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Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is a commonly diagnosed condition in reproductive aged women that can affect fertility. By definition, women with PCOS have a hormonal imbalance; the ovaries produce more androgens (male hormones) than normal, which is due to high insulin levels leading to the increase in production of androgen in the ovary. 

PCOS affects 1 in 20 women of childbearing age and while there is no cure, it can be effectively managed to help you conceive.

Diagnosis of PCOS

To be diagnosed with PCOS, two of the three following criteria must be met:

  • Little to no ovulation with possible irregular menstrual cycles
  • Clinical signs of high androgen levels (unwanted hair growth, acne) or tests that show high androgen levels in the blood
  • Ultrasound of the ovaries indicating more than 12 follicles

The term “polycystic” ovaries can be misleading and sound worrisome to patients or health care providers who are not familiar with the ovaries. The “cysts” in this case are actually small ovarian antral follicles that contain eggs, and should not be confused with larger cysts that can be of medical concern.

Most women are born with these antral follicles and select one dominant follicle each month, which is then ovulated or released in anticipation of pregnancy. In women with PCOS, there is an excess amount of these small follicles, and the selection of one dominant follicle does not happen every month or sometimes does not happen at all. This is referred to as oligo-ovulation or an-ovulation, and leads to infrequent menstrual periods.

PCOS & Infertility

The main source of infertility in women with PCOS is the infrequent ovulation described above. Women who do not ovulate regularly, ovulation can be induced with oral medications such as clomiphene citrate or letrozole, and should ideally be done under the supervision of a gynecologist or reproductive endocrinology & infertility specialist.

PCOS & Pregnancy

After conceiving, women with PCOS are at risk of developing certain pregnancy complications such as gestational diabetes, preterm delivery and pre-eclampsia, and this can be exacerbated by obesity. The Endocrine Society recommends assessment of BMI, blood pressure and oral glucose tolerance prior to attempts at conceiving.1

At Laurel Fertility Care, skilled reproductive endocrinologists are available to help patients with PCOS who are having difficulty conceiving. If you are interested in learning more, please contact us to arrange an appointment.

References:

  1. Diagnosis and treatment of polycystic ovary syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2013; 98(12):4565-4592