The effects of PCOS on fertility

Polycystic ovary syndrome (PCOS) is a chronic hormonal disorder that is caused by the ovaries having an imbalance in hormone production. It is not an incredibly rare condition, as it is estimated that 13% of people of reproductive age have it, with a further estimated 70% of them remaining undiagnosed. It cannot be permanently cured, and those who have PCOS may face difficulties with their fertility, but it can be managed and pregnancy is still possible. In this article, a leading gynaecologist explains the effect PCOS has on fertility and the options patients can explore to overcome it.

What is PCOS?

The ovaries are the gonads of the female reproductive system, producing oestrogen and progesterone, but also androgens (male hormones) like testosterone and androstenedione. The hormone levels are balanced in such a way that the body’s hair growth, muscle mass, and menstrual cycle are regulated. However, PCOS occurs when the androgen levels are elevated, disrupting the body and menstrual cycle. It also causes small cysts to grow on the ovaries, which are the namesake of the disorder.

What are the effects of PCOS?

PCOS is often accompanied by the following symptoms:

• abnormal menstrual cycles, with heavy bleeding
• excessive hair growth on the body (called hirsutism)
• acne or oily skin
• pattern baldness (uniform thinning of the hair or hair loss on the scalp; also called alopecia)
• unexplained weight gain or difficulty losing weight
• pigmentation of the skin, especially in skin folds
• insulin resistance

People with PCOS are more likely to have comorbid conditions like type 2 diabetes and hypertension. There is also a mental toll that comes with PCOS, as patients may struggle with depression, anxiety, negativity towards their body or body dysmorphia.

Infertility or fertility issues are very common with PCOS.

How does PCOS cause infertility?

This can be due to the ovaries failing to release an egg (anovulation) during what is supposed to be the ovulation. There will be no indication of anovulation because menstruation will still occur as normal, where the blood and uterine tissue are shed, but there will be no egg amongst them.

Another way that PCOS may cause infertility could be that the uterine lining (endometrium) becomes too thick due to the hormonal imbalance, and thus the uterus is too hostile for the implantation of an egg.

Those with PCOS who have managed to successfully get pregnant are still not in clear waters, unfortunately. They have a higher risk of complications like pre-eclampsia, gestational diabetes, miscarriage, or necessitating a C-section delivery.

Can fertility be improved by treating PCOS?

PCOS cannot be cured, but there are a few treatment methods that those with PCOS may consider to improve their fertility. Sometimes, lifestyle changes can lead to a significant improvement in symptoms. Patients who have obesity or diabetes are encouraged to maintain a healthy diet and participate in regular physical exercise in order to manage their weight.

There are medicinal options like clomiphene, which induces ovulation by assisting the body in egg production, and metformin, which is primarily a diabetes medication but can lower insulin levels to help stabilise periods.

Surgical options are only explored if no other treatment has been fruitful. One procedure, called laparoscopic ovarian drilling, involves accessing the ovaries through small incisions on the abdomen and using a laser or heat source to puncture the surface of the ovaries to encourage them to release more eggs, but the results only last for around eight months, so the procedure may need to be performed multiple times if the patient is planning for more pregnancies.

In-vitro fertilisation (IVF) is another procedure that involves extracting an egg from the ovaries, and in a sterile setting, fertilising it with sperm to create an embryo. Once an embryo is considered viable, it can be transferred into the uterus of the patient and ideally, the rest of the pregnancy will proceed as normal.

If you are struggling with PCOS, or have issues with your fertility, you can consult with a specialist viaTop Doctors