It is estimated that one in 10 women suffer from PCOS (polycystic ovay syndrome). This disorder is one of the most common causes of infertility in women. The effects of PCOS are particularly wide-ranging with a host of hormonal symptoms like irregular or absent periods, acne, and facial and body hair. While an astoundingly large percentage of the female population is believed to have PCOS, many women are not diagnosed for years and there is a considerable amount of misdiagnosis because of the disease’s many effects. Additionally, the causes of PCOS are not completely understood. Shining a light on PCOS, the popular website Refinery29, set out to find the important facts every woman should know about getting pregnant with PCOS and enlisted the help of board certified reproductive endocrinologist Isaac E. Sasson, M.D., Ph.D. from our Chesterbrook office to provide his expertise and insight.
“The disease is polygenetic,” explains Dr. Sasson. “It’s not a single-gene disorder. It’s not like cystic fibrosis or sickle cell disease, where there’s one bad gene. Rather, it involves a number of genes we all have, which, for some unknown reason, “aren’t working well together,” Sasson adds.
Relationship between PCOS and fertility
While PCOS is most commonly associated with fertility, the Refinery29 author explains that, “part of the reason fertility issues have become such a focal point is simply because the first doctors to identify PCOS just happened to be gynecologists, so historically, the related gynecological and reproductive issues have gotten the most attention.” Because of the many different effects the disorder can have on many parts of the body, Dr. Sasson says, “PCOS is a terrible name.” To illustrate this point, the author uses the disorder’s effect on insulin levels, which can lead to weight gain, as an element of PCOS that is not directly related to gynecology or fertility. Some women may just have the metabolic-related parts while others might only have the reproductive symptoms like ovarian cysts, therefore two names for the disorder would likely make explanation easier.
For fertility, PCOS is such a strong factor because, as Dr. Sasson explains, the disorder prohibits the ovarian follicles (or egg sac) from developing one large (approximately 20 millimeter) follicle, which holds the egg that will be available for fertilization in normal ovulatory function. Typically, a woman in her 20s and early 30s will produce about 18 to 20 follicles and one will grow to release a single egg. Dr. Sasson told Refinery29 that when examining certain women with PCOS who have many small follicles, “that never developed fully, thanks to disrupted ovulation and menstruation. They don’t have a big one that grows.” It’s these small (or undeveloped) follicles that are mistaken as cysts. These follicles don’t develop into mature eggs so they can’t be fertilized. As Dr. Sasson says, “they’re stuck at the starting line.”
Getting Pregnant with PCOS
Although PCOS is one of the leading causes of infertility, the good news is, with treatment, success is very common. At Shady Grove Fertility, our stepped approach to care starts with low-tech treatments. Beginning with a prescription drug like Clomid or Letrozole, these oral medications will, “boost the follicle stimulating hormone,” or, move the egg from the starting line, as Dr. Sasson says. If the oral medications don’t work, a patient may move on to injectable gonadotrophins that also stimulate the follicle growth. Combined with timed intercourse, these non-invasive protocols have good records of success.
If Clomid or gonatrophin injections do not work, the next step of treatment is the more advanced intrauterine insemination (IUI). For healthy women age 35 and younger, Shady Grove Fertility found that these women with PCOS had the most successful outcomes.
Many studies have shown that overweight women have higher risks of infertility and miscarriage. For women with PCOS, weight gain is often associated with the disorder, which can add to difficulties with fertility. Weight is one of the toughest symptoms of PCOS to treat and it’s often harder for women with PCOS to keep weight off. Plus, metformin, a medication prescribed to treat PCOS sufferers’ sensitivity to insulin, can also lead to weight gain. The solution, per studies cited in the article, is exercise. “The most recent study on this topic concluded that weight-loss and exercise—not simply weight-loss due to exercise—can improve fertility in women with PCOS,” the article states.
Finally, the emotional toll of PCOS is addressed, providing some useful advice. Creating environments to openly discuss PCOS can ease the anxiety and stress that the symptoms bring on. Most importantly, women are not alone in this struggle.
Medical Contribution by: Isaac Sasson, M.D., Ph.D., of Shady Grove Fertility’s Chesterbook, PA office.
To learn more about getting pregnant with PCOS or to schedule an appointment with Dr. Sasson or one of our other physicians, please call our New Patient Center at 1-877-971-7755 or click here to complete this simple form.
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