Hope for Women with Polycystic Ovarian Syndrome (PCOS)

“There are treatment options that improve ovulation, and alongside lifestyle alterations, women who have PCOS may be able to get pregnant.”

Unknown Cause

Described by Italian doctor Antonio Vallisneri in 1721, the exact causes of Polycystic Ovarian Syndrome (PCOS) are not known, but it is postulated that environmental, lifestyle and familial factors may predispose a woman to get PCOS. However, with the option of treatments that improve ovulation alongside lifestyle alterations, women who have PCOS may be able to get pregnant.

The Regular Cycle

Having regular menstrual cycles is a sign that important parts of the female body are working normally. The menstrual cycle provides the body with important chemicals called hormones which are important to keep one healthy. It also prepares the body for pregnancy.
For sufferers of PCOS, hormonal imbalances cause irregular menstrual cycles, which means that ovulation does not take place as and when it should. This impedes and reduces the chances of one becoming pregnant.

Normal Circumstances

Under normal circumstances, the pituitary gland, located at the base of the brain, produces hormones that direct the function of the ovaries. Each month, the gland secretes the Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) into the bloodstream. When these hormones reach the ovaries, immature eggs start to mature, expanding the size of the follicles that hold the eggs. As the eggs mature, the follicle secretes estrogen which is the main female sex hormone.
Once the amount of estrogen reaches a certain level, the follicle opens, releasing the egg in a process called ovulation. The free egg travels down through the fallopian tube where it awaits fertilisation. Eventually, the remaining follicles and eggs dissolve. If the egg which has been released is not fertilised, the egg and the lining of the uterus are shed in the next menstrual period.

The Disrupted Cycle

If one has PCOS, the pituitary gland may release abnormally high levels of LH into the bloodstream. As a result, the follicles do not mature and subsequent ovulation and menstruation fail to take place. The immature follicles do not dissolve and remain as fluid-filled sacs or cysts. This disrupts the menstrual cycle.

Increased levels of LH also lead to excess production of the male hormones testosterone and androgens. This circumstance further impedes ovulation. As a result, sufferers of PCOS experience irregular menstrual cycles, making it difficult for them to get pregnant. Externally visible conditions brought on by excess male hormones, such as increased hair growth on the face and body, are also seen in women who suffer from PCOS.

Insulin Resistance

Subsequently, higher levels of insulin may also be found in the bloodstream as women with PCOS tend to be insulin resistant. This means their cells are unable to make efficient use of insulin which is produced from the pancreas to metabolise sugar for energy. When cells do not use insulin efficiently, the body’s demand for insulin increases and the pancreas makes even more insulin. Extra insulin sets off the ovaries to secrete more male hormones. In addition to infertility concerns, insulin resistance may trigger increased weight issues and heighten the risk of Type 2 diabetes and cardiac-related diseases.

Options available

With the option of treatments that improve ovulation alongside lifestyle alterations, women who have PCOS may be able to get pregnant. These include:

(a) Birth control pills can help regulate menstrual cycles and help address PCOS symptoms such as excess hair and acne. Metformin commonly known as Glucophage is a medication used in the treatment of Type 2 diabetes. In PCOS sufferers, it improves insulin levels. It can also help in reducing weight, lower sugar levels and restore the regularity of menstrual cycles. Clomiphene is a fertility medication for ovulation induction and its use increases the chances for pregnancy to take place.

(b) Surgery may be an option of choice to improve pregnancy chances if the ovulation induction with Clomiphene is unsuccessful. A procedure called Ovarian Drilling, a method that entails for small holes to be made in the ovary with a heated needle, may be administered to restore regular ovulation. Subsequently, Intra-uterine Insemination (IUI) and In-vitro Fertilisation (IVF) are the other options available if initial methods prove unsuccessful.

(c) Reducing excess weight has shown to improve blood sugar levels and increase the chances of having a healthy pregnancy. Even a 10 per cent weight reduction can help regulate menstrual cycles and improve symptoms. It also improves cholesterol levels, lowers insulin and reduces the risk of heart disease and diabetes.

Lifestyle modification

Treatment is normally applied with advice on lifestyle modification, which includes weight reduction necessitating a low carbohydrate diet and workout plan. In line with this, a low glycemic index diet plan will help one get carbohydrates and sugars from fruits, vegetables and grains. As for exercise and workouts, a moderate exercise commitment of at least three times a week can make a significant difference.

Consultation

You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. Do list them down and call 03-8076 7111 (TMC Fertility & Women’s Specialist Centre, Puchong) or 03-62871209 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.