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Houston Fertility Journal

    PCOS and Its Impact on Infertility, Treatments and Outcomes

    November 28, 2017 / by Center of Reproductive Medicine   

    Center of Reproductive Medicine


    In the healthcare industry, few topics are as difficult to broach as infertility treatments. Considering the sensitive nature of this issue, it’s easy to see why so many people struggling with fertility simply opt not to talk about it at all. Thankfully, some of the complications that couples encounter when they’re trying to conceive are beginning to trickle into the sphere of public awareness. One such condition is polycystic ovary syndrome, commonly known as PCOS.

    The links between PCOS and infertility continue to be proven, and perhaps more than ever, it’s essential to be cognizant of what PCOS is and how it might be affecting you and your loved ones. Organizations like the PCOS Awareness Association and the National Polycystic Ovary Syndrome Association have been instrumental in helping get the word out to those who may not know the true source of their fertility issues.

    Recent research has confirmed that PCOS is widely recognized as the most common hormonal disorder plaguing reproductive-age women. As such, it has become one of the most formidable foes standing in the way of those individuals who are undergoing infertility treatments. Patients with PCOS have enlarged ovaries that develop small cysts on the outer edges.

    In addition to being extremely painful, this condition can hinder ongoing efforts to conceive and even raise the risks associated with a woman’s ability to carry a pregnancy through to term. However, the best way to discuss PCOS is to first share some knowledge about the condition, its origins and potential treatment.

    So let’s address this important topic head-on, with a brief look at the most common causes of PCOS.

    Causes of PCOS


    Unfortunately, even modern science has yet to identify the root cause behind the manifestation of PCOS in some women. Some doctors believe that high levels of male hormones in the body can affect hormone production and ovulation, though this theory has yet to be fully substantiated or embraced by the medical community.

    We’re learning more about the disorder all the time, including which factors could play an integral role in its development in women. Here are just a few of the major risk factors and conditions that might be related to the eventual emergence of PCOS:

    • Your genes: It might go without saying that a woman’s genetic makeup might have something to do with a hormonal disorder like PCOS. Nevertheless, it’s not often a question that is addressed at first, and even worse, the fact that PCOS has been misdiagnosed for years only contributes to the lack of sound information on one’s family history when it comes to this condition. Be sure to do some digging and uncover if any of the women in your family have dealt with either PCOS or similar issues that may never have been formally diagnosed as such. This could be the key to preventative measures that could avoid the development of PCOS altogether.
    • Low-grade inflammation: Women who exhibit low levels of inflammation might be showing tell-tale signs of PCOS. White blood cells typically produce enough of an arsenal to fight off infection, but when they’re not able to, inflammation -- often in the form of light pain or swelling -- results. PCOS can cause such a response from the body, often stimulating a woman’s ovaries to build up excess androgen. Over time, this can cause a chain reaction that creates heart disease and other ancillary problems. If you’re experiencing any lingering inflammation, it might be worth a look to establish the root cause and prevent any further damage to the body.
    • Insulin problems: Typically, the pancreas produces insulin to help the body process sugar as an energy source. But women who ultimately develop PCOS can experience a resistance to insulin, driving up their blood sugar levels and oftentimes leading to increased insulin levels in the body. All that backed-up storage can boost androgen production (see above) and make ovulation extremely irregular. As much as 70 percent of women with PCOS face insulin resistance, lending credence to the fact that this phenomenon has a direct relationship with the development of PCOS itself.
    • Obesity: Of course, we already know that being overweight is a contributing factor to a wide variety of health conditions, but it also puts women at risk of developing PCOS, in part because it can lead to insulin resistance. Obesity also leads to increased inflammation and even high androgen levels. So, if you believe that you might be at risk of PCOS (or even if you’re looking to conceive as soon as possible), it might help to shed a few pounds, as it greatly reduces your body’s chances of developing most of the conditions that indicate the impending onset of PCOS.

    Symptoms of PCOS


    So we’ve touched base on some of the causes and risk factors that might lead to PCOS. But what about the symptoms that might tip you off to the fact that your body is already dealing with the conditions? We’ve got you covered there too. Like most major disorders, PCOS certainly leaves it mark on your daily life.

    Sometimes, they begin to take effect around the time of puberty but can develop as late as early adulthood. What is key when it comes to PCOS is to avoid a misdiagnosis. Far too often, the below symptoms are attributed to a condition that you might not even really have!

    A fertility specialist will be best equipped with the knowledge and experience to suss out the truth. Here are some of the most notable symptoms you need to watch out for:

