Polycystic ovary syndrome (PCOS) is a disorder that doctors associate with an imbalance in female sex hormones. The imbalance can lead to a variety of symptoms and may affect a woman’s fertility.

What Is PCOS?

Every month, in women of childbearing age, tiny fluid-filled cysts known as follicles, develop on the surface of the ovary. Female sex hormones, including estrogen, cause one of the follicles to produce a mature egg. The ovary then releases this egg, and it breaks out of the follicle.

In women who have PCOS, there is an imbalance in female sex hormones. The imbalance may prevent the development and release of mature eggs. Without a mature egg, neither ovulation or pregnancy can occur. This hormone imbalance may also include an abnormal increase in testosterone, which is primarily a male sex hormone. Note that women also produce testosterone, although it is usually in small amounts.

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Causes Of PCOS

Experts do not know exactly what causes PCOS, but it may involve genetic factors. If a woman’s mother or sister has the condition, she has a higher chance than others of developing it.

Additionally, excess insulin in the body also increases a woman’s risk of developing PCOS. Insulin is a hormone produced by the pancreas, and it is used by the body to convert sugar present in food into energy. Notably, women with PCOS often have insulin resistance. Insulin resistance is the body’s inability to lower blood sugar levels correctly. Blood sugar levels can become too high, which causes more insulin production.

Too much insulin further increases testosterone production, which leads to some of the symptoms of PCOS.

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Symptoms Of PCOS

Not everyone with PCOS will have the same signs or symptoms. Also, PCOS symptoms can occur at any age or time during a person’s reproductive years. Symptoms can also change over time. Some of the most common symptoms of PCOS include:

• Abnormal hair growth on the face, chest, or back
• Acne or a darkening of the skin
• Weight gain
• Thinning hair on the head
• Infertility
• Irregular periods
• Ovarian cysts
• Depression
• Increased skin tags

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How PCOS Affects Fertility

Dr. Dakshayani Ravikumar, Clinical Director, Art Fertility Clinics, Chennai, says that the effects of PCOS on fertility can be different from person to person.

• Ovulation problems are usually the primary cause of infertility in women with PCOS. Ovulation may not occur due to an increase in testosterone production or because follicles on the ovaries do not mature.
• Even if ovulation occurs, an imbalance in hormones may prevent the lining of the uterus from developing properly to allow for the implantation of the mature egg.
• Due to unbalanced hormones, ovulation and menstruation can be irregular. Unpredictable menstrual cycles can also make it difficult to get pregnant.

Dr Dakshayani Ravikumar

Other Complications Of PCOS

Infertility is often one of the main complications of PCOS, but it is not the only one. Dr. Dakshayani lists the health conditions that women with PCOS are at a greater risk for than others:

• High cholesterol levels
• High blood pressure
• Heart disease
• Diabetes
• Weight gain
• Sleep apnea
• Depression and anxiety
• Poor body self-image
• Endometrial cancer

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When To See A Doctor?

“Anyone who is having difficulty becoming pregnant should speak to a doctor, who will be able to explain the various treatment options. Anyone who is concerned that they are unable to become pregnant or who has symptoms that may indicate PCOS, should see a doctor,” advises Dr. Dakshayani.

Even if a woman does not wish to become pregnant, getting an early diagnosis of PCOS can help prevent complications. Assessment for PCOS can help target treatment and improve the chances of conceiving. “If a woman does become pregnant, it is also essential to know if PCOS is present, as studies have found a higher risk of pregnancy complications with PCOS, such as gestational diabetes, premature delivery, and high blood pressure,” adds Dr. Dakshayani.

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PCOS Diagnosis And Treatment

There is no specific test to diagnose PCOS; doctors make a diagnosis based on several factors. Tests may include a physical exam, knowing medical history, blood tests for hormone levels and glucose levels, and an ultrasound scan.

PCOS treatment can increase the chances of conceiving in those who wish to become pregnant. It can also help people manage their symptoms. Since symptoms vary from individual to individual, treatment is not always the same. Options also depend on whether or not the woman wishes to become pregnant.

Dr. Dakshayani shares treatment options for PCOS symptoms:

• Birth control pills to help correct hormonal imbalances
• Insulin-sensitising drugs to improve the body’s use of insulin and testosterone production
• In the case of diabetes, medication to control blood sugar levels
• Exercise and healthful eating to help boost overall well-being and control weight
• Maintaining a healthy weight can help reduce insulin and testosterone levels and improve symptoms

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Fertility Treatment For PCOS

If a woman with PCOS wishes to become pregnant, the doctor may prescribe medications to regulate menstrual periods and encourage ovulation. “Surgery may be an option if the medication does not improve fertility. One surgical procedure is laparoscopic ovarian drilling, in which the surgeon makes small cuts in the abdomen and inserts a needle. Electric current is used to destroy a small amount of tissue that produces testosterone in the ovary. Decreasing testosterone levels may allow regular ovulation to occur,” explains Dr. Dakshayani.

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Tips For Increasing Fertility

Below are some lifestyle tips that can help increase fertility.

• Weight Management

Losing excess weight may help balance hormone production and increase the chances of ovulation and pregnancy. People with a low weight who have difficulty conceiving may want to see their doctor as well, as this may be another risk factor for infertility.

• Stress Management

Long-term stress can affect hormones. For example, ongoing stress can increase cortisol in the body, which may trigger a rise in insulin production. High insulin levels can lead to an imbalance in female sex hormones and infertility. Finding healthful ways to manage stress may also boost fertility. Tips for managing stress include getting regular exercise, balancing work and home life, spending time with friends and family, and getting enough sleep.

• Dietary Changes

For some people with PCOS, a low glycaemic diet may improve symptoms and fertility. This type of diet involves eating fewer foods that cause a spike in blood sugar levels, resulting in lower insulin levels and less testosterone production.

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Other Factors That Affect Female Fertility

PCOS is only one of the many possible causes of female infertility. Some other common reasons include the following.

• Endometriosis: A growth of uterine tissue outside of the uterus can also lead to infertility, especially when it develops in the fallopian tubes.
• Structural Problems: A problem with the structure of the fallopian tubes or other parts of the reproductive system can make it difficult to become pregnant.
• Fibroids: These noncancerous tumors in the uterus can cause fertility problems by preventing implantation.

However, many women with fertility problems, including PCOS, can become pregnant with medical help. The first step to take to increase the chances of pregnancy is for an individual to see a doctor and get an accurate diagnosis. By doing this, they can start treatment as soon as possible.