diagnosis guide
If you’ve just received a medical diagnosis, or you’re concerned that something in your present or past health history might be jeopardizing your fertility, check here for quick info on common medical conditions and how they can affect conception and pregnancy.
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Polycystic Ovary Syndrome (PCOS)
What It Is
An overproduction of male sex hormones (such as testosterone) in the woman’s ovaries, which disrupts normal, healthy ovulation. Most women with PCOS have ovaries that are riddled with cysts—little sacs of liquid that represent eggs that didn't develop properly.
Experts aren't sure but most believe the underlying cause of PCOS is a metabolic disorder in which the body doesn't handle insulin properly and develops an insulin resistance. Untreated, PCOS can not only cause infertility and miscarriage, but may lead to serious health problems, such as heart disease, diabetes, and later in life to endometrial cancer.
Who Gets It
Women. 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, lack of exercise, and eating a diet high in simple carbohydrates, plus junk and fast foods encourage insulin resistance and can lead to PCOS.
Symptoms
The most common 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. As many as 85 to 90 percent of women with PCOS are overweight.
How It's Diagnosed/Detected
PCOS is often misdiagnosed since the symptoms are diverse enough that doctors may not put the pieces together. For instance, a woman may visit her dermatologist for acne and her ob/gyn for her irregular periods.
The American Association of Clinical Endocrinologists has agreed on the following criteria for diagnosing PCOS. A woman is considered to have the condition if she fits the following three criteria: (1) She has a history of irregular menstrual cycles and/or cycles with no ovulation, beginning at puberty, (2) she has high levels of male hormones, as measured by a blood test, (3) and her symptoms aren't caused by other disorders, such as low thyroid or an adrenal gland tumor.
If your doctor suspects you have PCOS, she should take a careful history, order blood tests (for male hormones, but also to rule out other hormonal problems), and perform a physical exam, which should include a transvaginal ultrasound evaluation of your ovaries. Most women with PCOS have ovaries that are riddled with cysts—little sacs of liquid that represent eggs that didn't develop properly.
How It Affects Fertility (And Pregnancy)
Women with PCOS can get pregnant if they treat PCOS and tackle its underlying causes (see below).
Treatment
When your immediate concern is getting pregnant, you need to tackle PCOS on several fronts. First and foremost: Try to lose some pounds if you're overweight. Many experts recommend that women try weight loss, along with improved diet and exercise, for three to six months before they turn to medication.
When lifestyle changes alone don't help you conceive, the first treatment of choice is Metformin, a drug used to regulate blood sugar levels in people with Type 2 diabetes. In women with PCOS, even those who are lean, Metformin often jumpstarts ovulation, probably by normalizing the body's use of insulin, which helps get hormones back into healthy balance.
Pregnancy Prognosis
In one study, 40 percent of obese PCOS patients who lost as little as 5 percent of their body weight (just 10 pounds if your weight is 200 pounds) achieved a spontaneous pregnancy, with no other intervention at all. Even if shedding some pounds alone doesn't solve PCOS-related fertility woes, it will still help you have a better response to fertility drugs if you need them. In a recent study of PCOS patients who weren't ovulating, 40 percent of those given 500 milligrams of Metformin two or three times daily ovulated, and of those women, 79 percent became pregnant. The women in the study who didn't conceive on Metformin alone were then also given a low dose of Clomid—a medication to induce ovulation, which only has a 11 to 20 percent success rate when used by itself in PCOS patients. But when combined with Metformin, Clomid increased pregnancy rates to 89 percent. Fertilization rates with IVF also appear to be bumped up by as much as 20 percent when women with PCOS are given Metformin a month before ovulation induction. Some fertility experts also feel Metformin is important in preventing miscarriage—a problem that plagues women with PCOS at three times the normal rate. In a study of women who became pregnant on Metformin and continued taking the drug throughout their pregnancies, the rate of miscarriage was 8.8 percent compared to 41.9 percent in women who stopped taking the drug.
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