    • Infertility: Of course, this is the point at which many women finally receive the diagnosis and treatment they need to begin to combat their PCOS. Unfortunately, at this point, the condition has often progressed and persisted for far too long without any opposition. However, because PCOS exhibits different symptoms in different women, it’s notoriously hard to identify. Yet, it remains one of the chief causes of fertility problems in women looking to conceive a child.
    • Irregular ovulation: Because PCOS has such a direct effect on a woman’s ovaries, it’s no surprise that menstruation reflects its role on the body. In fact, irregular periods are one of the easiest ways to ascertain that something may be wrong. Some women miss their periods entirely. If that sounds like a terrible consequence of PCOS, that’s because it is. Ovulation is at the root of any woman’s reproductive health, so it stands to reason that PCOS will jeopardize it on such a fundamental level.
    • Hair growth issues: At its core, PCOS causes a hormonal imbalance that manifest itself in a variety of troubling ways. One such consequence is abnormal hair growth in women suffering from the disorder. Most commonly, hirsutism -- the appearance of hair growing in typically male-pattern areas such as the face, chest and back -- may plague some women, as a result of increased androgen levels. Conversely, hair loss can occur in connection with PCOS or even increase as women reach middle age.
    • Pelvic pain: In many instances, the inflammation involved in PCOS can causes overwhelming pain in women, either during periods or even intercourse itself. Sometimes, heavy bleeding may accompany the pain. Nonetheless, PCOS can make life very rough for those who suffer from it, becoming an everyday burden that can have a tremendous negative effect on quality of life. If this type of pain sounds familiar, be sure to investigate the possibility of PCOS.
    • Acne and mood: We know what you must be thinking. These symptoms are so commonly associated with adolescence that it seems bizarre for them to show up now. But remember that PCOS throws your hormones out of whack in much the same way that puberty does. So, your skin might be breaking out or developing skin tags and dark patches. You may find yourself experiencing mood swings, battling depression or dealing with increased levels of anxiety. All of this is, unfortunately, fair game for PCOS.
    • Sleep and fatigue: Women dealing with PCOS can wind up feeling deprived of their usual energy levels. Feeling tired all the time can mean that the body is working overtime to fight some disorder or dysfunction, and such is the case here. Moreover, fatigue can be exacerbated by the poor sleep that PCOS patients struggle with. The disorder can lead to insomnia and even other problems like sleep apnea, a condition which causes the afflicted to stop breathing for brief periods as they sleep.

    Treatment for PCOS


    The symptoms of PCOS can certainly be devastating, but there are still options for patients hoping to reclaim their lives or even conceive a child. The easiest way to self-treat is to make some much-needed lifestyle changes. These involve healthy habits like getting enough rest and eating a balanced diet but also include exercise plans to keep you active and shed excess weight.

    If this approach isn’t working (PCOS is different in everyone, after all), your fertility specialist likely has several options that he or she can bring to the table. The ultimate goal for women looking to conceive is to downplay or eradicate the harmful effects of PCOS.

    Here are a few ways in which you can treat the disorder:

    • Hormonal treatment: Because PCOS can affect ovulation, women with the condition might not even have a period at all. Luckily, hormonal treatments can help to regulate your ovulation, correcting the hormonal imbalances of PCOS. This can create an increased chance of conception. A number of options are currently out there, including estrogen modulators like Clomid and follicle-stimulating hormone injections. In any case, hormonal treatments may be able to compensate for the damage normally caused by PCOS.
    • In vitro fertilization: More commonly known by the acronym IVF, this process appears to be growing in popularity every year and has demonstrated significant results for patients facing fertility issues, including those with PCOS. What makes IVF such a great option is its ability to help regulate ovulation and create a more hospitable environment for any prospective embryo to grow. The success rate for IVF -- which involves the external fertilization of an egg and then implantation into the patient -- currently sits around 25 percent. While that may not sound impressive, it offers a welcome boost from the odds you’ll face with PCOS on your own.
    • Fertility monitoring: If you’re diagnosed with PCOS and still hoping to get pregnant, this is another way to find the best time to attempt conception. As we’ve mentioned, PCOS can adversely affect ovulation, but fertility monitoring uses indicators like basal body temperature, cervical fluid and ovulation tests to determine when you can maximize your chances of conceiving. Sometimes, PCOS can make even slight ovulation cycles difficult to detect. So any help you can receive in this department makes a huge difference.
    • Intrauterine insemination: This process involves inserting sperm samples directly into the uterus. While it doesn’t help to boost ovulation, IUI does present many more opportunities to get pregnant than a woman may otherwise have. In particular, this approach can be the ideal choice if a male partner has fertility complications of his own, such as low sperm count or decreased sperm motility. It might not be the best option for everyone, but IUI is always something to consider for your own circumstances.
    • Fertility surgery: Perhaps the most invasive route of all is fertility surgery. Of course, we don’t recommend this lightly, but if you’ve exhausted your options and are still eager to become pregnant, surgery could be your best shot. The development of cysts on your ovaries can lead the exterior to become overly hard and therefore further complicate ovulation. Surgery allows the doctor to drill directly into your ovaries to stimulate ovulation. Again, don’t go through with surgery without first trying the above treatments. Even in the best case, surgery’s effects only last a matter of months and might be best accented by IVF or IUI anyway.

    The Reality of PCOS

    According to reports, as much as 20 percent of women across the globe -- and roughly 5 million women in the United States -- experience PCOS during their reproductive years. Considering the severity of this condition and its ability to wreak havoc on one’s potential for parenthood, this revelation is a particularly startling one for any women looking to conceive.

    What makes combatting PCOS even more difficult is the failure to properly diagnose it in young women exhibiting the symptoms we discussed above. The lack of a universal definition for PCOS and the need for greater awareness mean that women and girls everywhere (PCOS can strike as early as age 11) might suffer needlessly.

    Thankfully, the medical community -- and fertility specialists in particular -- are wising up to the effects of PCOS. While no cure currently exists, the aforementioned treatments have largely proven successful in eliminating or decreasing the condition’s many symptoms.

    Even if you believe you or someone you love may have PCOS, all hope is not lost for conceiving a child.

    With the right fertility specialist on your side, you may be able to receive an accurate diagnosis for PCOS and develop a treatment plan that can sidestep your condition to achieve a successful pregnancy. Just know that you’re far from alone in having to face PCOS, and there’s never been a better time to fight off the devastating effects this disorder can have on your body and your emotional well-being.

    Don’t be afraid to seek the help and relief you need to bring that much-desired bundle of joy into your family.


    Topics: PCOS

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