If you’ve been linked to infertility for a period of time, I suspect you’ve heard PCOS and infertility mentioned in the same sentence. PCOS has been identified as one of the leading causes of infertility in women. By the way, PCOS stands for Polycystic Ovarian Syndrome. This can occur in about 10% of women. Large numbers of women with PCOS are unaware they have it, and less than 25% of those with it are believed to have been diagnosed.
Researchers tend to believe that there are unusually high levels of insulin produced in certain women, and that this abundance is counteracted by the body which produces higher levels of male androgen hormones. In fact, the relationship between PCOS and infertility is not fully understood. But, in any case, the subject is complicated because women with PCOS are resistant to insulin, which causes problems with diabetes.
This is what is known. When a woman experiences menstruation, there are several follicles that develop in the ovaries. Each of the follicles has an egg, which is the most expensive term for “egg.” During the menstruation process, only one of the follicles will persist and generate an egg that will be available for ovulation. Specifically, the egg matures and LH levels rise, forcing the egg to exit the follicle. This is the essence of ovulation.
However, when a woman has PCOS, things are a little different. Generally, you will not generate enough female hormones for this to take place fully. The bottom line is that the follicles do not produce mature eggs. Alternatively, some follicles can turn into cysts. When this happens, it can be seen on ultrasound. It resembles a string of pearls in the ovary, with the “pearls” being the follicles that did not develop. Usually each of the ovaries has a series of cysts on the outside. Now, when ovulation does not occur, the progesterone necessary to thicken the uterine wall is not produced. Therefore, it is easy to see the relationship between PCOS and infertility, since the uterus is not prepared to receive a fertilized egg, even if one was available.
It is believed that certain aspects of PCOS and infertility could get worse over time. For example, irregular menstrual cycles can cause you to miss a period at all. Polycystic ovary syndrome and infertility can even branch into other seemingly bizarre symptoms. You may notice an increase in acne or experience pelvic pain. Some women have to deal with hair growth on the chest, face, and even the back. In addition to having hair where you don’t want it, the hair on your head can also get thinner. Other women with PCOS and infertility gain weight and, as noted, others face high insulin levels leading to type II diabetes.
There are some recommended interventions for women with PCOS and infertility. Some women can see improvement with just regular weight loss. Sometimes this is enough to adjust hormonal balances. When insulin plays a role, some doctors will recommend medications such as metformin. This is designed to improve the way a woman’s body absorbs insulin. A drug of this type does not act as much on blood sugar levels, but affects the insulin levels itself.
I know not everyone is crazy about pharmaceuticals, but there is another class of medications that I will mention for women with PCOS and infertility. Clomid is used to block estrogen in the brain and tricks the body into thinking that estrogen levels are excessively low. As a result, the body will respond by creating more FSH and LH. These will trigger ovulation. However, full disclosure forces me to point out that still roughly 35% of women who use it get pregnant, so clearly other issues are at play.
One final intervention for PCOS and infertility that I will mention is in vitro fertilization (IVF) and in vitro maturation (IVM). With in vitro fertilization, as you may already know, mature eggs are fertilized and placed in the woman’s uterus. Lesser known IVM, in which immature eggs are removed from the woman at an early stage of menstruation. The eggs then mature in a laboratory so they can be fertilized at that time.