Polycystic ovary syndrome impact on fertility: Understanding causes, signs, and implications
Polycystic Ovary Syndrome (PCOS), a common hormonal disorder affecting women of childbearing age, disrupts ovulation and often leads to irregular or absent menstrual periods, making it a leading cause of female infertility[1][2][3].
### Causes of PCOS
PCOS is typically characterised by hormonal imbalances, with elevated levels of androgens (male hormones like testosterone) and an altered ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH)[1][4]. Additionally, many women with PCOS have insulin resistance, leading to higher insulin levels, which exacerbates hyperandrogenism and worsens symptoms[1]. Genetic and environmental factors also play a role in PCOS development[1][2].
### PCOS and Fertility Challenges
The irregular or absent ovulation caused by hormonal imbalances and insulin resistance can impair fertility. Despite these challenges, many women with PCOS can conceive naturally, especially with mild symptoms or effective management[2]. Studies indicate that while women with PCOS may have a higher number of oocytes retrieved during IVF, their egg maturity, fertilization rates, and embryo development are similar to those without PCOS, suggesting that fertility treatments can be effective[1].
### Treatment Options for PCOS
Treatment for PCOS symptoms may include lifestyle changes, medications, and assisted reproductive technologies. Lifestyle modifications, such as weight loss, exercise, and stress management, can improve insulin sensitivity and restore ovulation[2]. Ovulation induction medications, like letrozole or clomiphene citrate, are often first-line treatments to stimulate ovulation[2]. Insulin-sensitizing agents, such as metformin, can help regulate menstrual cycles and support ovulation in PCOS patients[2]. If medications are insufficient, procedures like Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF) may be recommended. IVF success rates can be comparable, though obesity may worsen some outcomes in PCOS patients[1][2].
### Managing Stress and Other Considerations
Managing stress may boost fertility by avoiding long-term stress, which can affect hormones and increase insulin production. Tips for managing stress include getting regular exercise, balancing work and home life, spending time with friends and family, getting enough sleep, and finding healthful ways to manage stress. Tests to diagnose PCOS may include blood tests, ultrasound, and pelvic exam. PCOS affects approximately 10 million women aged 15-44 years in the United States[5]. Without a mature egg, ovulation or pregnancy cannot occur.
Symptoms of PCOS can include abnormal hair growth, acne, weight gain, thinning hair, infertility, irregular periods, ovarian cysts, depression, increased skin tags, and high blood sugar levels[6]. Too much insulin also increases testosterone production, which leads to some of the symptoms of PCOS. A low glycemic diet may improve symptoms and fertility in people with PCOS by avoiding foods that cause spikes in blood sugar levels, resulting in lower insulin levels and less testosterone production.
PCOS is a common and treatable cause of infertility. The first step to increase the chances of pregnancy is for an individual to see a doctor and get an accurate diagnosis. Laparoscopic ovarian drilling, a surgical option for PCOS-related infertility, involves a surgeon destroying a small amount of tissue that produces testosterone on the ovary to allow regular ovulation[7]. Endometriosis, structural problems, and fibroids are other common causes of female infertility[8].
In conclusion, PCOS primarily affects fertility by disrupting ovulation due to hormonal imbalances and often insulin resistance. Treatments focus on restoring ovulation through lifestyle modifications, medications, and assisted reproductive technologies, offering many women with PCOS a significant chance to conceive naturally or with medical assistance[2][3][4].
[1] American College of Obstetricians and Gynecologists. (2021). Polycystic Ovary Syndrome (PCOS). Retrieved from https://www.acog.org/womens-health/faqs/polycystic-ovary-syndrome-pcos
[2] Mayo Clinic. (2021). Polycystic ovary syndrome (PCOS). Retrieved from https://www.mayoclinic.org/diseases-conditions/polycystic-ovary-syndrome/symptoms-causes/syc-20353496
[3] National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Polycystic Ovary Syndrome (PCOS) Fact Sheet. Retrieved from https://www.niddk.nih.gov/health-information/women/puberty-childhood-development/polycystic-ovary-syndrome-pcos
[4] Office on Women's Health. (2020). Polycystic ovary syndrome (PCOS). Retrieved from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
[5] Centers for Disease Control and Prevention. (2021). National Survey of Family Growth 2015-2017. Retrieved from https://www.cdc.gov/nchs/nsfg/highlights/2015-2017/nsfg_2015-2017_key_statistics.htm
[6] National Health Service. (2021). Polycystic ovary syndrome (PCOS). Retrieved from https://www.nhs.uk/conditions/polycystic-ovary-syndrome/symptoms/
[7] American Society for Reproductive Medicine. (2021). Laparoscopic Ovarian Drilling. Retrieved from https://www.asrm.org/resources-and-publications/patient-resources/glossary-of-reproductive-medicine-and-procedures/laparoscopic-ovarian-drilling
[8] American Society for Reproductive Medicine. (2021). Infertility Fact Sheet. Retrieved from https://www.asrm.org/resources-and-publications/patient-resources/fact-sheets/infertility-fact-sheet
- Mens health discussions around PCOS should address the impact of elevated testosterone levels, a common characteristic of PCOS, on fertility.
- In light of the association between PCOS and insulin resistance, along with diabetes mellitus being a condition characterized by high insulin levels, research collaboration between health-and-wellness and women's health sectors could advance our understanding of these interrelated conditions.
- Science could help develop targeted treatments for low testosterone in men who are suffering from infertility caused by PCOS, as its impact on male partners' fertility has received limited attention so far.
- Given the higher prevalence of PCOS among women of childbearing age and the associated risks, such as Type 2 diabetes and cardiovascular disease, a focus on preventive measures and early detection in women's health care could contribute significantly to overall health outcomes.
