Top 10 Things to Know About PCOS

In the fertility space, we receive a lot of questions about PCOS and how it can affect family-building. To help give you a better idea of how PCOS affects the body and fertility, we’ve compiled a list of the top 10 questions we receive about PCOS answered by ORM reproductive endocrinologist, Dr. Amanda Hurliman. 

1. What is PCOS?  

Polycystic Ovarian Syndrome, or PCOS, is an endocrine disorder. It’s one of the most common hormonal disorders in women and people of childbearing age and can lead to complications when it comes to fertility. These types of disorders usually involve an imbalance of hormones in the body, particularly estrogen and androgens (like testosterone and insulin), which can adversely impact the ovaries. 

2. What are the symptoms of PCOS? 

There are a few number symptoms that present in individuals with PCOS. Some of the most common symptoms include: 

  • Irregular menstrual cycles. The dominant hormone in the ovaries is estrogen but in someone with PCOS, a shift in hormones can lead to testosterone and androgen becoming the dominant hormone, instead of estrogen. This shift in hormones makes it harder for eggs in the ovaries to develop, ovulate, and be released. These irregular menstrual cycles can cause problems with infertility and can also put an individual at risk for ovarian cysts. 
  • Excess Androgens. Elevated levels of androgens can present themselves in the form of excess facial and body hair growth. 
  • Polycystic Ovaries.  When there are eggs in the ovaries but they aren’t receiving the hormone signals to develop, they just sit there. This causes a surplus of eggs and many follicles (the house where the egg matures) to develop and grow in the ovaries without signaling the body to select and release an egg at the appropriate time. This high number of follicles in the ovaries is where the term “poly” comes into the name, Polycystic Ovarian Syndrome. The word “cystic” is a bit of a misnomer, as the “cysts” are actually just the immature follicles within the ovaries.
  • Weight Gain. Many individuals with PCOS experience weight gain. This is likely due to a change in hormones and metabolism, making it harder for the individual to both lose weight and maintain weight loss.

3. What causes PCOS?

Interestingly, the cause of PCOS is unknown. There have been a number of research studies working to understand what exactly causes someone to develop PCOS  but a direct cause has not been identified. We do, however, have a few ideas of some factors that might play a role:  

  • Genetics: PCOS tends to run in families, so there’s likely a genetic component. At this time, if there is a specific gene or genetic mutation that’s responsible for the development of PCOS, it has yet to be identified. 
  • Environment: There are a number of studies that suggest environmental factors, such as air pollution, could also play a role in PCOS.  
  • Lifestyle:  Other daily influences, such as diet and exercise, may also contribute to PCOS. Even though it’s inconclusive if these influences affect the development of PCOS, we do know that management of diet and exercise can be a game-changer when it comes to managing PCOS. 

4. How is PCOS diagnosed? 

“I have irregular menstrual cycles, do I have PCOS?”. The short answer is, maybe. There are a number of conditions & situations that could cause an irregular period, including PCOS. That’s why it’s important to evaluate what might be causing irregular cycles, so you can find the right treatment plan to maintain health, happiness, and help you become pregnant if you’re trying to grow your family.

Because there is no single test to diagnose PCOS, it’s important to make sure there’s not something else going on that may look like PCOS. 

To be diagnosed with PCOS, 2 of 3 of the following symptoms must be present:  

  1. Irregular menstrual cycles. Whether they are coming every 35 days, 50 days, or once every few months, or every two weeks, these are considered irregular cycles and is a possible indicator of PCOS.  
  2. Elevated androgens and hormonal imbalances. Physical signs, such as excess facial or body hair growth, can be an indication of elevated androgen and hormonal imbalances. Lab tests can be a more definitive way of determining if an imbalance of hormone levels is present in the body. 
  3. Polycystic ovaries. An individual with PCOS will have polycystic ovaries, which is when the ovaries have many follicles but no maturing eggs. We can see if ovaries are polycystic with the help of an ultrasound.

If an individual meets these criteria, PCOS could be a likely cause. However, PCOS is a diagnosis of exclusion, meaning we want to rule out any other possible diagnoses that could be causing these symptoms. Things like an ovarian cyst and improper thyroid function can present symptoms similar to that of PCOS. 

5. Can PCOS put me at risk for other health problems? 

As we know, a significant portion of individuals with PCOS experience weight gain. This can be especially frustrating as, generally, people with PCOS have a harder time losing weight and maintaining weight loss, likely related to changes in metabolism and hormonal shifts. This puts these individuals at increased risk for developing cardiovascular disease risk factors such as diabetes, high blood pressure, and high cholesterol. 

PCOS is also closely tied to insulin resistance. Insulin resistance is when the body can’t respond properly to insulin, increasing blood sugar levels. High insulin can be both a symptom and a main driver of PCOS, as it can impair ovulation and increase levels of testosterone in the ovaries. In those with PCOS, oftentimes, the body can make insulin but is unable to use it effectively, increasing the risk of developing high blood pressure, high cholesterol, and type 2 diabetes.

