PCOS Management and Fertility Treatment

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a hormonal imbalance. Women with PCOS have ovaries that produce more androgens (male hormones) than normal. This is due to high insulin levels leading to the increase in production of androgen in the ovary.

PCOS affects 1 in 20 women of childbearing age. While there is no cure, it can be effectively managed to help you conceive.

Diagnosis of PCOS

Symptoms of PCOS often first occur at the onset of puberty, but may also develop later in life, and are often associated with weight gain. Some other common symptoms of PCOS include:

  • Menstrual cycle irregularities, including heavy or prolonged bleeding, infrequent periods or no periods at all
  • Increase in weight
  • Insulin resistance
  • Skin irregularities including severe acne
  • Multiple follicles in ovaries
  • Hirsutism – excessive growth of body hair, including on the face
  • Hair loss

To be diagnosed with PCOS, two of the three following criteria must be met:

  • Little to no ovulation with possible irregular menstrual cycles
  • Clinical signs of high androgen levels (unwanted hair growth, acne) or tests that show high androgen levels in the blood
  • Ultrasound of the ovaries indicating more than 12 follicles

The term “polycystic” ovaries can be misleading and sound worrisome to patients or health care providers who are not familiar with the ovaries. The “cysts” in this case are small ovarian antral follicles that contain eggs and should not be confused with larger cysts that can be of medical concern.

Most women are born with these antral follicles and select one dominant follicle each month, which is then ovulated or released in anticipation of pregnancy. In women with PCOS, there is an excess amount of these small follicles, and the selection of one dominant follicle does not happen every month or sometimes does not happen at all. This is referred to as oligo-ovulation or an-ovulation and leads to infrequent menstrual periods.

The variety of ways that the symptoms of PCOS can present makes it notoriously difficult to diagnose, but if you’re struggling to get pregnant, understanding what is happening in your body is incredibly important.

How PCOS May Cause Fertility Challenges

When menstruation doesn’t occur regularly or normally, it can become difficult to get pregnant without intervention. Being overweight or underweight can also add to fertility challenges, and there is a higher risk of miscarriage and gestational diabetes associated with PCOS. Due to these reasons, it is good to identify the risk of PCOS and begin treatments before trying to get pregnant.

As describe above, the main source of infertility in women with PCOS is infrequent ovulation. For women who do not ovulate regularly, ovulation can be induced with oral medications such as clomiphene citrate or letrozole and should ideally be done under the supervision of a gynecologist or reproductive endocrinology and infertility specialist.

Treatment & Success

Since PCOS is most likely caused by hormonal imbalances, some of the most effective treatments involve hormone therapy. This often takes the form of different varieties of hormonal birth control including:

  • Birth control pills
  • Progestin therapy
  • Hormonal IUDs
  • Vaginal rings

These therapies aren’t always appropriate, especially if you are trying to get pregnant. There are other types of medication that can be prescribed to help increase ovulation if you’re trying to conceive. If these treatments aren’t successful, you may need to consider a more aggressive intervention, most likely in vitro fertilization.

Lifestyle changes with diet and exercise are also successful ways to manage PCOS. By limiting processed foods, adding healthy fats, and lean meats to your diet this will help lower glucose levels and improve the body’s use of insulin.

Whatever your needs, our fertility experts can advise you along the way. Navigating PCOS and fertility treatments can feel complicated, and our providers are here to help you navigate through your fertility journey

PCOS & Pregnancy

After conceiving, women with PCOS are at risk of developing certain complications such as gestational diabetes, preterm delivery, and pre-eclampsia, and this can be exacerbated by obesity. The Endocrine Society recommends assessment of BMI, blood pressure and oral glucose tolerance prior to attempts at conceiving.

Although PCOS is normally associated with infertility, not all women who have PCOS are infertile. Most women suffering from it can achieve successful pregnancies and deliveries.

At Laurel Fertility Care, skilled reproductive endocrinologists are available to help patients with PCOS who are having difficulty conceiving. The decision to start a family is life-changing, full of anticipation and dreams. As the premier boutique clinic in the Bay Area, we are dedicated to helping your family grow, offering a personalized care approach full of hope!

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In some cases a third party, such as a donor and/or a gestational carrier is needed.

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