Polycystic ovary syndrome (PCOS)–in which the ovaries overproduce male hormones–is a leading cause of fertility problems. Yet you can't always count on your doctor to diagnose it. Learn the signs, plus how to overcome it to get pregnant.
When Joy Burch, a 29-year-old nurse in Newark, Delaware, didn't get pregnant after a year of unprotected sex, she consulted her gynecologist, who prescribed Clomid to "improve" her ovulation. Another year passed and she still couldn't get pregnant. So Joy turned to a reproductive endocrinologist, who recommended a combination of injectable fertility drugs and intrauterine insemination (in which sperm are placed directly into the uterus). After ten cycles of this combination, Joy still wasn't pregnant, and she still had no name for what was causing her infertility. Finally, after more than two years of unsuccessful fertility treatments, Joy consulted another physician, who immediately identified the culprit: polycystic ovary syndrome.
Joy's experience is not unusual. PCOS goes undiagnosed in many of the five to ten million sufferers in the United States, according to the American Association of Clinical Endocrinologists. Untreated, PCOS can not only cause infertility and miscarriage, but may lead to serious health problems, such as heart disease, diabetes, and endometrial cancer, later in life. But luckily, as Joy Burch discovered (she's now the mother of twins) it's possible to control PCOS so you can get pregnant and stay healthy. The tricky part is figuring out if you have the disorder, then finding a doctor who knows how to treat it and help you get pregnant.
The Causes of PCOS
The fertility-threatening disorder occurs when the ovaries overproduce male sex hormones such as testosterone (women normally produce male hormones in their ovaries, but in small amounts). This creates a hormone imbalance that disrupts normal, healthy ovulation.
In about 80 percent of patients with PCOS, the first symptom is a menstrual cycle that is abnormally long (40 days or more between periods), chronically irregular, or absent. About 70 percent of women have extra hair growing in the sideburn area of their face as well as on their chin, upper lip, nipple area, chest, lower abdomen and thighs. Acne, especially if it persists into adulthood, is common with PCOS, as is a skin condition called acanthosis nigricans, in which a woman develops patches of light brown to black skin discoloration on the neck, underarm area, or groin. Finally, as many as 85 to 90 percent of women with PCOS are overweight, according to some estimates.
What triggers the problem in the first place? Experts aren't sure, but most believe the underlying cause of PCOS is "a metabolic disorder in which the body doesn't handle insulin normally," says Richard S. Legro, MD, professor of obstetrics and gynecology at Pennsylvania State University College of Medicine in Hershey.
Normally, the body converts food into blood sugar for energy; the pancreas produces insulin to help get the blood sugar into cells. But women with PCOS experience insulin resistance—the inability of the body to respond to and use the insulin it produces efficiently. When insulin resistance develops, the normal amount of insulin isn't able to enter cells. The body compensates by producing ever higher amounts of it, leading to a build-up of insulin in the blood. Research suggests that when the blood’s insulin level gets high enough, it can set off a chain reaction that causes hormonal regulation to go haywire. One consequence is that the body produces more male hormones and inhibits the ovary from ovulating and functioning properly.
Insulin resistance may be partly inherited, since it (and PCOS) seems to run in families. But most experts also believe it has strong lifestyle links: Obesity can cause insulin levels to rise. Lack of exercise may also play a role, according to Ronald F. Feinberg, MD, PhD, author of Healing Syndrome O: A Strategic Guide to Fertility, Polycystic Ovaries and Insulin Imbalance, who explains, "Muscle’s mass utilizes insulin. If you don't exercise and your muscles are weak, your body is less efficient at processing insulin." Finally, eating a diet high in simple carbohydrates, junk, and fast foods also encourages insulin resistance, since these foods cause your blood sugar to rise quickly, which jumpstarts your pancreas to make more insulin. So even if your weight is normal, poor exercise and eating habits may still play a role in the development of insulin resistance and PCOS.