If you've been trying to get pregnant and are handed a diagnosis of polycystic ovary syndrome, it can be a lot to process. Not only are you trying to find out what is causing your infertility, but you're now also facing a health problem that can impact your ability to conceive as well as cause other symptoms and health issues. Let's take a look at what PCOS is, why it can impact fertility and what can be done about it.
PCOS is caused by a reproductive hormone imbalance. According to materials from the Office on Women's Health, typically, there is a certain rhythmic ebbing and flowing of reproductive hormones, including estrogen and progesterone, that work carefully together to release an egg at the proper time during the menstrual cycle. But hormone levels can be impacted by many factors, including having high levels of male hormones (also known as androgens) or producing too much insulin, and this can put your whole system out of whack the OWH explains. Understandably, it's not hard to see how ovulation problems can make trying to conceive difficult, if not impossible.
"PCOS is the most common endocrine disorder affecting women of reproductive age," Dr. Ilana Ressler, a reproductive endocrinologist with RMA of Connecticut who specializes in patients with PCOS, tells SheKnows.
According to Ressler, PCOS is diagnosed when a patient meets two of the following three criteria:
- Irregular menstrual cycles,
- Elevated androgens, which are “male hormones,” like testosterone, or having symptoms of elevated androgens (e.g., acne or excess/unwanted hair growth) and
- Polycystic-appearing ovaries on ultrasound.
Dr. Christine Mullin, a physician and director of the in vitro fertilization program and preimplantation genetic diagnosis program at Northwell Health Fertility, tells SheKnows that PCOS is most often detected in early adulthood (late teens and 20s) and can cause enlarged ovaries in addition to cystlike follicles within the ovaries.
How can PCOS impact fertility?
It all boils down to hormones, both docs say. PCOS often interferes with ovulation, which means maybe you'll ovulate, and maybe you won't. Also, in addition to irregular ovulation, Mullin says that those with PCOS can have prolonged menstrual cycles, where you have no idea when or if you're ovulating, and it can take months to have a period.
"This makes it difficult to determine your most fertile times, and therefore, [it's] difficult to conceive," she says. "If you’re not ovulating, an egg cannot be fertilized by sperm, so you can’t get pregnant."
What treatments are available for someone with PCOS who wants to conceive?
For those who are not interested in conceiving, treatment for PCOS is pretty easy — Mullin says, "Typical treatment for PCOS is birth control because most birth controls contain the hormone progestin that can help to alleviate symptoms."
For people who do want to get pregnant, however, it becomes a bit more complicated, she says. "Things get a bit more complex for women who are planning for a family, but there are medications like clomiphene, letrozole or metformin that give women a similar dose of hormones that birth control provides, which can help to regulate ovulation and menstrual cycles," Mullin explains.
If oral medications don't work out, Mullin says there are other options, including injectables. And if there is a continued struggle, there are still other options, Ressler notes, including IVF.
While conception troubles are stressful, it's helpful to know that there are treatments available if you're experiencing PCOS. As Mullin says, "It may take longer for women with PCOS to conceive, but ultimately, with the right dose of hormones and some patience, successful pregnancies are quite common."