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PCOS, Ovulation and Fertility

7 September 2020

Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition affecting 5-10% of women of reproductive age. In PCOS, the ovaries are bigger and have many follicles that contain immature eggs. It is the number one cause for non-ovulation and is often associated with infertility and metabolic disorders.

How do I know if I have PCOS?

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 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

PCOS, ovulation and fertility

PCOS is one of the most common causes of female infertility, representing 80% of all cases of infertility related to non-ovulation. Women with PCOS may have eggs that either don’t fully mature or aren’t released from the follicles. This is often related to hormonal changes. 

  • LH and FSH are hormones that encourage ovulation. Most women have equal amounts of LH and FSH during the beginning of the cycle and have an LH surge about 24 hours before ovulation. In PCOS, women may have LH levels two or three times above FSH levels. The change in LH to FSH ration is enough to disrupt ovulation.
  • Women with PCOS also tend to have increased levels of testosterone and dehydroepiandrosterone (DHEA-S), which can suppress normal menstruation and ovulation.
  • Progesterone levels can be used to check if the egg was released or not. By measuring progesterone 7 days after ovulation, if the levels are greater than 14ng/ml, ovulation has occurred. If levels are low, the cycle was anovulatory. This is important because you may have signs that ovulation happened, but the egg hasn’t actually been released from the follicle.

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. As you improve your lifestyle, you can continue using myLotus to track your LH levels and time intercourse to your fertile window.

If ovulation isn’t happening, the doctor may prescribe clomiphene citrate. In this case, you will still be able to track ovulation using myLotus 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.

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 in women with PCOS 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 tracking ovulation for timed intercourse is enough to help them get pregnant. Sometimes the doctor may also prescribe medication to help you ovulate.

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