Polycystic Ovary Syndrome (PCOS) & Fertility
Advice from a PCOS expert
Polycystic ovary syndrome or PCOS is the most common endocrine disorder in women of the reproductive age group. It affects about one in six women. The typical symptoms may include irregular periods, increased facial hair, and acne. Actually at IVFAustralia, we run a clinic to help diagnose PCOS and deal with some of the symptoms and talk about some of the long-term implications of the disorder. The simplest way to test for PCOS is with an ultrasound. The ultrasound looks at the ovaries and looks for polycystic ovaries. The term polycystic ovary makes you think of cysts, which are normally large, but these are really small follicles with eggs in them. With regard to other testing, we look at doing a blood test for you, which we normally do during the early part of the period if the patient has periods. We look at LH levels, which is a hormone made by the pituitary gland, and that's often elevated. And we also look at the testosterone levels, which may be raised, especially the free testosterone levels.
The main health implications of polycystic ovary syndrome can broadly be divided into firstly, reproductive consequences relating to a reduction in ovulation, which may lead to irregular or infrequent periods or difficulty falling pregnant. Secondly, emotional implications where polycystic ovary syndrome may adversely effect on one's emotional wellbeing. And thirdly, long-term health implications as women with polycystic ovary syndrome have an increased risk of developing diabetes and possibly heart disease later on in life.
A very important question which I'm often asked is what is the difference between polycystic ovaries and polycystic ovary syndrome? Polycystic ovaries is a diagnosis that is made by ultrasound in which there are at least 12 or more follicles seen in the ovaries. However, women with polycystic ovary syndrome usually also have other features such as irregular or infrequent periods, increasing hair growth or acne, and possibly also difficulty falling pregnant due to a reduction in ovulation.
Dr. Robert Lahoud:
The treatment of PCOS depends on the symptoms that the patient presents with. The common fertility treatments include fertility drugs such as Clomiphene or insulin sensitizing agents such as Metformin. And these medications may help to regulate periods and help people to fall pregnant. Occasionally, IVF may be needed, especially if there are other issues such as a sperm problem. And with regard to people who don't want to fall pregnant, often we use the oral contraceptive pill, which helps to regulate the periods and protect the uterus from the long-term effects of irregular periods. With regard to the acne and hirsutism, often again, we use hormone treatments such as the oral contraceptive pill, which is very effective at reducing testosterone levels and increasing insulin levels, which are beneficial for the skin. Sometimes we can use cosmetic treatments such as laser and electrolysis for hair removal, which do work effectively in the short term also.
Dr. Michael Costello:
If you have, or believe you may have polycystic ovary syndrome, then please contact us through the website here at IVFAustralia.
As many as twenty five percent of women of childbearing age have PCOS, but most don’t even know that they have it until they begin trying to get pregnant.
- What is Polycystic Ovary Syndrome? (PCOS)
PCOS (Polycystic Ovary Syndrome) is a common hormone problem that can affect fertility and make it more difficult to have a baby. It’s a combination of having polycystic ovaries, as diagnosed on an ultrasound scan, with symptoms of a hormone imbalance such as irregular periods or male hormone side-effects such as abnormal hair, acne or weight gain.
- What exactly are polycystic ovaries?
Polycystic ovaries occur when a high number of eggs can be seen on an ultrasound scan. Each egg reveals a small dark circle on the ultrasound scan, giving the appearance of multiple cysts, hence the name. However, there are actually no “cysts” at all, it’s just a high number of eggs that are present.
- What causes PCOS?
The exact cause of PCOS is currently not known. Several factors may influence the onset of PCOS, including genetics.
Higher levels of androgens, or ‘male hormones’, are present in women with PCOS. These high amounts of hormones can prevent ovaries from releasing an egg during each menstrual cycle, and can cause extra hair growth and acne, which are consistent symptoms of PCOS.
Higher levels of insulin are also present in women with PCOS. This hormone controls how the food you eat is converted into energy. Many women with PCOS also have insulin resistance.
- PCOS Symptoms
Symptoms of PCOS include irregular periods (or no periods at all), increased hair growth, acne, obesity and difficulty falling pregnant. You might experience very heavy yet infrequent periods, along with pain, bloating and tenderness.
Imbalances in hormonal production affect ovulation, which may occur irregularly or not at all. There may also be a mild increase in testosterone levels, causing darker and thicker hair growth and acne.
Hormonal imbalances also cause problems with sugar metabolism, leading to weight gain - and a higher risk of gestational diabetes if you fall pregnant.
- Irregular period (or no period at all)
The hormone imbalance can prevent release of the eggs so that the periods become either very irregular or, in some cases, stop altogether.
