Polycystic Ovarian Syndrome (or PCOS) is a condition that affects many aspects of women’s health both short and long term, including fertility. Here is all you need to know about PCOS and if you suffer from it, how it can affect your fertility and what you can do about it.
We spoke to Dr James Hopkisson, Medical Director at TFP Fertility Group, to find out more.
What is PCOS?
PCOS is a gynaecological condition which affects 10% of women worldwide, however more than half never have symptoms.
Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3in) in size. The follicles are underdeveloped sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means ovulation does not take place.
What are the symptoms of PCOS?
There are three main features of PCOS:
- Hormonal imbalances – PCOS causes a disturbance in the levels of the sex hormones oestrogen and progesterone and also increases the amount of the male hormone, testosterone. This has numerous effects but the most recognised are greasy skin, acne and unwanted facial and body hair.
- Polycystic ovaries on ultrasound scans – Contrary to the name, women with polycystic ovaries do not have cysts on their ovaries. Instead, there are numerous small follicles that typically measure only a few millimetres (2 – 6). These follicles contain eggs, but those eggs have a tendency to be immature and of lower quality than in women of comparable age with normal ovaries.
- Irregular periods – Most women with irregular menstrual cycles are not ovulating. This is a common problem in women with PCOS and the main cause of infertility. The small follicles described above fail to grow as they should and the eggs literally get ‘trapped,’ which is why women with PCOS have so many more than women with normal ovaries.
The most common characteristic of PCOS is irregular menstrual periods or no periods at all. It changes how a woman’s ovaries work, which can have an impact on fertility.
Typically, the signs and symptoms of PCOS become apparent during your late teens and early 20s. The most common characteristic of PCOS is irregular menstrual periods or no periods at all.
However, there are other symptoms to be aware of:
- Difficulty getting pregnant
- Weight gain
- Oily skin or acne
- Excessive hair growth (hirsutism) on the face, chest, back and buttocks
- Rarely symptoms of PCOS include decreased breast size, deeper voice and thinning hair
How can PCOS affect fertility?
Dr James Hopkisson, Medical Director at TFP Fertility Group, says: “This condition unfortunately contributes to problems with both fertility and quality of life.
“There is a need to increase funding for research into providing solutions to alleviate both the debilitating effects of PCOS and to improve reproductive health.
“Polycystic ovarian syndrome Is a condition that affects many aspects of women’s health both short and long term, ranging from cardiovascular disease, diabetes and fertility.
“From a fertility perspective, there is a need to develop safe and effective treatments for ovulation induction and assisted conception.
“Strategies are needed to minimise the risks of hyperstimulation syndrome, improve efficacy of treatments for disorders of ovulation and increase the chances of having a family.”
What causes PCOS?
Despite years of research, the exact cause of PCOS is unknown. There are several possible explanations including genetics, resistance to insulin and hormonal imbalance:
- Genetics – It has been found that PCOS often runs in families, so if your mother, sister, grandmother or aunt have it, then you have a higher chance of also having it. There is a male link too, as PCOS is associated with premature baldness in men. If any of this applies to you we would recommend getting yourself checked. However, it is worth noting that specific genes associated with the condition haven’t yet been identified.
- Resistance to insulin – Insulin, a hormone produced in the pancreas, helps control the amount of sugar in your blood. If you have a resistance to insulin, as diabetics do, your pancreas is forced to produce excessive amounts to compensate. The increased levels of insulin lead the ovaries to produce too much testosterone, which in turn interferes with the development of the follicles and prevents normal ovulation. Insulin resistance can also result in weight gain, making PCOS symptoms worse as excess body fat causes the body to produce even more insulin.
- Hormonal imbalance – The imbalances in oestrogen and progesterone levels and overproduction of testosterone and other androgens (male hormones) may also be part of the cause and not just a consequence of the syndrome. Excess insulin is associated with an increased production of androgens which highlights how everything is connected.
How to treat PCOS
Currently, there is no cure for PCOS but it is possible to treat the symptoms:
- Lifestyle changes – As discussed, excessive weight and body fat can lead to PCOS or make the symptoms worse, and so it is highly recommended you follow a healthy balanced diet and partake in regular exercise. We would not advocate the Atkins diet, but it is important to limit carbs and specifically avoid refined carbohydrates like white bread, pasta and sweets. This can help to regulate your menstrual cycle and lower your blood sugar levels, which should, in turn, reduce insulin levels.
- Prescribed medication: The contraceptive pill is often recommended as it has been found to induce periods for most women who have irregular ones or none at all. The pill also reduces male hormone levels. Some pills contain anti-androgens (e.g. Yasmin, Dianette) which will reduce elevated levels of male hormones even more and can help stop excess hair growth and acne. Metformin, a drug used by people with type II diabetes, can also help regulate hormonal levels and induce ovulation in some women. There are numerous supplements out there but the one for women with PCOS to consider is inositol. This is increased by metformin and makes your body more sensitive to insulin.
- Laparoscopic ovarian drilling (LOD) or diathermy: This is a low-risk procedure performed under general anaesthetic. Your doctor inserts a small telescope into your abdomen, through or just below your belly button that allows them to directly visualise your ovaries, womb and fallopian tubes. A second, finer instrument is then inserted through your lower abdomen, and this is used to make tiny holes in the surface of both ovaries (the drilling or diathermy). Whilst this sounds invasive and odd, to say the least, it is incredibly effective as 80% of women with PCOS who do not ovulate despite fertility medications (e.g. Clomid or clomiphene) resume menstruation without the need for further treatment. It can also reduce the level of male hormones and luteinising hormone (LH), thereby correcting the hormonal imbalance.
- Assisted conception and IVF: Some women with PCOS ultimately need IVF to conceive. It is essential the clinic approach such treatment with caution as there is a much higher risk of over-responding to the drugs used to stimulate the ovaries. It is also important to focus on maximising the quality of your eggs as this is the key determinant of success for most couples.
Research taken from TFP Fertility Group, one of the largest providers of IVF in the UK with clinics across Europe.