PCOS and Fertility

Polycystic ovary syndrome (PCOS) affects nearly 2.2% to 26.7% of women aged 15 to 44, however 70% of the women affected have not yet been diagnosed. 

Even though the most common treatment are birth control pills, they are not the only way to treat PCOS. Contraceptive pills are not free from side effects. Women with a family history of thrombosis, for instance, should be advised to choose contraceptive methods that don’t have estrogen in their composition. In turn, women who already have conditions such as thrombosis should not take combination pills (combined oral contraceptives) at all.

Most women with PCOS who treat it with birth control pills believe that if they stop taking the pill, all of their symptoms will immediately return, such as increased body hair growth, acne, and weight gain. However, lifestyle changes might improve the quality of life and stop the metabolism chaos, by easing the syndrome’s symptoms and the chances of developing comorbidities such as diabetes, heart conditions, hipertension, anxiety, depression and even infertility. 

PCOS can be diagnosed according to the Rotterdam criteria, which consists in checking whether patients have at least two of the three following symptoms: 

  • Irregular periods (at least 8 per year, without hormonal interference) 
  • Signs of hyperandrogenism (excessive testosterone, excessive body hair growth, acne, etc.) 
  • Polycystic ovaries detectable with ultrasound (a better term would be multifollicular ovaries, and 12 or more cysts in at least one of the ovaries should be observed) 

Peripheral insulin resistance is the main factor to be treated in PCOS, since insulin decreases the levels of sugar in the blood and stimulates the transportation of sugar to the interior of our cells, increasing our fat storage. When the levels of this hormone are high for a long time, the cells become resistant and the symptoms of peripheral insulin resistance are manifested.

Excessive insulin in our blood increases the presence of the Luteinizing Hormone (LH), which makes the ovaries produce more testosterone, increasing skin and hair oils and acne. It is important to keep in mind that processed foods and carbs (pasta and sweets) are known for increasing the body’s insulin level.

In addition to an unbalanced diet, stress is one of the factors that worsens the PCOS. Many people are currently unhappy with their jobs, are under pressure to attain goals, constantly need to work overtime, work at unsafe environments and, on top of everything, can’t sleep well. This is worrisome because stress increases the release of cortisol, which can make insulin resistance stronger, causing weight gain and worsening PCOS symptoms.

The good news is that a low-carb diet is instrumental to treat PCOS. Without carbs in excess, the stimulation to produce insulin decreases, and the syndrome’s symptoms are reduced. Additionally, exercise is essential, since physical activity makes our cells more sensitive to the effect of insulin, and the body starts to need lower levels of the hormone.  

Besides lifestyle changes, PCOS can be treated with medicine like metformin, which reduces peripheral insulin resistance. This intervention has had good results, which are even related to fertility. It is also possible to use spironolactone to ease the effects of PCOS, like increased body hair growth, for instance.

Women with PCOS usually worry about their fertility, because they are informed that they are not fertile. Nonetheless, for the most part, this is NOT true! 

Irregular periods make it hard for women to observe when they are ovulating, and they might have anovulation, which make it harder for women to get pregnant.  This is often resolved by inducing ovulation. In view of this, it is crucial that women who have irregular periods search for medical help immediately, instead of only seeing a doctor after 6 to 12 months of trying to conceive.

Nonetheless, I am sure you must know a woman with PCOS who got pregnant without any fertility treatment.  For patients who are overweight or obese, weight loss has been of help when it comes to fertility, as it frequently induces ovulation.  

After a professional evaluates the woman’s overall health, if needed, the following are two of the main types of medicine that can be used to induce ovulation: 

  • Letrozole: This aromatase inhibitor is preferred by women with PCOS due to its effects.  It has a different mechanism, but its effect is similar to Clomid’s (clomiphene citrate). Both could promote a twin or triplet pregnancy.  
  • Metformin can induce ovulation for some patients, but  it is not recommended as an official option for inducing ovulation.  

Your doctor might (or not) want to monitor your ovaries during this kind of treatment with ultrasound, and if you are looking for other options to treat infertility, the doctor might recommend an IUI (intrauterine insemination).    

All things considered, even if you are not ready to start trying to get pregnant, it is important to have a professional evaluate you to check if you have PCOS, since it can cause chronic comorbid conditions over time.

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