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How PCOS can affect fertility

27 September 2020

It’s estimated that one in ten women of childbearing age is affected by Polycystic Ovary Syndrome (PCOS), making it the most common female hormone condition. While it may be incredibly common, PCOS manifests in many different ways. Some people notice that their periods become irregular or stop altogether. Other people report weight gain or excessive hair growth. Due to the fact that it’s a hormonal condition, PCOS can also have a serious effect on your fertility. When you’re struggling to get pregnant it can be incredibly frustrating and stressful. However, Allie has shared her story with myLotus about her pregnancy after being diagnosed with PCOS and the resources her doctors shared with her to help her through her fertility journey.

How can PCOS affect your fertility?

Polycystic ovary syndrome affects both ovulation and hormones and is listed as one of the most common reasons as to why people struggle to conceive. Your ovaries make and release an egg each month to either be fertilised leading to pregnancy or pass as a period. Due to hormonal imbalances, if you have PCOS an egg may either not develop or not be released during ovulation as it should.

PCOS causes your body to produce higher levels of androgens. The two main androgens are testosterone and androstenedione. Typically men produce ten times the amount of testosterone as women. People who are diagnosed with PCOS tend to have slightly higher levels of testosterone than what is usually found in women. Normally, most of the testosterone in women is converted in the ovarian follicle to oestrogen.

Androgens can interfere with ovulation as they cause hormone imbalances that lead to an egg not being released. This is why you may also notice that your period is irregular or you miss it altogether. However, if you’re trying to get pregnant but are ovulating less than normal your chances get slimmer and slimmer.

Allie’s Fertility Story

“You know some people want to be lawyers or doctors? When I grew up I wanted to be a mum. Little did I know it’d be such a rollercoaster.” Allie is 36 and lives with her partner and two-year-old daughter. While her child is still young, Allie’s fertility journey lasted almost a decade.

“I remember sitting in class, aged eleven, and learning about periods and the menstrual cycle. It was like a boogie man to me and my friends. However, over the next few years, they got theirs and realised it wasn’t so bad. It wasn’t until I was 15 and still hadn’t had my first period that I thought something may be wrong,” she says. She went to see her GP with her mum and after answering questions she was referred to a gynecologist.

In her first session with a specialist Allie says she was asked about her weight gain over the last five years, “it was steady. I went from being average weight to putting on three stones with no real explanation.” Her doctor also asked her about other symptoms. She’d noticed hair growth on her face but thinning on her head. However, due to the fact that she’d never been taught about PCOS in school, she didn’t recognise them as a sign of an underlying condition.

“At that age, you just want to be normal. When everyone is talking about having their first kiss and getting drunk for the first time you don’t want to talk about how your hair is falling out,” she says.

Over the next few months, Allie underwent hormone tests and ultrasound scans in order to be diagnosed with PCOS. The blood tests deduced she had higher levels of testosterone and after a few ultrasound scans it was found that she had a higher number of follicles in her ovaries that were filled with fluid.

In 2002 she met her partner, Rich. “We started talking about trying to have a baby in 2007 and Saffie was born in 2018.” Like so many people diagnosed with PCOS, Allie found that her condition meant conceiving would be more complicated.

Initially, her doctors told her to exercise regularly and eat a cleaner healthier diet. She was also prescribed a combination of metformin to correct her resistance to insulin and clomifene citrate to help stimulate her ovaries to release an egg.

“The early days of trying to get pregnant just felt like a lot of scans and medication. It wasn’t just a physical process. I found it so hard to get out of the headspace that it was me that was stopping us having a baby."

After a few years of trying Allie took a break. “I needed time with supportive people around me, to build my self-worth back up, take the pressure off my relationship, and look after my body.” She explored IVF and a surgery called laparoscopic ovarian drilling (LOD) which gets rid of the tissue on the ovaries that produce the testosterone.

However, after looking into her condition and options Allie started to take clomifene citrate and conceived a year later. “We took all the advice on board. I was taking medication and we completely overhauled our lifestyle. I feel our baby was a miracle and I’m so grateful. But when you go through something like that you need to be sure that you have a strong support system around you and listen to your body."

"If you need a break take a break and look after your whole being- physically and mentally.”

What is the medical advice on fertility & PCOS?

There’s no definitive answer as to what causes PCOS. While some research highlights the importance of lifestyle, diet, and wellness, other studies have said that genetics could play a big part in the likelihood that you’ll be diagnosed with it.

The NHS advises that if you’re trying to get pregnant, your PCOS may be treated in a combination of ways. Lifestyle is listed as a key factor. If your doctor considers your BMI to be too high as a result of your PCOS they may ask you to lose weight through exercise and changing your diet. A normal BMI is between 18.5 and 24.9. Your doctor may put you in touch with a dietician to draw up a food plan.

Similarly, you may be offered medication. Clomifene is listed as the first medication often offered to women trying to conceive- the medication that Allie was prescribed. Metformin may also be prescribed alongside clomifene to lower cholesterol levels and encourage monthly bleeds. Metformin is not licensed for treating PCOS in the UK but is sometimes used to control symptoms.

If you are unable to get pregnant after using medications your doctor may recommend gonadotropins and may suggest looking down the route of assisted reproductive methods.

PCOS can make it more difficult to get pregnant. However, the diagnosis isn’t a confirmation that you won’t conceive. If you are diagnosed with PCOS and are thinking of having a baby you should speak to your doctor about the best course of action.

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