Treatment Options
Polycystic Ovary Syndrome
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is a common condition caused by an imbalance in reproductive hormones. This hormonal imbalance can lead to reproductive complications that may prevent an individual from successfully conceiving. PCOS is one of the leading causes of infertility among women of childbearing age. The term, “polycystic” means many cysts. The disorder is commonly characterized by causing fluid-filled sacs to grow on ovaries that may also be larger than average in size. PCOS is stated to affect as much as 5 million women in the United States; however, according to the PCOS Foundation, that number may be higher as less than half of all women with the condition have been misdiagnosed.
The Cause of PCOS
Although this condition is highly prevalent, the exact cause of the syndrome is still unknown; however, women with PCOS share these common factors that are consistently present: hyperandrogenism and insulin resistance.
Higher than Normal Androgen Levels
Androgens are a set of hormones that are involved in the development of male characteristics, such as testosterone. Androgen is also present in females in smaller amounts; however, women with hyperandrogenism, or androgen levels that are higher than normal, may experience complications or symptoms that may inhibit their ability to achieve pregnancy.
Insulin Resistance or High Levels of Insulin
In normal circumstances, insulin is a hormone that helps the body regulate the intake of glucose for energy. However, studies have found that women struggling with PCOS often experience insulin resistance, hindering their ability to effectively metabolize nutrients for energy and leading to elevated blood glucose levels and changes in sugar metabolism
Common Symptoms of PCOS
Due to hormonal imbalance or insulin resistance, women who are struggling with PCOS may experience the following symptoms:
- Irregular or absent periods
- Anovulation
- Excessive hair growth on the face and body
- Thinning hair or balding
- Acne or oily skin
- Diabetes
- Weight gain
- High blood pressure
- Patches of thickened and/or darkened skin
- Increased urination
- Higher depression and anxiety levels
- Infertility
PCOS and Fertility
PCOS may potentially interfere with the maturation of eggs and ovulation. This leads to a lack of healthy and matured eggs to be released from the ovaries for fertilization. The infertility rate among patients with PCOS is high, as they find it difficult to become pregnant on their own. The key factors contributing to infertility in individuals with PCOS include:
One of the primary characteristics of PCOS is irregular or absent menstrual cycles, which often result from anovulation and the lack of regular ovulation. Ovulation is the process where a mature egg is released from the ovary. Without ovulation, there is no egg available for fertilization by sperm, making conception difficult.
PCOS is associated with elevated levels of androgens, which are male hormones such as testosterone. High levels of androgens can disrupt the normal functioning of the reproductive system, leading to irregular ovulation and problems with egg maturation.
Many individuals with PCOS also experience insulin resistance, a condition where the body’s cells do not respond effectively to insulin. This can lead to higher levels of insulin in the bloodstream, which in turn can increase androgen production and disrupt normal ovulatory function.
In PCOS, the ovaries often contain numerous small follicles, which are the structures that house immature eggs. These follicles may struggle to mature properly, leading to a lack of dominant follicles that are required for ovulation.
Elevated levels of luteinizing hormone (LH) are often seen in individuals with PCOS. An LH surge is necessary for triggering ovulation, but in PCOS, this surge may not be well-coordinated with other hormonal signals, leading to irregular ovulation.
The uterine lining (endometrium) may not develop normally due to irregular hormonal patterns in PCOS. This can affect the implantation of a fertilized egg and increase the risk of early pregnancy loss.
Chronic low-grade inflammation is commonly associated with PCOS. Inflammation can disrupt normal hormonal signaling and impact overall reproductive health.
Diagnosing PCOS
Your OB/GYN or fertility doctor may screen your condition by looking at a combination of factors and tests to best evaluate you a diagnosis for PCOS.
Ultrasound: If your ovaries appear to have 10+ resting follicles or a circle of resting eggs, also referred to as “string of pearls”, a physician may interpret that as a sign of PCOS.
Blood Test: A specialist will look at your AMH level and if there are high levels of androgen (testosterone, DHEA sulfate, etc.). Additional testing may be ordered to measure triglyceride levels or measure glucose tolerance, cholesterol levels, and triglyceride levels.
Symptoms: Having cysts on ovaries alone does not lead to a PCOS diagnosis. Your doctor will evaluate all your symptoms to look for common signs of the syndrome.
Lifestyle Changes
Although there is yet to be a known cure for PCOS, individuals can start implementing lifestyle changes that could potentially address the common symptoms of the disorder and increase the chances of achieving a successful pregnancy.
Weight Loss
Gaining a significant amount of weight can affect hormone levels. Our fertility specialists may recommend losing at least 10% of your body weight to potentially bring hormonal levels back to normal. Weight loss may also assist with regulating your menstrual cycles better and help with irregular periods.
Reducing Sugars and Carbohydrates Intake
As most women with PCOS have insulin resistance, having excessive amounts of foods high in sugar or carbohydrates may potentially lead to complications. To avoid a buildup of glucose in the blood, a diet consisting of low glycemic index foods will allow insulin to be released at a lower rate, promoting the body to use foods as a source of energy rather than storing it as fat. Complex carbs should also be preferred over refined carbs, which are often found in processed foods.
Exercise
Not only will exercising lead to weight loss, increasing daily workouts and activities will also help build muscle mass, which could help decrease the insulin resistance prevalent in PCOS, lower cholesterol levels, and may help with hormonal levels and imbalance.
Treatments
Treatment varies significantly based on a physician’s evaluation of your medical history, current fertility conditions, and diagnosis. Some PCOS patients may be given oral medication such as Clomid or Letrozole to assist with ovulation by helping eggs grow. Ovulation induction may also be done through injectable FSH medications if oral medication alone does not stimulate the eggs to grow. Supplements such as prenatal vitamins may also be ordered for the patient. Possible procedures a physician may recommend IUI or IVF.
If you believe you are struggling with PCOS and are seeking the best course of treatment, schedule a consultation with us today to speak with a fertility specialist.