What is PCOS?
PCOS or Polycystic Ovarian Syndrome is a common hormonal condition affecting 1 in 5 women of reproductive age. In PCOS, the ovaries are bigger and have many tiny follicles that contain immature eggs. It is the number one cause for non-ovulation and is often associated with infertility and metabolic disorders.
PCOS has 3 main characteristics:
- Irregular or infrequent periods
- High levels of male hormones, which may cause physical signs such as excess hair (usually on the face, chest, back or buttocks)
- Polycystic ovaries: ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs
Your doctor will request a blood test to check your testosterone levels and a scan to check for polycystic ovaries. You may also have other signs and symptoms of PCOS: difficulty getting pregnant as a result of irregular ovulation or failure to ovulate thinning hair and hair loss on the head weight gain oily skin or acne
PCOS: Other risk factors
Women with PCOS present also present an increased risk of developing:
- Cardiovascular disease
- Diabetes type 2
- Gestational diabetes
- Impaired glucose tolerance
- Sleep apnoea
- Endometrial cancer
- Anxiety and depression
- Eating disorders
Getting pregnant with PCOS
PCOS is one of the most common causes of female infertility, representing 80% of all cases of infertility related to non-ovulation. Infertility in PCOS is not only associated with the fact that the egg is not released from the ovary, but with the fact that it may not have developed properly due to the hormonal changes.
The first line of treatment for getting pregnant with PCOS is lifestyle changes, folic acid supplements to prevent the risk of birth defects and reducing the consumption of tobacco and alcohol. Studies suggest a weight loss of just 5% can lead to significant improvement in PCOS. This can be achieved by exercising regularly and eating a healthy balanced diet. Daily food intake should include at least 5 portions of fruit and vegetables, whole foods, lean meats, fish and chicken.
To induce the ovary to ovulate, the doctor can prescribe clomiphene citrate. You will be able to track ovulation and time intercourse to your fertile window to increase your chances of conception.
Around 15% of women are resistant to clomiphene, in which case the doctor may suggest a different medication (exogenous gonadotropins – FSHr or HMG). In this case, you will also be able to track ovulation using MyLotus and time intercourse or you may have IUI – clinics in Uk are now using myLotus for IUI cycles to ensure the detection of LH and there for reduce the risk of abandoned cycles.
Laparoscopic ovarian surgery (ovarian drilling) is an option for women who are not ovulating, are resistant to clomiphene and need surgery for another reason like pelvic pain. This procedure can also improve ovulation and pregnancy rates.
The third line of treatment is IVF when previous treatments have failed. The risk of OHSS is the main complication and the doctor may adjust the medication dose to prevent it.
In conclusion, PCOS is the most common hormonal condition affecting fertility. Although some people may need IUI or IVF, for most women, lifestyle change, weight loss and monitoring their LH surge for timed intercourse is enough to help them get pregnant. Sometimes the doctor may also prescribe medication to help them ovulate.
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