PCOS and Infertility: Signs and Symptoms of PCOS

What Is PCOS?

Hormones are powerful and complicated substances that our bodies produce. When our hormone levels are balanced, as nature intended, we rarely have hormone-related problems. If something disrupts that balance, problems are usually not far behind.

For example, women naturally produce a small amount of androgens, the male sex hormones. Polycystic ovary syndrome (PCOS) is when ovaries produce an abnormal amount of these androgens. PCOS is fairly common, affecting 6% - 12% of women of reproductive age in the US (about 5 million). It affects the ovaries and ovulation (release of a mature egg).

Other factors that may contribute to the development of PCOS include:

• Excess insulin. Your blood sugar levels rise if your cells become resistant to insulin, causing your body to produce more insulin. Excessive insulin may trigger increased androgen production, leading to difficulty with ovulation. ‍
• Heredity. Certain genes may be linked to PCOS. ‍
• Low-grade inflammation. Women with PCOS frequently have a low-grade inflammation that triggers their ovaries to produce more androgens. This can lead to problems with the heart and blood vessels. 

PCOS causes numerous small, fluid-filled "bubbles," or sacs, to grow inside the ovaries. Each of these sacs contains an immature egg. Normally, the presence of a mature egg will trigger the ovary to release it. This is ovulation. In PCOS, these eggs never mature, so ovulation doesn't happen. Increasingly more of these sacs containing immature eggs develop in the ovaries, causing the signs and symptoms of PCOS.    

What Are the Signs of Polycystic Ovary Syndrome?

What are some signs that could indicate you may have PCOS? Signs of PCOS may appear shortly after puberty, but it could develop later during the teen years or even into early adulthood. The first signs may point to another condition or even go unnoticed. As many as 70% of women with PCOS may go undiagnosed, sometimes for several years.

In most cases, PCOS is suspected after someone experiences two of the following three signs:

• Irregular periods. Because PCOS prevents ovulation, those suffering from this condition may have irregular or missed periods. This is a common sign of PCOS. When women with PCOS have a period, it may be unusually heavy.
• Hirsutism. Excess facial and body hair is called hirsutism and results from elevated levels of the male hormone androgen. Severe acne and male-pattern baldness may also occasionally occur with PCOS.
• Polycystic ovaries. When suffering from PCOS, the ovaries may enlarge and contain follicles, or fluid-filled sacs, that surround eggs. These eggs cannot mature and are not released, meaning the ovaries fail to function as they should.

Early diagnosis and treatment may help reduce the incidence of long-term complications.

Symptoms of PCOS

According to the American College of Obstetricians and Gynecologists, the common symptoms seen in women with PCOS include some or all of the following:

• Menstrual disorders such as absent periods, heavy periods, unpredictable periods, or periods that occur too frequently or infrequently.
• Infertility. PCOS is one of the more common causes of infertility among females.
• Obesity. Four in five women with PCOS are obese. ‍
• Hirsutism. This disorder exhibits excessive hair growth on the chest, abdomen, face, or upper thighs. It may affect over seven out of ten women with PCOS. ‍
• Severe acne. The acne that occurs during and after adolescence and does not respond to usual treatments is a symptom of PCOS. ‍
• Patches of darkened, thickened skin with a velvety texture called acanthosis nigricans. ‍
• Oily skin.
• Formation of multiple small fluid-filled sacs in the ovaries. ‍
• Skin tags, which are small flaps of excess skin usually found in the neck area and the armpits. ‍
• Mood changes. PCOS may increase the incidence of depression, anxiety, and mood swings. ‍
• Pelvic pain. This can occur any time, during a woman's period or not, along with heavy bleeding. ‍
• Headaches. Hormonal changes promote headaches. ‍
• Difficulty sleeping. Those with PCOS often report poor sleep or insomnia. Some studies show a link between PCOS and sleep apnea, where a person stops breathing for short periods during sleep. 

