Polycystic Ovarian Syndrome (PCOS)
What is polycystic ovarian syndrome? PCOS is an endocrine (hormonal) condition. It is diagnosed by clinical or hormonal changes associated with increased androgen activity, irregular ovulation and a characteristic appearance of ovaries on ultrasound. PCOS is common, with five to ten per cent of women of childbearing age experiencing the condition. Many women do not even know they have the condition and are often not diagnosed with it until they begin trying to get pregnant. Women with PCOS may experience one or more of the following symptoms: • irregular or only occasional periods which may be very heavy when they occur; • difficulty in getting pregnant because of irregular ovulation or no ovulation; • problems with weight management and a high upper body fat distribution; • excessive hair growth or occasionally loss of hair due to excessive hormones; • acne; • ultrasound appearance of polycystic ovaries; • prediabetes or diabetes; • abnormal blood fats, such as cholesterol.
What are polycystic ovaries? The term ‘polycystic ovaries’ describes the appearance of the ovaries on an ultrasound scan – they contain many small follicles (12 or more) and the ovaries are often larger than average. As many as 20% of women who are of childbearing age have ovaries that appear polycystic on ultrasound although many will have no symptoms of PCOS. If you have polycystic ovaries but have regular cycles and are ovulating, your fertility will not be impaired.
What causes PCOS? A genetic predisposition can cause PCOS, however other conditions such as weight gain or environmental factors may play a role. There may be a mild increase in androgen levels, causing dark thick hair growth and acne. Hormonal imbalances cause problems with sugar metabolism known as insulin resistance leading to a higher risk of diabetes. This increase in insulin can affect the reproductive and androgenic (testosterone) hormones to interrupt the normal reproductive cycle resulting in irregular periods.
Normal ovary Developing egg Uterus
How does PCOS affect my fertility?
How do you test for PCOS?
PCOS can affect your chances of falling pregnant naturally. Some of the ways it can affect your fertility include:
There is no specific test for PCOS however your doctor will consider your symptoms before testing.
• Your menstrual cycle may be irregular and ovulation erratic;
A physical examination is generally completed, followed by an ultrasound scan to check for the presence of many small follicles.
• Women who are obese have a reduced implantation rate, even with normal ovulation; • Increased risk of anaesthetic and pregnancy complications, mainly associated with weight; • Women who are significantly overweight have an increased risk of miscarriage (this is not directly caused by PCOS). For many women who are ovulating and have PCOS the causes of infertility may be due to other factors, such as tubal blockages.
Blood tests are required to make the diagnosis and may reveal altered hormonal patterns including slightly increased testosterone levels or normal levels with increased activity. These levels may vary considerably and are best assessed early in the menstrual cycle (if there is one). Blood tests may also indicate a change in blood glucose and insulin levels.
How do you treat PCOS? As the exact cause is unknown there is no single cure or treatment for PCOS. There are however a number of options available at improving symptoms, which a fertility specialist will discuss with you. These include:
Reducing your body mass index (BMI) For women who are overweight, this is the most important form of medical treatment, and can return ovulatory cycles to normal as well as reduce long-term metabolic risks. Combining healthy eating with moderate exercise is of proven benefit. For women who are not overweight, healthy eating and regular exercise are also important in maintaining wellbeing and the best reproductive health.
Insulin sensitising agents These medications, such as metformin, help to reduce insulin resistance, resulting in reduced levels of androgens and often the return of normal ovulatory menstrual cycles. Even if normal cycles do not return with the use of metformin, the success of ovulation medications for pregnancy may be improved.
Ovulation induction Medication may be required to stimulate ovulation. Such medication can include clomiphene or gonadotrophin hormones also known as Follicle Stimulating Hormone (FSH). The side effects of these medications may include bloating, breast tenderness, mood changes, multiple pregnancy and Ovarian Hyperstimulation Syndrome. When medication is not successful, in some cases, key-hole surgery is performed to reduce the number of follicles in the ovary.
Oral contraceptive pill To regulate periods and avoid overgrowth of the lining of the uterus, often hormonal treatment, such as the oral contraceptive pill may be used. The pill also helps to decrease androgen levels reducing excessive hair growth and acne symptoms.
Assisted reproduction technologies For patients who do not respond to ovulation induction, diet and lifestyle modification, there are options available including assisted reproductive technology procedures such as in vitro fertilisation (IVF).
Support Coping with infertility caused by PCOS can be emotionally challenging and frustrating. At Melbourne IVF we offer confidential fertility counselling services at any time during treatment, encouraging you to take positive steps so you can feel more in control of your treatment, emotions and physical health.
When to seek advice? If you have been trying to fall pregnant for 6 months and have any of the conditions outlined within the section ‘What is polycystic ovarian syndrome?’, it is recommended you seek advice from your GP or a Melbourne IVF fertility specialist. For some women with irregular periods, a thick lining may build up in the uterus which in rare circumstances can cause uterine cancer. If you do not have regular periods, it is important you seek advice from your doctor.
More Information Melbourne IVF can help provide you with more information via phone or through our website. Talk to our Community Liaison Administrator about making an appointment with a Melbourne IVF Fertility Specialist at one of our fertility clinics around Melbourne, by calling 1800 111 483.
PI-COM-0085.3 | 8APRIL2016