- Hair growth and loss
The hormone imbalance leads to slightly more male hormone being released. This can cause hair to grow in unwanted places, or alternatively, thinning hair and hair loss.
- Weight gain
Hormonal imbalances also cause problems with sugar metabolism, leading to weight gain - and a higher risk of gestational diabetes if you fall pregnant. You may put weight on easily or find it harder to lose. If you are concerned you’re overweight for your height - calculate your BMI.
- Difficulty falling pregnant
PCOS makes it harder to conceive due to lack of ovulation. Some women may occasionally ovulate and some never do. Simple ovulation checking with a single blood test in the second half of your cycle is a good place to start if you’re not sure. If your periods are far apart or non-existent, you’re probably not ovulating and therefore have no chance of conceiving without treatment. This is very easy to sort out with simple medications, so seek medical help early.
- What are the long term risks of PCOS?
Very variable. Most women with PCOS have no long-term effects but there is an association between PCOS and metabolic problems linked to insulin resistance and some women can be affected by this. When a woman is diagnosed with PCOS, she should also have her metabolism tested and followed up over the years. It is also important to ensure that young women with PCOS have medication to ensure that they have regular periods, otherwise overgrowth of the lining of the uterus, called hyperplasia, can cause problems in later life.
- Are polycystic ovaries always bad?
No. Where the only feature is polycystic ovaries and there are no symptoms and no hormone imbalance found on testing, there is no syndrome. Polycystic ovaries on their own are not serious and, in some cases, can provide reassurance that there are still plenty of eggs available for future fertility. If there’s no hormone imbalance, there’s no need to worry about any of the problems below.
- How does PCOS affect my fertility?
The symptoms of PCOS including irregular or no periods, along with a documented increase in the risk of miscarriage, mean the chance of getting pregnant naturally is low if you have PCOS, and you should seek medical support.
It is important to remember that the presence of polycystic ovaries is not always bad news. Many younger women can have severe side-effects from the syndrome caused by the hormone imbalance associated with polycystic ovaries. However, as women age, the follicle number drops and the hormone imbalance corrects itself.
The result is that women who suffer polycystic ovary syndrome in their teens and twenties can sometimes end up having more eggs in their thirties without the syndrome and therefore a better chance of conception.
- PCOS Fertility Treatment
There are a number of options available, depending on the main issue you are experiencing.
Weight loss can be more difficult because of the higher levels of testosterone, but it has a very beneficial effect on balancing hormones and restoring regular periods in obese women. So exercise and a change of diet could have a significant impact.
Insulin sensitisers, such as Metformin, reduce the impact of insulin resistance and can also assist in weight loss.
Ovulation inducing drugs such as Clomiphene (Serophene or Clomid) can stimulate the ovaries.
If you do not respond to Clomiphene, injectable drugs (FSH) can be used, but these require specialist facilities and close monitoring of the response to avoid severe side effects and multiple pregnancies.
IVF treatment may sometimes be necessary in very difficult situations but is not usually required.
- Diagnosis of PCOS
Testing for PCOS can include an ultrasound scan, which can indicate the presence of many small follicles.
Blood tests can reveal changes, with higher levels of testosterone and LH (often in conjunction with a higher LH to FSH ratio) than women with normal cycles. These levels may vary considerably and are best assessed early in the menstrual cycle (if there is one). Blood tests may also indicate a change in blood glucose and insulin levels.
- Where can I get help managing PCOS?
If you are experiencing any of the above symptoms and you would like help managing them, IVF Australia runs regular PCOS clinics at our Greenwich clinic and Westmead Clinic for women wanting more information on the diagnosis, assessment and management of PCOS. Please contact the clinics directly for more information or book an appointment with a PCOS fertility specialist.
The Polycystic Ovary Syndrome Association of Australia Inc (POSAA) is a ‘self-help’ association for women with PCOS and those who suspect they have it. The Association brings together sufferers, their families and friends, and medical professionals interested in supporting the group and PCOS patients.
The Association’s overall purpose is to offer support to women with PCOS, promote understanding and awareness of the syndrome and encourage research into PCOS. POSAA is proud to have been instrumental in the formation of the PCOS Australia Alliance and the subsequent launch of world-first guidelines for the diagnosis and care of women with PCOS. For more information, visit the POSAA website.
If you know or suspect you have PCOS and have been trying to conceive for more than 12 months (6 months if you are over 35) please call 1800 111 483 or book an appointment with a fertility specialist.
Appointments are available in the next couple of weeks and will cost approximately $150 for a couple after the Medicare rebate.