Polycystic ovary syndrome (PCOS) is a problem caused by an imbalance in the hormones that regulate the menstrual cycle. Because of this imbalance, the egg may not be released when it should or may not develop properly. It is a relatively common problem affecting about 10% of women of childbearing age.
In order to be diagnosed with PCOS, two of the following four conditions must be met:
- An excess of androgens, which are the “male hormones” in a blood test.
- Symptoms of high androgen levels: acne, hirsutism, thinning scalp, and so on.
- Irregular menstrual periods: Most women with PCOS have very long or no cycles at all.
- Cysts on one or both ovaries as diagnosed by ultrasound.
Causes and symptoms of polycystic ovary syndrome
There is some uncertainty about the causes of polycystic ovary syndrome. The occurrence of polycystic ovarian syndrome is thought to be multifactorial and related to genetic and hereditary factors. That is, women with PCOS are 50% more likely to have an immediate female relative (mother, aunt, sister or daughter) with PCOS.
In any case, as we have already said, not all women have all the symptoms described in polycystic ovary syndrome. In fact, many of them are unaware that they have the problem. For this reason, we will now tell you which are the most common symptoms of polycystic ovary syndrome.
Higher than normal androgen levels
Because androgen levels are higher than normal, one of the symptoms may be the appearance of hair on areas of the face, chin or parts of the body that are more common in men (between the breasts or around the nipples, for example), as well as weak or receding hairline, as in cases of male pattern baldness.
Increased androgens also contribute to acne on the face, chest and upper back.
Peripheral insulin resistance
Insulin is the hormone that controls how we use up sugar in the body to release energy. When the body’s cells do not respond normally to insulin, there is said to be a “resistance”. As a result, insulin is higher in the blood and this makes it more difficult for these women to lose weight.
Over time, insulin resistance often degenerates into type II diabetes, especially if the woman has poor eating habits, doesn’t get enough exercise or if there is a family history of diabetes.
Peripheral insulin resistance can also lead to patches of darker skin around the armpits, groin and neck.
Progesterone disruption
Disruptions in the levels of progesterone, one of the key hormones in the regulation of the menstrual cycle, cause erratic cycles.
Hormonal imbalances
Hormone imbalance can also lead to mood disturbances: anxiety, depression and eating disorders are among the most common.
In summary, polycystic ovary syndrome is closely related to other diseases such as diabetes, as mentioned above, as well as hypertension, hypercholesterolemia (high blood cholesterol that can lead to heart disease or stroke), sleep apnoea due to obesity, uterine cancer and others.
Fertility implications for women with polycystic ovaries
Polycystic ovary syndrome is one of the most common causes of infertility. In fact, most women who have PCOS find out they have it when they start wondering why they are not getting pregnant.
However, having PCOS doesn’t mean you can’t get pregnant. Yes, it is one of the most common causes of infertility, but it is treatable. So what it means is that the egg, as a result of the hormonal imbalance, is not released, and the ovary doesn’t ovulate, so it has no chance of finding the sperm. But that doesn’t mean you don’t have options, even without fertility treatments, as we will see below.
Treatments for getting pregnant with polycystic ovary syndrome
Weight loss (in cases of being overweight or obese)
If you are overweight or obese, healthy eating and regular sport will help you lose weight, make your menstrual cycle more regular and reduce insulin resistance. As insulin resistance makes weight loss difficult for these women, it is advisable to consult a nutritionist for dietary advice and support. Sometimes even assistive treatments such as orlistat, or operations in the case of morbid obesity, are recommended.
In vitro fertilisation treatments
In vitro fertilisation (IVF) treatments are one of the options with the highest success rates if you are aiming to get pregnant. With this technique, we can stimulate the ovaries and induce ovulation, fertilising the egg with the sperm in a laboratory and then proceed to the implantation of the embryo in the uterus.
If you are interested, on this page we talk about the price of in vitro fertilisation that applies to the different types of treatment. These range from IVF using your own eggs and your partner’s sperm, IVF using your own eggs and donor sperm, and the ROPA method for female couples.
In terms of success rates, the cumulative probability of pregnancy in IVF using a woman’s own eggs, after three complete cycles when the embryo is at the blastocyst stage, is as high as 71%, although this varies depending on the woman’s age.
Clomiphene
Clomiphene: this is a medicine that helps a woman ovulate. It increases the secretion of the LH and FSH hormones, which will help the egg to form and be released. It is normally used for six months at a time under medical supervision. There are other alternative medications, such as letrozole or gonadotropin injections, which stimulate the ovaries.
Surgery
Sometimes, depending on the causes of PCOS, they can be treated surgically.
Can polycystic ovary syndrome affect my pregnancy?
Polycystic ovary syndrome is a condition that can affect women, as they have a higher rate of miscarriages. Also, due to insulin resistance, they often have gestational diabetes, so their pregnancies have to be closely monitored and are treated as risk pregnancies.
Other possible pregnancy problems in women with PCOS influence the likelihood of having premature babies, or having babies that are too large (macrosomia, which increases the risk of caesarean section) or having high blood pressure in pregnancy or at delivery (pre-eclampsia or eclampsia).
