Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders – affecting up to 1 in 5 women of reproductive age. However, unfortunately it’s often not well understood. Here we give an overview of PCOS and the relationship to fertility.
What is PCOS?
Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman’s ovaries work and disrupts hormonal balance in the body. Lots of people with PCOS don’t know they have it or have few symptoms. For others PCOS can cause things like irregular periods, easy weight gain, acne and mood changes.
There are 3 main criteria for diagnosing PCOS. You need to have 2 of these to meet the criteria for PCOS.
- Absent or reduced ovulation – this means the ovaries aren’t releasing eggs as frequently as normal. One of the possible symptoms of this is irregular periods
- High levels of androgens (such as testosterone) – this is diagnosed on a blood test or through an examination if you have symptoms such as unwanted hair
- Polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (these are actually follicles rather than cysts). This can only be diagnosed on an ultrasound scan
What are the symptoms?
For those people who develop symptoms of Polycystic Ovary Syndrome they will usually start to show in your late teens/early twenties. There are things you can do to manage the symptoms of PCOS — like diet, lifestyle changes and medications.
Some of the possible symptoms are below:
- irregular ovulation or absent ovulation
- irregular or absent periods
- heavy or very light bleeding when you have a period
- painful periods
- excessive hair growth — commonly on your face, back, buttocks, or nipples
- hair loss from your head
- weight gain or difficulty losing weight
- oily skin and acne
- difficulty getting pregnant — however most people with PCOS can still get pregnant
What are the causes?
The exact cause of PCOS is unknown but there are a couple of things that can increase your chances of having it:
Genetics – PCOS tends to run in families so your genes might play a role. If a close relative has PCOS and you have some symptoms it could be worth looking into.
Your weight – PCOS can make it easy to gain weight and can make it difficult to lose. However if you’re overweight it can make you more likely to get PCOS. More evidence is needed, but being overweight is thought to increase your levels of male hormones — which can affect your ovaries and the hormones they produce.
Your insulin levels – High levels of insulin (a hormone that helps control your blood sugar levels) can cause you to produce too much androgen hormones which is a key factor in PCOS. Insulin can be influenced by a high carbohydrate diet and an inactive lifestyle.
How to test for PCOS?
If you have irregular periods or you aren’t ovulating then it’s worth speaking to a doctor.
Since PCOS is based on three main features (irregular periods, high levels of androgen hormones, and polycystic ovaries) diagnosing it will usually involve:
- Questions about your menstrual cycle — so it’s a good idea to track your periods
- A hormone test — especially your levels of androgen hormones like testosterone
- An ultrasound scan — to check if your ovaries have a lot of follicles in them (however this isn’t always necessary)
Since PCOS can increase your risk of some other conditions they may also test for:
- Blood pressure
- HbA1c levels — an indicator of your blood sugars over the last three months
- Lipid profile — to check your cholesterol and triglyceride levels
Before giving a diagnosis of PCOS your doctor will also look to rule out other conditions that can have similar symptoms.
What impact does PCOS have on fertility?
Studies show that the majority of women with PCOS will be able to conceive and go on to have healthy babies.
People with PCOS are more likely to seek out and require fertility treatments than people who don’t have it. But research shows that over their lifetimes, both people with and without PCOS have a similar number of pregnancies and children. In fact, the majority of people with PCOS who are trying to conceive will become pregnant and give birth without any fertility treatment.
It’s common for people diagnosed with PCOS to worry about their ability to become pregnant, even if they don’t want to be pregnant any time soon. Knowing that there are options available to become pregnant can help reduce anxiety.
PCOS and ovulation
Ovulation, the release of an egg from the ovary, typically happens about once a month. Pregnancy is technically only possible if you have sex during the five days before ovulation or on the day of ovulation. But the most fertile days are the three days leading up to and including ovulation.
People with PCOS may ovulate less frequently and have irregular menstrual cycles. This can make it is harder to predict when ovulation happens which can make conceiving harder. Having sex every 2 – 3 days can ensure you are having sex within the fertile window.
Visiting your doctor about PCOS
If you have PCOS and are thinking about becoming pregnant or are struggling to conceive it is a good idea to visit your GP.
Your GP can help you optimise your health and PCOS prior to trying to conceive. There are also some tests they may want to do before you start trying.
If you are struggling to conceive your GP can refer you for further investigations or to a specialist. NICE (The National Institute of Health and Care Excellence – a body that informs best medical practice in the UK) advises that women be investigated for infertility if they have been trying for a year. However they say that if there is a known predisposing factor for infertility (such as PCOS) then doctors should make an earlier referral.
We’ve included the relevant excerpt from the NICE Guidelines below in case you want to show them to your doctor.
NICE Guidelines: Fertility problems: assessment and treatment
Clinical guideline [CG156]
184.108.40.206 Offer an earlier referral for specialist consultation to discuss the options for attempting conception, further assessment and appropriate treatment where:
- the woman is aged 36 years or over
- there is a known clinical cause of infertility (such as PCOS) or a history of predisposing factors for infertility. [new 2013]
A link to the NICE guidelines is here.
When you visit your GP they may arrange the following initial tests:
- test to confirm ovulation (mid-luteal phase progesterone)
- serum gonadotrophins (in women with irregular menstrual cycles)
- thyroid function tests (if needed), prolactin measurement (in women with an ovulatory disorder), and screening for chlamydia.
- An oral glucose tolerance test should also be offered preconception (or should be offered before 20 weeks)
If you are having difficulty conceiving with PCOS you should speak with your GP or specialist and take their advice on the best approach.
Making sure your general health is optimal can help improve your chances of conceiving.
- Taking folic acid supplements
- Stopping or reducing smoking and cutting down on alcohol
- Reviewing any medications with your doctor or pharmacist
- Having sexual intercourse every 2 – 3 days or timing intercourse around ovulation can help maximise chances of conception
For women with PCOS that are overweight even a modest amount of weight loss can improve symptoms although we realise this is easier said than done. Aiming for a 5% weight reduction can help improve ovulation and increase chances of pregnancy.
Medical treatment in PCOS usually aims to restore ovulation
- Metformin: Metformin can be used on its own to improve ovulation although there are more effective medications to stimulate ovulation
- Medications to stimulate ovulation: : Clomiphene citrate, letrazole or gonadotrophins are medications that can be used in women with PCOS to stimulate ovulation. These are usually prescribed by a fertility specialist and may require ultrasound scans to monitor the ovaries
If medications haven’t been successful then other forms of fertility treatments might be considered in women with PCOS. These include intrauterine insemination (IUI) or IVF.
- PCOS Charity. Verity.