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Understanding PCOS and Your Fertility

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If you’ve been diagnosed with PCOS, you may have a lot of questions. One of the most common questions we hear about PCOS is how it affects the chances of getting pregnant. The short answer is that many people with PCOS conceive and carry a pregnancy with the help of preconception care and/or fertility treatment.

Read on to learn everything you need to know about PCOS and its impact on fertility.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects 5-7% of people with ovaries in Canada. The condition makes it difficult to metabolize glucose and insulin, which can then cause levels of androgens and estrogens to go out of sync. Because of this, those with PCOS struggle to grow follicles (sacs in the ovaries that contain eggs) to maturity — meaning they often won’t regularly release an egg. This can present as irregular or missed periods.

Besides hormonal shifts, PCOS can also cause structural changes in the ovaries. For example, those with PCOS tend to have a lot of small follicles in their ovaries. As a result, their antral follicle counts are usually high, and their ovaries are often larger.

What are the Symptoms of PCOS?

Some common symptoms of PCOS are:

  • Irregular periods or no periods (amenorrhoea)
  • Acne
  • Heavy periods
  • Mood changes
  • Difficulty in becoming pregnant
  • Difficulty sleeping and sleep apnoea
  • Increased facial and body hair
  • Obesity
  • Thinning hair on the head
  • Headaches
  • Darkening of the skin in the creases on the neck, groin, and around the chest
  • Skin tags

Some people develop symptoms relating to PCOS around the time of their first period, while others may not realize they have the condition until they struggle to conceive. The number and severity of symptoms range for every patient; therefore, if you have PCOS, your experience might differ from someone else.

What causes PCOS?

A combination of factors may play a role in PCOS, including:

  • Genetics. PCOS tends to run in families.
  • Insulin Resistance. Insulin is a hormone that helps the body process sugar. Up to 70% of people with PCOS are resistant to this hormone, meaning their cells can’t use it properly. When this happens, the body overproduces insulin, triggering the ovaries to produce more androgens.
  • Inflammation. People with PCOS often have higher levels of inflammation than people without this condition. It could link this inflammation to increased androgen levels.
  • Obesity. Being overweight is a major cause of insulin resistance and may contribute to inflammation in the body.

How is PCOS Diagnosed?

The first step is for your doctor to take a detailed medical history and perform tests to confirm the diagnosis. Although patients with PCOS can suffer from a variety of symptoms, you must present with 2 out of 3 of the following to receive a formal diagnosis:

  • Irregular or no periods
  • High levels of androgens in the blood, acne, or excessive hair growth
  • polycystic ovaries (many small fluid-filled sacs on the ovaries) that are visible on an ultrasound scan

Since insulin resistance in PCOS has been linked to the development of long-term health conditions like diabetes, early diagnosis is important to manage symptoms and reduce future health risks.

How Does PCOS Cause Infertility?

High androgen levels in the body cause the ovaries to either ovulate irregularly or not at all. Therefore, many with PCOS have irregular or absent periods.

This can make it difficult for patients with PCOS to time fertile windows, since irregular menstrual cycles can make it tricky to predict when, or if, an egg has been released.

Research also suggests that over-exposure to androgens could decrease egg quality. This could mean that even if an egg is released from the ovary, it may not be of suitable quality to result in a pregnancy.

That said, infertility caused by PCOS is often treatable and many patients conceive and have healthy pregnancies.

What is the Treatment for PCOS?

While there is currently no cure for PCOS, there are treatment options that can ease the symptoms of PCOS and improve the chances of pregnancy. Recommendations can include:

  • Lifestyle modifications. Weight management through a healthy diet and exercise regime can help regulate ovulation.
  • Reducing stress levels can reduce levels of the stress hormone cortisol, which has been linked to PCOS in some patients.
  • Ovulation-inducing medications like metformin, letrozole, or clomiphene can induce ovulation in people with PCOS with very few side effects.
  • In Vitro Fertilization (IVF) can be used to help patients with PCOS to conceive if other treatment options are not successful.

Are There Any Risks Associated with PCOS Treatments?

The treatments available for PCOS carry a low risk for complications. There are, however, some rare side effects that your fertility team will monitor during fertility treatment. These may include:

  • Ovulation induction can cause more than one egg to ovulate, meaning this treatment carries the risk of a multiple pregnancy (twins, triplets, etc.). At TRIO, we carefully monitor all our patients undergoing ovulation induction.
  • Because patients with PCOS have a high number of follicles, they’re at an increased risk of developing ovarian hyperstimulation syndrome (OHSS) during IVF treatment. If you have IVF treatment with TRIO, you will be closely monitored by your medical team to reduce any risk.

If you have PCOS and are struggling to conceive, or just have more questions about the different treatment options, our team is always here for you. Please reach out and speak with a TRIO fertility specialist today.