Polycystic ovary syndrome (PCOS) is a hormonal disorder characterized by ovulatory dysfunction caused by hyperandrogenemia, i.e. an excess of male hormones, and affects approximately 10% of women. It is closely related to female infertility, which is why it is difficult to become pregnant if the patient suffers from polycystic ovaries, which does not mean that it is not possible.
Difference between polycystic ovary syndrome (PCOS) and polycystic ovaries (PO)
It is important to point out that polycystic ovary syndrome (PCOS) is not the same as polycystic ovaries (PO). Although both can cause fertility problems, their characteristics and treatments are different.
For a case to be considered polycystic ovary syndrome, at least two of these symptoms must be present:
1. Anovulation/ Oligoanovulation
2. Clinical or biochemical signs of hyperandrogenism
3. Detection of more than twelve follicles in at least one ovary.
In contrast, women with polycystic ovaries have follicles in the ovaries but suffer from hormonal disorders associated with the first two points. This is why POs can be treated by the gynecologist while, in the case of PCOS, the help of the endocrinologist will also be necessary. It should be noted that, although they are different, both can lead to fertility problems.
Why does polycystic ovary syndrome occur?
Ovarian function depends on many hormones, and when one or more of them is not produced at the right time and in the right concentration, it interferes with the development of the eggs and, consequently, with the functioning of the ovaries.
In the case of polycystic ovary syndrome, an excess of luteinizing hormone and a high level of insulin cause the woman to produce more testosterone than usual. As a result, the eggs do not mature sufficiently and are not expelled during ovulation, so they remain installed in the ovary in the form of small cysts.
As a general rule, cysts caused by anovulation are benign and do not require removal. However, non-ovulation causes the woman not to generate progesterone, one of the essential hormones in the menstrual cycle, so it disappears or becomes irregular, also leading to irregular ovulations. This is the main reason why it is more complicated to get pregnant.
How to know if you have polycystic ovary syndrome
The symptoms of polycystic ovary syndrome usually appear between the ages of 20 and 30. However, in some women they appear at puberty and even before the first menstruation. The most common symptom is an irregular menstrual cycle. Some consequences, which can be interpreted as symptoms, would be:
1. Oligomenorrhea: very long menstrual cycles (more than 35 days). It occurs in 80% of the cases.
2. Polymenorrhea: menstrual cycles of less than 24 days.
3. Hypermenorrhea: abundant menstrual periods.
4. Amenorrhea: absence of menstruation, related to infertility.
On the other hand, women with polycystic ovary syndrome are more likely to develop high blood pressure, obesity, dyslipidemia (alteration of blood cholesterol levels) and diabetes. In addition, as a consequence of the excessive secretion of testosterone, acne, alopecia, oily skin, dandruff and hirsutism (increased body hair and appearance in typically male areas, such as the face or chest) may also develop.
How to Treat Polycystic Ovary Syndrome
Treatment for polycystic ovary syndrome is usually pharmacological and includes contraceptives, anti-androgens and insulin-controlling medications. Surgical options, such as ovarian drilling to remove cysts laparoscopically or wedge resection to stimulate ovulation, may also sometimes be given.
Treatments for polycystic ovary syndrome depend on the symptoms, the intensity of the symptoms and whether they are aimed at treating hyperandrogenism, infertility or menstrual irregularity. When deciding on one treatment or another, it is essential to know the patient’s age and her desire to become pregnant in the short or medium term.
Can a patient with polycystic ovary syndrome become pregnant?
Although the probability of pregnancy with polycystic ovary syndrome is lower, it is possible. In fact, many women with this syndrome have no problem achieving pregnancy. In other cases, menstrual irregularity or lack of ovulation makes it more difficult to plan a pregnancy.
There are also natural treatments related to the regulation of ovarian function. Taking care of your health before, during and after pregnancy, as well as losing weight, controlling your diet, analyzing insulin resistance and having medical, gynecological and endocrinological check-ups can help stabilize hormone levels, reduce symptoms, regulate ovulation and therefore increase fertility.
In any case, if the patient notices any symptoms associated with polycystic ovary syndrome, she should see a doctor or gynecologist to rule it out or, if the diagnosis is confirmed, get treatment as soon as possible.
Polycystic ovary syndrome and fertility: ovarian stimulation techniques and in vitro fertilization.
As mentioned above, the symptoms of polycystic ovary syndrome directly affect fertility. The first step is to regulate the reproductive cycle, which is usually done with contraceptives, so this option is ruled out for women who want to become pregnant.
In such a case, the usual treatment is ovulation induction with hormonal treatment. In most patients clomiphene citrate is the first choice in ovarian stimulation treatment. If it fails, metaformin, taken with clomiphene, is tried.
Another common treatment to stimulate ovarian function and achieve pregnancy with polycystic ovary syndrome is the administration by the assisted reproduction specialist of gonadotropins (FSH and HMG), hormones directly involved in reproduction. They are administered to the patient by subcutaneous injections and increase the chances of multiple pregnancy.
The fact that the pregnancy can be multiple is due to the fact that the gonadotropins work on the ovary so that it produces several eggs, instead of just one, as happens in a regular menstrual cycle. This makes it easier for more than one egg to be fertilized.
Ovarian stimulation is also important for women with polycystic ovary syndrome who want to become pregnant and who, having been unsuccessful by natural means, resort to in vitro fertilization. Thanks to this, doctors will obtain a greater number of oocytes during the cycle and the probability of pregnancy will increase. In fact, in vitro fertilization is one of the methods most likely to achieve a pregnancy and gives assisted reproduction specialists more control over multiple pregnancies.
Pregnancy and polycystic ovary syndrome
Although pregnancy can be achieved with polycystic ovary syndrome, the risk of miscarriage is higher (up to 45%), especially during the first trimester.
In addition to the fertility problems suffered by women with polycystic ovary syndrome, there are other problems: hormonal imbalance or high insulin and glucose levels, which can interfere with the implantation of the fertilized egg and the development of the embryo in the first weeks. On the other hand, abnormal insulin levels influence the eggs to be of lower quality, making conception even more difficult.