How Polycystic Ovary Syndrome (PCOS) Affects Fertility and What to Do

Polycystic Ovarian Syndrome causes nearly 80% of infertility cases due to anovulation—the inability of the ovaries to release an egg during the menstrual cycle. Without ovulation, you can not get pregnant.

Although Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility in women, those with the condition you can still conceive even if you have the condition. PCOS leads to hormonal imbalance that affects your ability to ovulate. However, PCOS is a treatable condition that should not stop you from starting or expanding your family.

This article will teach you about PCOS, its causes, symptoms, how it affects fertility, and effective treatment options.

What is Polycystic Ovarian Syndrome (PCOS)?

Polycystic Ovarian Syndrome is a hormonal and reproductive disorder characterized by excess androgen hormone, polycystic ovaries, and anovulation. PCOS is one of the major causes of anovulatory infertility in females. It typically affects approximately 5 million women within the childbearing age group (15-44 years) in the United States. Metabolic changes in PCOS increase the risk of metabolic diseases in affected females. 

How Does Ovulation Work?

Ovulation releases matured eggs from the ovaries during the menstrual cycle. Hormones from the brain and other female sex steroid hormones regulate ovulation. Typically, regulatory reproductive hormones from the hypothalamus in the brain called Gonadotropin-releasing hormone control the menstrual cycle. The Gonadotropin-releasing hormone stimulates the release of gonadotropins—follicle-stimulating hormone(FSH) and luteinizing hormone (LH) from the pituitary gland.

These gonadotropins stimulate the ovaries at different phases of the menstrual cycle. During the follicular phase of menstruation, the pituitary gland releases follicle-stimulating hormone, which helps the eggs inside the ovaries to mature. As a result, estrogen production gradually increases as the eggs inside the ovarian follicles mature. Also, the cells in the ovarian follicle produce a small number of androgens—hormones responsible for male sexual characteristics.

At full maturation, the pituitary gland also secretes luteinizing hormone, which surges and triggers the dominant ovarian follicle to release the egg. The cells in the ruptured follicle begin progesterone formation after releasing the egg.

The rising serum concentration of estrogen and progesterone inhibits the Gonadotropin-releasing hormone from the hypothalamus and stops the pituitary gland from secreting both FSH and LH. These hormonal changes help to control the ovulation process in females.

How Does PCOS Affect Ovulation?

PCOS disrupts the normal cyclical hormone regulatory and inhibitory processes that control ovulation. The menstrual cycle in PCOS is associated with abnormal estrogen, progesterone, LH, and FSH levels. In PCOS, the pituitary gland does not respond optimally to progesterone inhibitory signals, so it continues to secrete only LH. The inability of the pituitary gland to secrete FSH affects ovarian follicle growth and maturation.

Consequently, multiple small follicles or cysts accumulate in the ovary because they are not capable of growing to a matured size that would trigger ovulation.

There is also an elevated blood level of insulin which stimulates excess androgen production in the ovaries. Excess androgen and inadequate FSH blood levels suppress ovarian follicular maturation and lead to anovulation. 

Causes and Symptoms of PCOS

Although scientists have not found the exact cause of PCOS, multiple factors are considered responsible for the onset of PCOS.

Genetic factors are one contributer to the cause of PCOS. Women who inherit genetic variations or mutations that affect the formation of androgens or sex steroid hormones are at risk. However, genetic factors alone are not sufficient to develop PCOS. The interaction of genetic predisposition and environmental factors such as obesity and insulin resistance raises your risk of PCOS.

Most PCOS symptoms are due to the hormonal and metabolic derangement of the disease. Here are the significant PCOS symptoms: 

• Irregular or absent menstrual periods: Some females may notice menstrual periods that are infrequent or heavy and unpredictable periods.
• Infertility
• Obesity
• Excess hair growth on the face, chest, abdomen, or upper thighs - a condition known as hirsutism.
• Severe acne
• Oily skin
• Women with PCOS are at risk of other medical conditions and may experience additional symptoms due to associated metabolic disorders.
• Health Risks of PCOS

The metabolic derangements in PCOS put females at risk of metabolic disorders and cardiovascular diseases.
Some of these medical disorders include:

• Obesity
• Impaired glucose tolerance
• Type 2 diabetes mellitus
• Cardiovascular disease
• Dyslipidemia 
• Depression
• Obstructive sleep apnea 
• Endometrial cancer
• Nonalcoholic fatty liver disease

 As a result of these associated health risks of PCOS, early diagnosis and prompt intervention are crucial to reducing disease progression and the risk of developing complications.

Diagnosis and Testing of PCOS

Diagnosis of PCOS begins with clinical history taking, physical examination, and investigations for confirmation.

The purpose of clinical history is to confirm PCOS symptoms. Your doctor will typically ask questions about irregular menstrual periods and symptoms suggestive of elevated androgen levels, such as excess hair growth and acne. During the physical examination, your doctor will examine your whole body to identify clinical signs of specific organ disease.

