Polycystic ovarian syndrome (PCOS) can make conception more difficult, but with the right lifestyle changes and medical interventions, you can improve your chances of having the family you've always dreamed of.
Luckily, many women with this condition are able to have children with medical assistance, lifestyle changes or a combination of the two. Some common signs of PCOS are:
PCOS generally presents itself on a spectrum, and occasionally a woman with none of the above symptoms or signs has the condition – likewise, there are women who have many of these symptoms and signs but do not have the condition at all. As PCOS can cause anovulation and irregular menstrual cycles, conceiving with the condition can be challenging for some women.
Here are some of the most common questions my patients ask about PCOS and fertility, and the advice I give them:
Generally speaking, irregular cycles are one of the most common features of women with PCOS, and are thought to be caused by elevated male hormones. An excessive amount of testosterone and other male hormones in the female bloodstream can disrupt ovulation, making it difficult for a normal menstrual cycle to occur. Without normal ovulation and menstrual cycles, women with PCOS have fewer chances to conceive naturally.
Any woman with PCOS who is trying to conceive should see a reproductive endocrinologist and an infertility specialist. Usually, their first move will be to check insulin and glucose levels. If either is outside its normal parameters, medications will typically be provided to help control them. Lowering a woman’s fasting insulin and glucose levels can decrease the amount of male hormones in her body, which can improve both her PCOS symptoms and her chance of conception.
It has been shown that with approximately a 5% to 10% reduction in body weight, a patient’s fasting insulin and fasting glucose levels improve significantly. Often, patients with PCOS find that a balanced, low carbohydrate diet works best for them. Women with PCOS should also consider doing regular cardiovascular exercise, as it has been shown to lower blood glucose levels.
That doesn’t mean that you don’t have any options, however. A medication by the name of Glucophage (also known as Metformin) can help women with PCOS lower their insulin and glucose levels, which can then lead to improved fertility.
Additionally, there are medications to help ovulation occur more predictably, such as Clomid or Letrozole. Both of these medications induce ovulation, meaning that they allow for an egg to be released at the appropriate time during the month. If a patient’s body is unresponsive to these medications, the use of injectable fertility medications to produce eggs is a potential next step.
However, studies that are randomized and blinded are still lacking – meaning we can’t know for sure. While many of the supplements have shown improvements of fertility in smaller groups of women, larger studies with significant statistical power have not been performed.
With that said, there are very few downsides to these supplements. While we do not know if they are truly effective, it is safe for women to take them – even if they produce only a marginal increase in fertility.
Some women might completely lack a normal menstrual cycle altogether, while others might have a normal cycle that only goes out of sync once or twice a year. For those women who experience unpredictable (or no) ovulation, however, it can be difficult to conceive.
It is important to understand that polycystic ovarian syndrome does not affect fertility in only one way. That is why a consultation with a reproductive endocrinologist and infertility specialist may be most beneficial. If necessary, a fertility specialist can advise on when a patient should move forward with any specific procedure – including something like IVF, if no other option seems reasonable.
If you are a woman with PCOS and you are wondering what you can do before seeing a specialist, I would suggest immediately looking at diet and lifestyle changes. A healthy lifestyle including balanced eating and exercise is an excellent starting point and can be started at any time. As stated above, many women who are overweight see a significant improvement in their fertility rate following a 5% - 10% reduction in their overall body weight.
PCOS can be a difficult and incredibly frustrating condition to live with – even if you aren’t trying to conceive. While diet and exercise can certainly help, it is crucial to find a doctor that thoroughly understands the condition, as it is possible to manage the disease.
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