What PCOS Means For Fertility

PCOS and fertility

When I first started trying to get pregnant I was convinced that I had PCOS because I had so many symptoms. My cycles were irregular, I had skin tags, extra body hair, I was tired and totally addicted to sugar.

When it comes to fertility PCOS can be a disaster because it messes up hormones, creates cysts on ovaries and stops ovulation. It is estimated that PCOS is the cause of 75% of anovulatory cycles. There is no way you can get pregnant if you’re not ovulating!

I studied PCOS in-depth and even wrote a dissertation about it because I wanted to understand PCOS for myself and be able to help other women with it. If you have PCOS or think you might, then check your symptoms, find out how it affects fertility and get clear on treatment options.

What is PCOS?

PCOS is a dysfunction of the ovaries and is defined as enlarged ovaries with more than 10 cysts 2-8mm in diameter. Polycystic ovary syndrome is often confused with polycystic ovaries or PCO. The difference is that polycystic ovaries (PCO) are where there are more cysts on the ovaries, but this doesn’t create all the problems that we see with PCOS.

Polycystic Ovarian Syndrome (PCOS) is widespread and yet it is underdiagnosed and undertreated. Most studies agree that 10% of premenopausal women suffer from PCOS, however, some argue that the syndrome is far more common in 20-25% of women.

What Causes PCOS?

PCOS is a complicated condition, therefore, it stands to reason that there is a combination of genetic and environmental factors at work. It is widely recognised that there is a genetic link and that 40% of women with PCOS have an immediate female relative who is also a sufferer. It is likely that either parent can pass on the gene. Being overweight and stress are believed to trigger PCOS because they affect hormones and disrupt the hypothalamic-pituitary-ovarian (HPO) axis.

PCOS Diagnosis

To be diagnosed with PCOS you need at least two out of three of the following characteristics:

  1. Oligoovulation (irregular ovulation) or anovulation (no ovulation).
  2. Hyperandrogenism (high male sex hormones, like testosterone).
  3. Polycystic ovaries (10 or more cysts on the ovaries).

Checklist Of PCOS Signs

There is a wide range of signs and symptoms associated with PCOS:

  • No ovulation.
  • Irregular ovulation.
  • Irregular periods.
  • Irregular bleeding.
  • No periods.
  • Difficulty getting pregnant.
  • Weight gain.
  • Excess body hair
  • Thinning hair on the head.
  • Oily skin and acne.
  • Skin tags.
  • Dark patches on the skin.
  • Tiredness.
  • Depression.

How Does PCOS Affect Hormones?

  • There is a disruption to the hypothalamus, pituitary, ovaries, adrenals, adipose tissue and liver, which causes a multitude of hormonal problems. A self-perpetuating cycle of hormonal positive and negative feedback loops result in anovulation.
  • Increased high-frequency pulses of GnRH from the hypothalamus stimulate excess LH and insufficient FSH from the pituitary.
  • High levels of LH lead to the ovaries producing increased androgens (oestrogen and testosterone).
  • Hyperinsulinemia causes increased androgens to be produced by the ovary and the adrenal glands.
  • Lower levels of SHBG result in higher levels of testosterone in the blood.
  • Low levels of FSH mean that a dominant follicle does not mature, and numerous small follicles develop inside the ovaries, but never reach maturation or release an egg. These follicles become ‘cysts’ and produce increased oestrogen, which signals to the hypothalamus and pituitary.
  • Oestrogen creates negative feedback to reduce FSH and positive feedback to increase LH in preparation for ovulation.

How Does PCOS Affect Fertility?

PCOS affects women in different ways. Sometimes they experience mild symptoms and it doesn’t stop them from getting pregnant. In other cases, it can be a disaster for fertility and cause:

  • Hormonal imbalances.
  • No ovulation.
  • Irregular cycles.
  • Chronic inflammation.
  • Insulin resistance.

Treatment

PCOS cannot be cured but medication can be used to treat the symptoms. Treatment will vary depending on the type of PCOS  and the symptoms.

  • Clomiphene citrate stimulates ovulation and is usually the first drug that will be prescribed, however, 20-25% of women are clomiphene resistant, it has many side effects and it is unsafe to continue after six cycles.
  • Metformin is often used if clomiphene doesn’t work. Metformin is a drug originally designed for diabetics because it reduces hyperinsulinemia and insulin resistance. It has proved effective in lowering blood sugar, insulin and inducing ovulation in women with PCOS.
  • Letrozole is sometimes used instead of clomiphene, but it was originally used to treat breast cancer and is not licensed to treat PCOS.
  • Laparoscopic Ovarian Drilling Surgery (LOD) is where heat or lasers are used to destroy tissue on the ovaries that are producing male hormones. This can be very successful, however, there can be severe complications, such as removing excessive ovarian tissue which may lead to ovarian failure.
  • IVF is recommended for women with PCOS, they need to be carefully monitored during IVF because there is a risk of ovarian hyperstimulation, where too many follicles are produced.

Natural Ways To Help PCOS

  • Change your diet and avoid inflammatory food, processed food, sugar, refined carbohydrates, toxins and red meat.
  • Exercise more and get fit to help improve your chances of getting pregnant.
  • Lose weight to balance your hormones and promote ovulation. It has been shown that a 5-10% reduction in weight can increase pregnancy rates by 55-100%.
  • Reduce stress and practise stress management tools to lower your stress and balance your hormones.
  • Take supplements that are specifically designed to support your body and address your imbalances.

So there you have the facts about PCOS and how they affect fertility. If you have PCOS, then there is a lot you can do yourself to improve the symptoms. Work out your symptoms and then put a plan in place to assess your lifestyle and change the things that you can control, like food, stress and exercise. As ever, reach out if you want my help to put together your own customised plan.

Warmest wishes,

Rachel xx

Rachel Bolton Lic. Ac., Lic. Tui Na.

I help women get pregnant and have healthy babies, even when they've been told they have a 0% chance. Whenever you're ready...here are 3 ways I can help you.

1. Join the free Fertility Heroes Facebook group. In our private Facebook group you'll get fertility tips, research and inspiration. Only the women in the group will know you've joined and see your posts.

2. Apply for a free Fertility Analysis Session to work out what is missing from your fertility puzzle and what to do about it.

3. Join the Plan Yourself Pregnant Membership. Get customised support to work out why you're not pregnant and get your personal plan to optimise your fertility, balance your hormones, improve your womb lining and increase your egg quality.

References

Franks S. & Hardy K. (2008). Folliculogenesis in Polycystic Ovaries. In A. Dunaif, J. Chang, S. Franks & R. S. Legro (Eds.), Polycystic Ovary Syndrome: Current Controversies from the Ovaries to the Pancreas. (pp1-8). [Electronic Version]. Humana Press.
Gangar E. & Allanach V. (2001). GYNAECOLOGICAL NURSING: A practical Guide. [Electronic Version]. Oxford: Churchill Livingstone.
Homburg R. (2002). What is polycystic ovarian syndrome? A proposal for a consensus on the definition and diagnosis of polycystic ovarian syndrome. [Electronic version]. Human Reproduction, 17, (10), 2495–2499.
Solomon C. G. (1999). The epidemiology of polycystic ovary syndrome. Prevalence and associated disease risks. Endocrinol Metab Clin North Am., 28, (2), 247-63. Retrieved November 1, 2008, from Pub Med website:
http://www.ncbi.nlm.nih.gov/pubmed/10352918
Tan W.C., Yap C. & Tan A. S. A. (2001). Clinical management of PCOS. [Electronic Version]. Acta Obstetricia Et Gynecologica Scandinavica, 80 (8), 689-696.

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