PCOS and Infertility: Strategies for Management
What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is a syndrome in which a woman’s body produces excessive insulin, and as a reaction to that extra insulin her body also produces high levels of androgens (male hormones). It is those high levels of androgens that create infertility problems for women with PCOS. Women with PCOS are also at higher risk for developing diabetes because their bodies are resistant to insulin. As a woman gets older, PCOS can become worse. While five to ten percent of women of childbearing age have PCOS, most are unaware that they have it. In fact, less the twenty-five percent of women with PCOS have been diagnosed.
The Effect of PCOS on the Menstrual Cycle
First let’s examine what happens in a typical menstrual cycle for women without PCOS. In the early part of her cycle, a woman’s body develops multiple follicles within her ovaries, each of which contains an egg. As her cycle progresses, most of the follicles fail to develop further, but one follicle will grow and mature. The mature follicle holds the egg that the woman’s body will release during ovulation. Ovulation occurs when the mature egg bursts from the follicle. LH hormones control this ovulation process; when a woman’s LH levels reach their high point in the menstrual cycle, ovulation occurs and an egg is released.
For women with PCOS, their bodies do not produce enough female hormones necessary for a typical menstrual cycle. Without enough female hormones, the follicles produced early in the menstrual cycle are not able to mature and produce eggs. These undeveloped follicles may even turn into cysts within the ovary, and additional small cysts may develop on the outside of the ovaries. Because the woman with PCOS cannot develop mature follicles that produce eggs, she will not ovulate. A further complication is that, without ovulation, her body will not receive the signal to produce progesterone, the hormone that causes the lining of the uterus to thicken in preparation for carrying a fetus.
Symptoms of PCOS
Of course, the most apparent symptom of PCOS is either an irregular menstrual cycle or the absence of menstruation altogether. (For those women who do menstruate at least some of the time, a few might even conceive during an irregular cycle during which ovulation actually occurs.) Often women with PCOS experience pelvic pain. Other symptoms, attributable to the increased production of androgens, include increased hair growth on the back, chest or face, acne, and thinning hair. Women who are obese, have high insulin levels or type two diabetes, are at risk for PCOS and should consider getting tested if they are planning on starting a family.
Treatment Options
Obviously PCOS affects a woman’s ability to conceive because of a lack of ovulation. But, there are several steps that can be taken to correct the problem. Among the most useful (and inexpensive) is weight control. Some women who are able to reduce their weight themselves through diet and exercise can actually eliminate PCOS, because weight loss helps correct.
A first-line medical treatment for PCOS is Metformin. Metformin is a drug that improves the body’s ability to absorb insulin. It is considered safe to use on women who do not have diabetes because it affects insulin levels and does not actually lower blood sugar directly. If you are considering requesting Metformin, consult your physician and be sure to get screened for diabetes or other risk factors first.
If weight management and/or Metformin do not eliminate PCOS and a woman remains unable to ovulate regularly, fertility drugs should be considered. Clomid, among the most common of the fertility drugs, bocks estrogen receptors in the brain, “tricking” the body to believe that it needs to produce more of the hormones necessary for ovulation (in particular FSH and LH) to combat low estrogen levels. Even when Clomid succeeds in making a woman ovulate, only thirty to forty percent of those women will actually become pregnant. Thus, Clomid may be augmented with procedures intended to facilitate egg fertilization, such as IUI.
For some women with PCOS, in vitro Maturation (IVM) or in vitro fertilization (IVF) may turn out to be the most useful treatment options. If a woman’s eggs are not maturing properly because of lack of appropriate hormones, then IVM allows immature eggs harvested early in a woman’s cycle to mature in laboratory conditions. Those properly matured eggs may then be used for fertilization. IVF, on the other hand, harvests eggs after they are already mature and therefore is best suited for women responding well to medications that encourage ovulation. The mature eggs are then fertilized in the laboratory with sperm collected from the male partner, and once the fertilized eggs have developed into blastocysts one or more are implanted direclt in the woman’s uterus. IVM is helpful for women who do not respond to drug therapy.
Yes, Anna! I Absolutely Want to Learn How to Overcome my Infertility!
Help Me Get Pregnant!
Sign me up for your FREE Secrets of Infertility mini-course today!
