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PCOS and Infertility

Updated: May 28

Polycystic ovary syndrome (PCOS) is a hormone imbalance that can impact ovulation. As the name suggested, most women who suffer from PCOS grow many small cysts (fluid-filled sacs) on their ovaries. These cysts make androgens (male sex hormones) and women with PCOS usually have a high level of androgens.


How Does PCOS Affect Reproductive Health?


As a leading culprit of infertility, PCOS can cause problems with a woman’s period, and they may find it hard to get pregnant. Additionally, individuals with PCOS may have symptoms such as weight gain, insulin resistance, acne, or excess hair growth on the face or body. Left untreated, it can ultimately lead to severe health problems, including diabetes and heart disease.



PCOS affects between 5% and 13% of women in their reproductive years and the percentage of infertility among women diagnosed with PCOS ranges from 70% to 80%. In Canada, it’s estimated that 1.4 million women may be diagnosed with PCOS.  According to the American Society for Reproductive Medicine, assessing infertility in women with PCOS or other causes of subfertility is recommended after six months of unsuccessful attempts at pregnancy, provided the couple engages in regular sexual intercourse (2 to 3 times per week) without using contraceptive methods.


What are the Risk Factors and Diagnostic Procedures of PCOS?


The causes of this condition are unknown. If your family has a history of PCOS, or type 2 diabetes, the chance of having it is higher than average.      

To diagnose PCOS, your healthcare provider will inquire about your symptoms and menstrual cycles and conduct a physical examination and probably a pelvic exam, which helps check the health of your reproductive organs. Additionally, blood tests will be performed to assess your blood sugar, insulin, androgens levels and levels of other hormones. An ultrasound may also be conducted to detect the size of ovaries and any ovarian cysts.



What are the treatment options for PCOS with the intention of getting pregnant?

 

The approach to treating PCOS varies based on several factors such as age, severity of the symptoms, overall health and whether you plan to become pregnant. Adopting a healthy lifestyle which includes regular exercise, and a healthy diet can help lose weight and reduce the risk of type 2 diabetes. For individuals intending to conceive, supplementing with folic acid can be beneficial to avoid fetal neural tube defects. Additionally, your healthcare provider may recommend medications to help your ovaries to release eggs normally. 




Clomiphene citrate stands as the primary medication for ovulation induction. The administration of exogenous gonadotropins or a surgery called laparoscopic ovarian drilling is another option. In-vitro fertilization (IVF) may also be used and is the first option for individuals with bilateral tubal occlusion or semen alterations. 


It should be noted that tubal patency evaluation and semen analysis may be needed to maximize the efficiency of treatment methods. Consulting your healthcare provider is essential as the most appropriate treatment depends on factors such as age, overall health conditions, treatment history and anxiety levels. 


References


1. Maria E Lujan, Donna R. Chizen, and  Roger A Pierson. 2008. Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies. www.ncbi.nlm.nih.gov/pmc/articles/PMC2893212/


2. Anderson Sanches Melo, Rui Alberto Ferriani and Paula Andrea Navarro. 2015.  Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. www.ncbi.nlm.nih.gov/pmc/articles/PMC4642490/



4. HealthLinkBC. 2022. Polycystic Ovary Syndrome (PCOS) www.healthlinkbc.ca/health-topics/polycystic-ovary-syndrome-pcos


5. Johns Hopkins Medicine. N.D. Polycystic Ovary Syndrome (PCOS)



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