• Regular Health Checks: Regular monitoring of blood pressure, glucose tolerance, and cholesterol and triglyceride levels to assess and address associated risks.

PCOS Infertility Treatment

The choice of PCOS treatment depends on the individual's specific situation, including their symptoms and goals. Some of the common approaches to managing infertility in PCOS include:

Lifestyle Modifications

• Weight Management: Achieving and maintaining a healthy weight can significantly improve fertility in women with PCOS. Weight loss through diet and regular exercise can restore menstrual regularity and increase the chances of ovulation.
• Dietary Changes: A low-glycemic index diet can help manage insulin levels, which are often elevated in PCOS. In some cases, the doctor may recommend specific dietary supplements, such as inositol, to support hormonal balance and improve ovulatory function.
• Stress Management and Relaxation: Reducing stress and maintaining a healthy lifestyle can improve fertility outcomes. Stress-reduction techniques, such as yoga, meditation, and acupuncture, can be beneficial.

Medications

• Ovulation-inducing Medications: Clomiphene citrate or letrozole are often prescribed to induce ovulation. These medications help stimulate the ovaries to release eggs. Monitoring with ultrasound and hormonal tests is essential to track ovulation.
• Gonadotropins: In some cases, injectable hormones called gonadotropins may be used to induce ovulation when oral medications are ineffective.
• Metformin: This medication is commonly prescribed to improve insulin sensitivity in women with PCOS. It may help regulate menstrual cycles and promote ovulation, especially when insulin resistance is a contributing factor.
• Luteinizing Hormone (LH) Injections: For women who don't respond to standard ovulation-inducing medications, LH injections can be used in combination with follicle-stimulating hormone (FSH) to trigger ovulation.
• Ovarian Drilling: In a surgical procedure called laparoscopic ovarian drilling, small holes are made in the ovaries using a heated needle or laser. This can restore ovulation in some cases.

Intrauterine Insemination (IUI)

Intrauterine Insemination (IUI) involves placing sperm directly into the uterus around the time of ovulation. It can be a suitable option for couples with PCOS-related infertility, especially when ovulation-inducing medications are used.

In Vitro Fertilisation (IVF)

When other treatments don't work, In-Vitro Fertilisation (IVF) can be an option. In IVF, doctors take mature eggs and mix them with sperm in a lab. They then put the embryos into the uterus. It's really important to consult with an IVF specialist, especially as some clinics have special plans for PCOS patients.

Ovulation Monitoring

Regular monitoring of the menstrual cycle and ovulation using hormonal tests and transvaginal ultrasound can help time intercourse or procedures like IUI more accurately.

Fertility Preservation

Women with PCOS who may undergo fertility-reducing treatments (such as ovarian drilling) or face potential fertility issues in the future should consider fertility preservation options, like egg freezing.

At Max Hospitals, we understand the complexities and challenges that come with PCOS, especially when it is impacting fertility. We take pride in having a dedicated team of specialists who are well-versed in the intricacies of PCOS and its implications. Equipped with highly experienced specialists, state-of-the-art facilities, cutting-edge technology, we strive to provide the best possible treatment for PCOS, and encourage you to reach out to our team of specialists if needed. Your unique needs and dreams of starting or expanding your family are of the utmost importance to us. Book an appointment today.