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Fertility and PCOS

Polycystic Ovary (Ovarian) Syndrome, otherwise known as PCOS is a hormonal disorder primarily of ovarian function, but it can have an effect on many body functions.

It affects around 15% of women in the reproductive age, and it can be a complicated condition to explain, diagnose, and treat.  To make things easier, in 2018, world medical bodies agreed on the characteristics and diagnosis of PCOS.

PCOS is characterised by irregular prolonged monthly cycles, with periods either

  • less than every 21 days, or
  • longer than 35 days, or
  • less than 8 cycles a year.

The second symptom is an excess of androgens, or male-type hormones, leading to possible body and facial hair, acne, and weight gain.  However, the symptoms are many and varied. 

PCOS can affect fertility and can also make it difficult for women to manage their weight.  Depression and anxiety are commonly experienced with PCOS. Later in life there is an increased risk of insulin resistance and late onset diabetes.

Symptoms of PCOS

Insulin Resistance

You will hear about the association of PCOS and insulin resistance. This is interesting for a few reasons. If there is fewer fat cells, then there is less insulin resistance.  So, one of the mainstays of treatment of PCOS is to stay in a healthy weight range. You will also read that the drug metformin is one of the mainstay treatments of PCOS as it is a diabetes treatment drug.

Ovulation problems/ Irregular periods

Women with PCOS experience irregular periods and ovulation problems because their body is given mixed signals, and the menstrual cycle is disrupted. Typically, periods can be :

  • Irregular
  • Infrequent
  • Absent

Weight issues

Being overweight can be a contributing factor to developing PCOS symptoms.

In what can be a vicious circle, many women with PCOS have difficulty managing their weight, and increased weight can result in worse physical symptoms.

Excessively overweight women are more likely to have irregular periods and experience fertility issues, due to the abnormal hormone levels being produced by the ovary. 

Acne and Abnormal Hair Growth (Hirsutism)

In some women with PCOS, the increased levels of male hormone can cause unwanted hair on your face, thighs, back, tummy and nipples.

The elevated levels of androgens can also lead to acne appearing on the face, back and other areas of the body.

How does PCOS affect fertility?

The name ‘Polycystic’ implies you might have multiple cysts on your ovaries, but this is not so. These ‘cysts’ are really follicles, each containing an egg.  With PCOS the follicles have difficulty growing and ovulating and this results in decreased fertility.

A woman’s age plays a part in PCOS and fertility.  Egg age is very important with fertility.  Seeking medical assistance before the age of 35 allows time for fertility intervention. 

PCOS and Ovulation

The most common problem with PCOS is a hormonal imbalance resulting in disrupted ovarian function and ovulation.

Each month in a normal menstrual cycle follicles develop and form eggs. One of these is released during ovulation.

With PCOS, there is a disruption in the normal regulation of egg growth and release.  The follicles stop growing at about half way to maturity, and ovulation doesn’t occur.

These follicles become small cysts in the ovary.  These cysts can lead to an increased amount of testosterone, causing irregular periods.

How is PCOS Diagnosed?

A diagnosis of PCOS, typically involves blood tests, ovulation monitoring and ultrasound.  A diagnosis of PCOS requires the presence of at least two out of the three main criteria:

  • Irregular periods – less than 21 days or greater than 35 days, or less than 8 periods a year.
  • Increased male hormones (androgens) causing excess hair growth, acne or raised testosterone levels.
  • Characteristic appearance of polycystic ovaries on ultrasound.

What are the treatment options for PCOS?

There are a number of treatment options for women with PCOS, and this is where it is important your fertility specialist creates a management plan that aligns with your individual circumstances.

Lifestyle is the first treatment for all women with PCOS, addressing diet, physical activity and weight. Even small changes can have a big impact.  If you are overweight, losing 5-10% of body weight can help to induce ovulation and restore regular periods.

Medications such as Metformin work to reduce insulin resistance, which can also assist in weight loss.

If testing indicates that ovulation is irregular or absent, medication that helps produce eggs will be prescribed.  In some cases, a low-dose oral contraceptive pill might help with irregular periods. 

Ovulation induction, using medications such as letrazole can stimulate the hormones necessary to promote the follicles, and release an egg.

For some women, a stronger category of medicines called ‘gonadotrophins might be needed.  Gonadotrophins are a synthetic version of your own hormones FSH and hCG.  When injected, they act directly on the ovary. This stimulates your ovaries to develop a couple of follicles and eggs in the case of ovulation induction or many eggs in the case of IVF. 

When taking hormone medications Dr Flynn will be closely monitoring the growth of your follicles.  During this time you will have regular visits to our practice, for ultrasounds and blood tests.

Other treatment options include Laparoscopic ovarian surgery, including ovarian drilling and Assisted Reproductive Technology.

Assisted Reproductive Technology (ART) is a general term referring to methods used to unite sperm and egg by artificial means.

The most common ART procedures include in vitro fertilisation (IVF), intrauterine insemination (IUI), and intra-cytoplasmic sperm injection (ICSI).

Dr Flynn’s success rate with these treatments is very high.

The good news is that ovulation issues are the most successfully treated area of infertility.

Ask your GP for a referral to Dr Michael Flynn - print this Referral Request and hand it to your GP.

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