PCOS

Polycystic Ovary Syndrome and Infertility

An Overview of PCOS & Infertility

Women with PCOS sure have their share of frustrating symptoms, including acne, excessive hair growth, balding, and weight gain. On top of all those, up to 70 percent of women with PCOS suffer from infertility. PCOS is, in fact, the most common cause of ovulatory infertility. If you have PCOS and suffer from infertility, here’s information about your treatment options and how to get support. 

Why Do So Many Women With PCOS Struggle With Infertility? 

A hallmark sign of PCOS is irregular or absent menstrual periods.

Some women with PCOS may not get a period for months, even years, while others will experience bleeding for several weeks at a time. A small percentage of women with PCOS will experience monthly cycles. 

Irregular or absent menstrual cycles in PCOS are due to an underlying hormonal imbalance. Normally, sex hormones are secreted at a steady pulse rate. In women with PCOS, luteinizing hormone (LH) is secreted at a rapid pulse rate.

This, in turn, sends signals to your ovaries to pump out higher levels of male hormones, such as testosterone. As a result, too much LH and testosterone throws off the levels of other sex hormones that work to control your menstrual cycle and affects ovulation. 

In PCOS, instead of a follicle maturing and getting released to be fertilized for pregnancy, the follicle never fully matures and sometimes doesn’t get released from the ovary. Tiny follicles that are incorrectly referred to as “cysts,” sometimes surround the ovary appearing as a string of pearls on an ultrasound. These are the follicles that never matured or got released from the ovaries.

 

PCOS and Infertility: Treatment Options

Infertility is commonly diagnosed after a couple has been unsuccessful at pregnancy for 12 months or longer. Knowing the risk, doctors may treat women with PCOS for infertility sooner than this. Miscarriages are also common in women with PCOS and can be due to the imbalance of sex hormones and higher levels of insulin

While pregnancy may seem hopeless, there have been many positive medical advancements to help women with PCOS conceive. 

Lifestyle Modifications

Changes in your lifestyle can make a big difference for regulating hormones and preparing your body for pregnancy. This, in turn, can improve your egg quality and ovulation, increasing your chances of conceiving. If you are overweight, losing as little as 5 percent of your total body weight has been shown to improve fertility in PCOS. Making changes to your diet, exercise, stress level, and sleep quality can all help to improve your fertility. 

Healthy Diet

The best diet for PCOS is an antioxidant-rich one that focuses on moderate amounts of unprocessed carbohydrates.

These include fruits, vegetables, beans, lentils, and grains, such as quinoa and oats. Including fats from unsaturated sources, such as olive oil, nuts, seeds, fish, and avocado is recommended. 

Avoiding refined or processed sources of carbohydrates, such as crackers, white bread, white rice, pretzels, and sugary foods like cookies, brownies, and candy is suggested to bring down insulin levels and inflammation. 

If you aren’t sure where to start, consider consulting with a registered dietitian nutritionist who can assist you with making sustainable changes to your diet. 

Regular Physical Activity

Studies show that regular exercise can improve ovulation and insulin resistance. In studies, women with PCOS who engaged in moderate exercise three or more days a week had better fertility than those who followed a low calorie diet plan. 

Try and get in at least 30 minutes of physical activity each day. This amount can be divided up into three, 10-minute segments or two 15-minute segments. Walking is one of the most accessible activities available and can be scheduled in during the day.

 

Acupuncture 

Acupuncture may help you conceive. This alternative treatment has been shown to improve hormone balance, BMI, and endometrial thickness in women with PCOS. Acupuncture can be done alone or in conjunction with assisted fertility treatments. 

Supplements

New research is now showing the benefits of certain supplements for improving ovulation, egg quality, and restoring hormone balance in PCOS. 

Inositol

Taking myo and d-chiro inositol in a 40:1 ratio has been shown to improve egg quality and ovulation in women with PCOS in as little as three months, and may even work better than metformin. When compared with metformin, a combination of myo and DCI in a 40:1 ratio showed significantly better results in regards to weight loss, ovulation, and pregnancy rates (46.7 vs.11.2 percent).

N-Acetylcysteine

N-Acetylcysteine (NAC) is a powerful antioxidant that fights oxidative stress and has been shown to improve pregnancy and ovulation rate in women with PCOS when compared to a placebo. 

