Polycystic Ovary Syndrome & Fertility
Polycystic ovary syndrome (PCOS) is a chronic disorder that involves a hormonal imbalance that causes abnormal functioning of a woman’s ovaries. Women with this disorder have elevated levels of androgens or male hormones. The condition often begins at puberty and worsens as a woman ages.
PCOS affects 6 percent to 15 percent of women in the United States. Among women who are infertile, from 30 percent to 40 percent have this condition.
Women with PCOS experience irregular menstrual periods, or have no period at all. Without a regular menstrual period (every 25 to 35 days), there’s a greater likelihood that no eggs will be released for fertilization. PCOS is often associated with abnormal growth of facial or body hair (hirsutism) and excessive acne. Weight gain also is associated with this condition in the majority of cases.
Polycystic ovary syndrome is often associated with metabolic syndrome, a term that describes a group of metabolic risk factors that appear in a person. The main features include insulin resistance, high blood pressure and cholesterol abnormalities. Excessive weight or obesity also is common. Any three of the following traits must be present in a woman to meet the criteria for metabolic syndrome:
- Abdominal obesity — waist circumference over 88 cm (35 inches)
- Serum triglycerides (cholesterol) 150 mg/dl or above
- HDL cholesterol 50mg/dl or lower
- Blood pressure of 135/85 or more
- Fasting blood glucose of 110 mg/dl or above
It is believed that genetics (family history) may play a role for some women who have PCOS. The condition is more prevalent among Hispanic women, and also tends to appear in some women who gain a great deal of weight.
There is no known cause for PCOS. However, women with this condition often have many small cysts on their ovaries, which give the condition its name (polycystic ovary syndrome).
Diagnosis includes learning about a woman’s menstrual cycle history and testing blood for hormonal levels. An ultrasound test can reveal an abnormal appearance of the ovaries — another indicator of PCOS. The physician also will look for excess hair growth and acne.
Women with PCOS are at significantly higher risk for high blood pressure, type 2 diabetes, heart disease, and high lipid (blood fat) levels. Much of this risk can be reversed by weight loss. If a woman with PCOS does become pregnant, she also faces a high risk of having gestational diabetes.
While PCOS can be difficult to treat, a combination of weight loss and medication is often beneficial for many women. The success of medication use often is enhanced by weight loss.
Weight loss through diet and exercise can help many women with PCOS to reduce their symptoms. In some cases, losing just 5 percent of body weight can help a woman return to regular menstrual periods. Weight loss also can help to lower a woman’s risk for other health problems associated with PCOS.
Medication may be prescribed to reduce symptoms or to help a woman become pregnant. The need for medication will vary with each woman and her circumstances. For women who do not wish to become pregnant, birth control pills can help to reduce symptoms. For women who do wish to become pregnant, a fertility pill (clomiphene) can be used to induce ovulation. A medication called metformin can help to control elevated insulin levels.
Other options exist for women with PCOS who wish to become pregnant, including in vitro fertilization.