How PCOS May Affect Fertility, and What You Can Do About It

PCOS is the number one cause of infertility in women worldwide. Though usually diagnosed during a woman’s child bearing years, PCOS starts much early in her life- some researchers say right from her conception.

The typical symptoms of  PCOS like absent or irregular periods, high levels of testosterone, starting to grow hair on the face, arms and chest and balding like a man does, all are a part of the PCOS roller coaster.

What is perhaps most devastating for a woman immediately after a PCOS diagnosis is the idea of the loss of fertility.

Most women are told that they will have to be on drugs for the rest of their reproductive life and will have to undergo fertility treatment to conceive.

This leaves most women confused, angry and, hopelessly disoriented about what to do next. Most of them, though want to know just how does PCOS cause infertility? If you are one of them, do scroll down to know more.

PCOS and infertility

This reproductive disorder causes an imbalance in important hormones in a woman’s body which enable the release of a mature egg every month leading to periods, conception, pregnancy and childbirth.

There is an imbalance in the secretion of testosterone, luteinizing hormone (LH), and other critical hormones – all of which cause a woman to stop ovulating.

Usually, women with PCOS have low levels of follicle stimulating hormone FSH and high levels of male hormones like testosterone. These affect ovulation.

The hormone imbalance also causes a woman’s ovaries to fill up with multiple cysts. This happens typically due to the high levels of testosterone in a woman with PCOS.  So, there are these multiple, faulty follicles that don't quite work right on the affected woman’s ovary. These stop the eggs from maturing and also stop the healthy follicles from working.

When a woman has PCOS, her ovaries show up as larger than normal in an ultrasound due to the presence of these multiple tiny cysts that contain immature eggs.

Women with PCOS are also at a higher risk for miscarriage, gestational diabetes, preeclampsia – a condition where the pregnant mother develops high blood pressure affecting her child, and premature delivery, according to several studies.

Polycystic ovarian syndrome has ‘ovary’ in it though it should have been insulin. Most women with PCOS are insulin insensitive. This means their body is not sensitive to the hormone insulin which breaks down sugar in their blood into energy. To bring down blood sugar levels, their pancreas has to produce higher levels of insulin. And this, in turn, increases the secretion of male hormones instead of female hormones which aid in ovulation, causing more hormonal fluctuations in an affected woman’s body. A perfect vicious circle!

Both of these, insulin insensitivity and out-of-whack hormone levels, work in tandem to cause infertility or sub-fertility in women with PCOS.

How is infertility in women with PCOS treated?

To regulate the period doctors prescribe birth control pills that contain estrogen and progestin- man-made versions of the real hormones to reduce secretion of male hormones. These ensure that the woman with PCOS menstruates every month, even though no egg is released from her ovary. The pills also control some of the other terrible symptoms of the syndrome namely acne, fatigue and hirsutism.

Usually, birth control pills have to be taken till a woman stops menstruating at menopause or when she wants to get pregnant.

Metformin is also prescribed in women with PCOS to increase insulin sensitivity and it does help in improving the ovarian health to quite a large extent especially in obese women.

It can not only improve abnormal insulin sensitivity, but also improve ovulation rates and lead to spontaneous conceptions.

In addition to birth control pills, women with PCOS are also prescribed specific fertility-enhancing medicines to help them ovulate so that they can get pregnant. These drugs are taken only after stopping the birth control pills.

Clomiphene is one such drug which helps women with PCOS get pregnant, and so is letrozole.

Women with PCOS have lesser spontaneous pregnancies as compared to non-PCOS women. And they need the help of in- vitro- fertilization more often than not to conceive.

Sometimes these drugs really don’t shake the ovaries enough to produce a viable egg and this usually happens when a woman is obese and has metabolic syndrome – a combination of high glucose, high waist-to-hip ratio, high cholesterol and triglycerides.

In this case, she has to fall back on the path less trodden which takes a detour into the realm of wholesome, nutritious foods and the right movements and exercise to relieve infertility due to PCOS.

Food, as we know, can act as medicine to heal polycystic ovaries, just like the right kind of exercise can.

Both of these will improve PCOS symptoms and allow women to conceive naturally and carry their pregnancy to term without any problem.

Last and not the least, women with PCOS need a good support system to lead normal, happy, healthy lives. They need husbands, family, friends and other like-minded women who understand what they are going through and can give them the hope and support to keep going.