Laboratory testing is essential in confirming a diagnosis of PCOS and screening for related metabolic diseases.

Another critical role of PCOS testing is to exclude hyperprolactinemia, non-classical congenital adrenal hyperplasia, and other health conditions that could present, like PCOS.

The following tests are necessary for PCOS diagnosis:

• Pelvic ultrasound scan: This helps to detect the presence of multiple small ovarian cysts. The presence of 12 or more follicles measuring 2-9 mm in diameter in each ovary indicates PCOS.

• Blood tests to check the serum level of androgens, progesterone, FSH, and LH to determine the FSH/LH ratio.

After PCOS confirmation, your doctor may order the following tests to screen for metabolic disorders:

• Oral blood glucose tolerance test and fasting blood glucose
• Serum cholesterol
• Liver function test

While to exclude other similar medical conditions, your doctor may order blood tests such as:

• Serum prolactin
• Thyroid-stimulating hormone to rule out thyroid disease.
• 17-hydroxyprogesterone serum level

Conducting and interpreting these test results will give your doctor insights into selecting the most appropriate therapeutic intervention.

Fertility with PCOS (Is It Possible to Get Pregnant?)

Those with PCOS can get pregnant despite the anovulation and hormonal defects with the condition. Fertility experts can use multiple therapeutic methods to raise the chances of conceiving. For instance, lifestyle adjustment, counseling, and ovulation-inducing medications can help increase the chances of ovulating and getting pregnant.

Infertility Rate with PCOS

The prevalence of infertility in women with PCOS varies but could be as high as 70-80% of cases. Anovulation is the major cause of infertility in PCOS. This is why one of the major therapeutic goals of fertility treatment in PCOS is to induce ovulation. 

Fertility Treatment Options with PCOS

There are different treatment options for PCOS. After clinical evaluation, your fertility doctor will determine the most appropriate approach that suit your unique health status.

Lifestyle Changes to Support Fertility

Your doctor will typically counsel you on the need to eat healthily, exercise regularly, and make general healthy lifestyle choices. Preconception care, including daily intake of folic acid, is also essential to prepare you for conception. 

Medications

Fertility experts typically employ various medications in the treatment of PCOS. While Clomiphene citrate can be used, it's worth noting that many physicians prefer starting with aromatase inhibitors such as Letrozole. This is primarily due to Letrozole's superior pregnancy and live birth rates when used in combination with metformin, as compared to Clomiphene citrate combined with metformin. Additionally, one significant advantage of Letrozole is its lower risk of causing multiple pregnancies, making it a safer medication in this regard.

Letrozole functions by inhibiting the enzymatic conversion of excess androgens produced by ovarian follicles into estrogen. This action disrupts the negative feedback loop of serum estrogen, allowing the pituitary gland to maintain its secretion of follicle-stimulating hormone (FSH), which, in turn, supports the ovulation process.

Aside from Letrozole, other ovulation-inducing drugs used in fertility clinics include:

• Gonadotropins: Administered through subcutaneous injections, these drugs mimic the function of pituitary gland FSH and assist in ovarian follicle maturation and ovulation.
• Metformin: Sometimes used as a supportive medication, Metformin helps reduce ovarian androgen secretion.

Ultimately, the choice of medication may vary from patient to patient, and it's crucial for individuals to discuss their specific needs and preferences with their fertility doctor to determine the most suitable treatment plan.

In Vitro Fertilization

In Vitro Fertilization (IVF) is an alternative and effective therapy in PCOS cases that do not respond to medications alone. During IVF treatment, the patient undergoes an egg retrieval, eggs are fertilized in the lab, grown into embryos, and transferred back to the uterus. Because IVF bypasses the fallopian tubes, IVF can be an effective choice for many people with PCOS as well as other conditions including endometriosis or damaged fallopian tubes.

Women with PCOS are at risk of ovarian hyperstimulation syndrome during the IVF process. This is because of the possibility of excess ovarian response due to FSH stimulation. However, this risk is minimal when working with experienced and skilled reproductive endocrinologists. We have a team of expert reproductive physicians with years of experience helping those with various causes of infertility achieve pregnancy through IVF.

Surgery 

Fertility experts may choose to conduct a specialized surgery called laparoscopic ovarian drilling. This surgical procedure helps to reduce ovarian androgen production and decreases the conversion of androgen to estrogens.

Do You Need PCOS Treatment?

PCOS causes hormonal and metabolic abnormalities, which reduces your chances of getting pregnant. However, you can still achieve your dream of starting or expanding your family even if you have PCOS. You need to consult fertility experts with a proven track record of helping those with PCOS get pregnant.

Our fertility experts are here to help you build your family. Our committed fertility specialist team provides personalized fertility care using current evidence-based reproductive technology solutions.

Take the first step towards achieving your dream of starting or expanding your family by contacting us today.