These additional risks are why it’s so important for those with PCOS to seek healthcare from a trusted physician. Not only to lower your risk of developing additional health problems but to create a treatment plan to help you live your happiest and healthiest life possible.

6. Is there a cure for PCOS? 

Unfortunately, there is currently no cure for PCOS. It is a chronic condition and once you’re diagnosed with it, you will manage it throughout your life. So, what can you do? There are a number of things you can do to help manage your symptoms and the routes for managing and maintaining PCOS can vary between individuals. If you are not trying to get pregnant, typically the use of birth control pills and medication to regulate the hormones is an effective way to treat PCOS. If you have PCOS and are looking to grow your family, it’s a good idea to talk to a trusted fertility specialist to explore your options for family building. 

7. Can I get pregnant if I have PCOS? 

Good news! Having PCOS does not mean you cannot get pregnant. It’s one of the most common causes of infertility but it is often very treatable. The primary way in which PCOS affects fertility is that it causes irregular menstrual cycles, which means the body is having trouble releasing an egg to be fertilized. If an individual has regular cycles, it’s much easier to pinpoint when they’ll be ovulating. But if an individual has irregular cycles, it becomes very difficult to know when, or even if, an egg is being released, making it nearly impossible to time exposure to sperm and achieve a pregnancy. 

Ovulation Predictor Kits + PCOS

Even with modern ovulation kits, those with PCOS have more difficulty pinpointing ovulation because they tend to have high resting levels of a hormone called luteinizing hormone (LH). Ovulation kits look for high levels of LH to determine when someone is ovulating, but if there are chronically elevated levels of LH, these tests will provide incorrect results. 

Generally, those with PCOS who are trying to grow their family can work with a fertility specialist to regulate ovulation and time exposure to sperm through timed intercourse or intrauterine insemination (IUI) to increase the chances of conceiving a pregnancy. 

8. Is the IVF process different for people with PCOS? 

In Vitro Fertilization (IVF) is very similar for patients with PCOS and those with infertility of other causes. In a typical IVF cycle, injection hormones are given to stimulate the growth of many follicles. Follicle and egg growth is closely monitored and when they reach a certain point, an egg collection procedure is performed. 

The primary difference between IVF for PCOS and others is the dosing of the hormonal medications used to stimulate the eggs to grow.  In general, those with PCOS need lower hormone doses as their egg supply is typically normal or high.  This slight change in treatment can help those with PCOS achieve a healthy pregnancy and lower their risk of ovarian hyperstimulation (OHSS) during IVF treatment.

Ovarian Hyperstimulation Syndrome (OHSS)

OHSS is a complication that occurs during the stimulation process during IVF treatment. It happens when the ovary over-responds to the stimulation medication and, as a result, produces hormones that cause the blood vessels to become leaky.  

OHSS can be mild, moderate, or severe.  In its mild form, OHSS causes abdominal bloating and discomfort that usually resolves within 5 to 7 days of egg collection.  In its severe form, OHSS can result in electrolyte abnormalities, fluid collection in the abdomen, fluid in the lungs, and kidney problems.  Fortunately, these days it’s rare for IVF patients to experience moderate or severe OHSS because of the use of lower-dose stimulation protocols and adjuncts to treatment that helps to minimize risk.

9. Even if I’m not trying to conceive, should I take proactive steps in case I decide I want to have kids in the future? 

At ORM, we believe in empowering everyone to be proactive about their fertility, especially for those who are approaching or are over the age of 30 due to naturally declining egg health.

In addition to aging, PCOS is another factor that’s simply going to impact the quality of eggs. It’s important to understand your reproductive health and potential so you can be informed and have a plan if you decide, one day, that you want to grow your family. 

10. I think I might have PCOS, where do I start? 

Start by talking to your doctor. Over 50% of individuals with PCOS go undiagnosed. If you have symptoms of PCOS, it’s important to find a physician you trust and someone who is knowledgeable about this condition. Working with someone you feel has their arms around you and understands your story can make all the difference and you can create a treatment plan that’s right for you together. 

The same rules apply when searching for a fertility clinic to grow your family with, especially when looking at pursuing IVF. Online success rates, published by Society for Assisted Reproductive Technology (SART), can be another good jumping-off point and help you get an idea of what clinics have the best laboratories and which clinics can give you the best chance of success in growing your family. 

The Take-Home Point… 

PCOS is a complicated but manageable condition. Find a care team you trust, explore treatment options and find what works best for you. And don’t forget, you are not alone! There is an abundance of support and resources for those living with PCOS, like the PCOS Awareness Association and communities on Facebook. 

ORM Fertility is here to support you on your journey to parenthood. If you are looking to build your family now or in the future, connect with one of our physicians today to discuss your treatment options and learn how ORM Fertility can help you grow your family.

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