PCOS: An infertility issue

PCOS is the most common endocrine disorder in women and a leading cause of infertility. It is estimated that about 8-10% of women in the reproductive age are affected by PCOS. Often women do not realize that PCOS is the underlying problem of their infertility.

• Do all women with PCOS have fertility problems?
• Is it possible for women with PCOS to have a successful pregnancy? The answer is
• Does this usually require medical intervention? The answer is “Yes”again!

First let’s understand how PCOS affects fertility.

A woman with PCOS has an abnormality in her hormonal pathway that is responsible for producing eggs and preparing the uterus for pregnancy. High levels of androgens (‘male’ hormones such as testosterone) and high insulin levels can affect the menstrual cycle and prevent ovulation (the release of an egg from the ovary). When an egg is not released on a regular basis, this is called anovulation. Ovulation can stop completely or it can occur irregularly.  This can make it more difficult for women with PCOS to conceive naturally, and some women may also have a greater risk of miscarriage.

What are some of the problems that a woman with PCOS may face?

• Women with PCOS often do not ovulate
• Women with PCOS have erratic and irregular menstrual cycle rather than a normal or routine cycle which is ‘predictable’.
• The endometrium is not efficiently prepared to sustain a pregnancy

How can women with PCOS improve their chance of pregnancy?

1. Weight management

Small reductions in weight can assist with fertility, so if you are above healthy weight, weight management and physical activity is the first treatment option. Even a five to ten per cent loss of weight has been shown to greatly improve the chances of becoming pregnant.

2. Estimate your ovulation time and monitor ovulation

There are days in a woman’s menstrual cycle when pregnancy is possible. This is generally around the middle of the cycle. If ovulation has occurred a ‘fertile window’ creates an opportunity to conceive.An ovulation calculator and an ovulation predictor kit may help you work out when you may be ovulating.

3. Induction of Ovulation:

Ovulation is a requisite for pregnancy and hence treatment options are aimed at getting the woman to ovulate and this is often termed as ‘Induction of Ovulation’.

Ovulation induction involves the use of medication to stimulate development of one or more mature follicles (where eggs develop) in the ovaries of women who have ovulation problems and infertility.

Depending on your overall diagnosis made by the doctor, your doctor may suggest oral anti-estrogen medications like Clomiphene or Metformin, an insulin sensitizer, to help induce ovulation.

If you don’t become pregnant using clomiphene and metformin, your doctor may recommend using gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) injections. Both FSH and LH work together in ovulation process. FSH helps stimulate the ovarian follicle, causing an egg to grow while LH causes the egg to be released from the ovary. Another medication that your doctor may have you try is Letrozole.

When taking any type of medication to help you ovulate, it’s important that you work with a fertility specialist and have regular ultrasounds to monitor your progress and avoid problems.

4. PCOS and IVF Success

The large majority of women with PCOS that have not gotten pregnant with other treatments will be able to get pregnant and have a baby with IVF (in vitro fertilization) if they are under 40 and monitored well under expert care. IVF is a part of assisted reproductive technology (ART)

Assisted reproductive technology is best tried after other less intensive treatments have proved unsuccessful, as it is often costly and demanding. This treatment is also more successful in women who have instituted lifestyle change effectively first, even if these changes have not improved fertility by themselves.

Inputs by Dr Duru Shah ,Director, Gynaecworld, the Center for Women’s Health & Fertility, Founder President, The PCOS Society (India)