Vitamin D 

Vitamin D is not only a vitamin but a hormone as well.

Vitamin D receptors have been found on a women’s eggs. Supplementing with vitamin D has been shown to improve egg quality and ovulation in women with PCOS on its own or while undergoing assisted reproductive therapy. 


Metformin

Metformin is the most common diabetes drug that has been useful to reduce insulin resistance in women with PCOS. For many women with PCOS, metformin can also improve menstrual regularity. There are studies that show that metformin may also reduce the risk of miscarriage and gestational diabetes. 


Clomid and Letrozole

Sometimes women with PCOS still need help improving their ovulation despite diet and lifestyle changes. Clomid has traditionally been given to women to improve ovulation. Newer research shows that letrozole may work better than clomid for women with PCOS. Letrozole doesn’t raise estrogen like clomid and seems to result in fewer multiple births. 


Gonadotropins for PCOS

The use of gonadotropins can also help women with PCOS conceive. Gonadotropins are made of the sex-hormones FSH, LH, or a combination of the two. Your doctor may suggest combining these hormones with fertility drugs or using them on their own. For example, letrozole with a “trigger” shot of LH mid-cycle.

Another option your doctor may recommend is using gonadotropins with an IUI (intrauterine insemination) procedure. IUI involves placing specially washed semen directly into the uterus via a catheter. The semen may be from a sperm donor or your partner.

A major risk of gonadotropins is ovarian hyperstimulation syndrome (OHSS). This is when the ovaries overreact to the fertility medication. If untreated or severe, it can be dangerous.

Intrauterine Insemination

Intrauterine insemination (IUI) is a fertility procedure timed to coincide with ovulation. Your partner will be asked to produce the semen specimen. The semen is then “washed” or the sperm is separated from other elements of the semen and gathered into a smaller, more concentrated volume. The specimen is placed into a thin, sterilized, soft catheter, and ready for insemination. A speculum, like one used during a gynecological exam, is placed in the vagina and your cervix is gently cleansed. Your doctor will insert the catheter in the vagina and release the sperm into your uterine cavity. Your doctor may allow you to remain lying down for a few minutes after the insemination. Success rates for IUI are approximately 15 percent to 20 percent per cycle and vary based on a number of factors, such as your age, type of ovarian stimulation, motility of sperm, among others.

In Vitro Fertilization

In vitro fertilization (IVF) is a more invasive and costly fertility procedure that is sometimes used if all other fertility treatments fail. IVF involves using injectable fertility drugs to stimulate the ovaries, so that they will provide a good number of mature eggs. The eggs are then retrieved from the ovaries and combined with sperm into petri dishes. If the eggs become fertilized, one or two are transferred into the uterus. This procedure is known as an embryo transfer. Two weeks later, your doctor will order a pregnancy test to see if the cycle was a success.  

When to Seek Help If you Experience Infertility 

If you have been struggling to get pregnant, you may want to seek the advice of a reproductive endocrinologist, also called “fertility doctors.” These type of doctors specialize in sex hormones and tend to have ultrasound machines in their offices to help determine your cause of infertility and provide the recommended treatment. 

Coping with infertility is hard on women and couples, especially when it seems that everyone around you is getting pregnant. If you find infertility has taken an emotional toll, consider working with a trained mental health professional or joining an infertility support group in your area. 

Sources:
Ghomian, A Randomized Clinical Trial on Comparing The Cycle Characteristics of Two Different Initiation Days of Letrozole Treatment in Clomiphene Citrate Resistant PCOS Patients in IUI Cycles. Int J Fertil Steril. 2015 Apr-Jun; 9(1): 17–26.

Johansson J. Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction. Evid Based Complement Alternat Med. 2013;2013:762615. doi: 10.1155/2013/762615. Epub 2013 Sep 2.

Le Donne M, Alibrandi A, Giarrusso R, Lo Monaco I, Muraca U. [Diet, metformin and inositol in overweight and obese women with polycystic ovary syndrome: effects on body composition]. Minerva ginecologica. 2012;64(1):23-29.

Ott J et al. Parameters for calcium metabolism in women with polycystic ovary syndrome who undergo clomiphene citrate stimulation: a prospective cohort study. European J Endocrinol. 2012;166(5):897-902.

Thakker D, Raval A, Patel I, Walia R. N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled clinical trials. Obstet Gynecol Int. 2015;2015:817849.

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