Symptoms of PCOS vary widely. Other conditions have similar symptoms, so women with these problems may or may not have PCOS. It is important to distinguish PCOS from other causes of irregular or absent menses such as functional hypothalamic amenorrhea or premature ovarian failure.

How Does PCOS Affect My Fertility?

PCOS doesn’t make it impossible for you to get pregnant. However, there are various side effects that can affect your fertility journey. Women with PCOS have a 30% increase in miscarriages as well as an increased chance of developing type 2 diabetes. If you believe you may have PCOS, a reproductive endocrinologist or fertility specialist is the best person to diagnose and manage your PCOS while providing you with your options.

How Is PCOS Diagnosed?

Because of the wide range of symptoms, no single test can diagnose PCOS definitively. Depending on the symptoms, it usually takes several exams and tests to diagnose this condition. These can include:

• Blood tests (FSH, LH, E2 Progesterone, free testosterone)
• Insulin: Resistance, elevated glucose, high triglycerides, high LDL (bad cholesterol) and low HDL (good cholesterol)
• Medical history
• Pelvic exam
• Thyroid: Function panel (TSH, free T4)
• Transvaginal ultrasound

Your healthcare provider will ask you questions about your past medical history and the history of your close family members. You'll be asked questions about the specifics of your symptoms, and the exam will likely include a pelvic exam.

Complications of PCOS

PCOS can disrupt the quality of daily life. There are other complications associated with this syndrome. Although this list appears daunting, your primary care physician or recommended specialists, such as fertility specialists, can address these complications. Schedule a consultation if you'd like more information.

• Infertility
• Miscarriage or premature birth
• Pregnancy-induced high blood pressure and/or gestational diabetes
• Nonalcoholic steatohepatitis, which is severe inflammation in the liver that's caused by fat accumulation
• Type 2 diabetes or prediabetes
• Metabolic syndrome, which is a group of conditions that includes high blood sugar, high blood pressure, and abnormal cholesterol or triglyceride levels
• Sleep apnea
• Eating disorders
• Depression and/or anxiety
• Abnormal uterine bleeding
• Cancer of the uterine lining, or endometrial cancer

Obesity is also associated with PCOS and is a known contributing factor to many of the complications of PCOS.

What Can I Do To Help PCOS?

Treatment for PCOS generally starts with lifestyle changes in diet and exercise, as well as proactive weight loss for those with higher BMIs. As the same steps are linked to increased fertility as a whole, Dominion Fertility always recommends a well-balanced diet and making sure you exercise at least 30 minutes a day. For more tips and information on how you can incorporate healthy lifestyle changes into your routine, read our blog on naturally increasing your fertility.

PCOS and Infertility

Because PCOS interferes with reproductive health, it is recognized as a leading cause of infertility. While some women with PCOS can and do get pregnant, a woman who has PCOS while pregnant is at higher risk for certain problems. 

Fertility Treatment for PCOS

At Dominion Fertility, once Polycystic Ovary Syndrome has been diagnosed, our patients have several optioins. A typical protocol can include starting with metformin, with a goal of controlling insulin levels, decreasing the male hormones, and improving ovulation rates. However, metformin alone is rarely enough to help a PCOS patient conceive. Further treatment may include ovulation induction, using oral medication, such as letrozole, that can induce the growth and release of a single mature egg. Letrozole can be combined with an IUI (intrauterine insemination) to enhance the chances of pregnancy. Women who fail to respond to letrozole or do not get pregnant with letrozole treatment may be candidates for injectable fertility medications (gonadotropins). Gonadotropins can be combined with an IUI or can be part of an IVF (in vitro fertilization) cycle. Success in conceiving is frequently achieved using letrozole or gonadotropins.

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Start Your Journey to Parenthood

If you suspect you're experiencing signs of PCOS, contact the fertility specialists at Dominion Fertility for an evaluation. With proper treatment, your family can grow healthy and happy. 

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