PCOS and Infertility
PCOS & Infertility
Polycystic Ovary Syndrome (PCOS) is a medical condition that includes such symptoms as infertility,
menstrual irregularities, hirsutism (excess body and facial hair), acne or oily skin, acanthosis nigricans (patches of thickened and dark brown or black skin), depression, and fluid-filled sacs or cysts on the ovaries. Because PCOS often results in a lack of ovulation, or ripening of the eggs in the ovaries, it is one of the most common causes of infertility in women.
The National Institutes of Health has been researching PCOS for many years to determine a cause and the best treatments. While the exact cause of PCOS remains unknown, researchers believe that a combination of genes and environmental features are mainly to blame.
Because PCOS can mimic other diseases, doctors look for two of the three following symptoms to make a diagnosis:
Chronic absence of ovulation
High levels of androgens (male hormones)
Cysts on one or both ovaries
Androgen levels are measured by blood tests, while observing cysts on the ovaries can be done using ultrasound. Not all women who are diagnosed with PCOS have cysts.
The good news is that most women who are infertile due to PCOS can be treated and eventually become pregnant.
Because the symptoms of PCOS are varied doctors may use a combination of treatments to alleviate problems associated with PCOS. Lifestyle changes are the main recommendation for women with PCOS. Doctors suggest women eat a lower calorie diet, lose excess weight, and get more exercise. Just losing weight and increasing the amount of exercise a women gets can minimize many symptoms of PCOS as well as conditions associated with the disease. Even a 5-percent weight loss can positively affect insulin resistance, increase glucose tolerance, and slow or reverse metabolic syndrome. Weight loss can result in a commencement of ovulation, improved pregnancy rates, lower androgen levels, and reduced blood pressure.
A discussion with a doctor can help women with PCOS develop a plan that will enable slow and steady weight loss while increasing activity levels.
Other treatments for PCOS include birth control pills to stimulate menstruation and lower the level of androgens in a woman’s bloodstream, insulin-sensitizing medications, which make the body more sensitive to the available insulin so cells can better use blood glucose, and antiandrogens, which prevent the body from making or using androgen hormones. These treatments can reduce the occurrence of acne, diminish facial and body hair, and regulate menstrual periods.
Because some of these treatments for PCOS can impair the ability to become pregnant and even cause birth defects, it is also important for a woman to discuss her desire to become pregnant before undertaking these medical treatments.
There are several medications health care providers can prescribe to help a woman with PCOS become pregnant. Clomiphene is the most common medication prescribed for PCOS-related infertility. Women who took clomiphene were six times more likely to get pregnant than women who didn’t get the treatment. The American College of Obstetricians and Gynecologists recommend women with PCOS who wish to become pregnant be treated with clomiphene. However, there is a higher rate of multiple pregnancies with the use of this medication.
Metformin, an insulin-sensitizing drug currently used in the treatment of diabetes, is also being used to treat infertility associated with PCOS, although it is not currently FDA-approved for use in infertility. While it did successfully restart ovulation in women with PCOS, metformin alone did not increase the rate of pregnancy.
Using a combination of metformin and clomiphene reduced the number of multiple pregnancies when compared to women treated with only clomiphene, and slightly increased the chance of pregnancy.
