Why PCOS Matters to Your Fertility

5 things you need to know about PCOS and how it affects your fertility.

You’ve skipped a period or two and have been breaking out like a teenager. It’s easy to dismiss it as stress or lack of sleep,  but these symptoms may indicate that you have polycystic ovarian syndrome, otherwise known as PCOS. Though the exact causes remain unknown, PCOS is a common disorder associated with hormonal imbalances and insulin resistance, which doctors think is caused by genetics. This condition affects 5-10% of reproductive aged women, but millions of women remain undiagnosed.

In honor of PCOS awareness monthwe want to shed light on the condition and help you understand how it may affect your fertility. Here are 5 things you should know about PCOS.

1. To diagnose PCOS, doctors are looking for three specific signs. The symptoms of PCOS can vary dramatically from person to person, which can make it tough to diagnose. That said, three symptoms seem to be consistent across the board.

Absent or irregular periods. This means having periods in an irregular way, less than 6-8 a year. A lot of women will have “regular” cycles that are longer or shorter than the regular 28-day cycle. This is quite common and is still considered a regular cycle.

– Acne and hair growth on the upper lip, chin, nipple area or lower abdomen. Though androgens are male hormones, both men and women have them. But men have higher levels, and excess androgens in women can lead to pimples and facial and abdominal hair growth. Other women with PCOS may have elevated testosterone levels on blood testing.

– Polycystic-appearing ovaries. If a woman has PCOS, the ultrasound will show multiple “cysts” in the ovaries. These cysts aren’t abnormal per se — they represent “follicles,” the tiny individual sacs in the ovaries which contain hibernating eggs. A polycystic ovary usually has 20 or more visible follicles. Many women who don’t have PCOS and have regular cycles can still have “polycystic-appearing” ovaries.

2. PCOS can resemble other medical conditions and can also affect other areas of your health. Even though PCOS is the most common cause of irregular periods, there are other treatable medical conditions that can cause irregular cycles. Diseases affecting other hormone producing sites in the body — like your thyroid, pituitary or adrenal gland — can lead to signs that imitate PCOS. So it’s worth talking with your doctor to rule out these problems.

Women with PCOS are also at higher risk  of developing diabetes, heart disease and uterine cancer. So your doctor can help you manage the condition and decrease the chance of these diseases affecting your health down the road.

3. You can’t cure PCOS, but you can manage it. Birth control pills can help smooth out the natural hormonal fluctuations that occur in PCOS and can thus lead to more regular cycles. The pill can also help treat the acne and hair growth associated with the condition. Finally, it (besides contraception) can lower the risk of developing pre-cancerous changes in the uterus. If you don’t like the idea of popping a pill every day but want to protect your uterus against cancer, the Nuva-Ring or progestin-IUD are two other good hormonal contraceptive options. Eating a well-balanced diet  with vegetable, lean proteins and healthy fat help regulate insulin sensitivity and reduce unpleasant symptoms.

4. If you are trying to get pregnant and have PCOS, you don’t necessarily need to take fertility drugs. Women with PCOS may not ovulate regularly, but they still do naturally and unpredictably. So if you’re trying to get pregnant, the key is to have regular intercourse (2-3 times a week). Since an egg can be fertilized for 12 to 24 hours after being released and sperm can survive for up to 5 days, having unprotected sex regularly is your best bet. Don’t get hung up on all the different ovulation predictor tests: basal body temperature charting and urine ovulation tests don’t work as well for women who have PCOS. If you are overweight, shedding some pounds can sometimes help correct the hormonal imbalances associated with PCOS, leading to more regular, ovulatory cycles.

If you can’t seem to get pregnant naturally, then you should see your gynecologist or fertility specialist. These doctors can prescribe fertility pills such as clomiphene citrate (Clomid) or letrozole (Femara) to help you ovulate. In certain instances, your doctor might prescribe a medicine called metformin to help with ovulation.

5. Even though you don’t ovulate regularly, your egg supply continues to decrease at a normal rate. Females are born with 1-2 million eggs, and by the time a girl has her first menstrual period, whether it’s at 10 or 16, her egg supply is down to about 300,000-500,000. This egg disappearing act continues whether or not a woman has regular cycles (just we shed skin and hair cells every day of our life). So, even if you’re not having regular cycles — whether it’s because you have PCOS or you’re on the Pill or you’re pregnant — the egg supply in your ovaries is decreasing. With that said, there is some medical research suggesting that women with PCOS may be more likely to hit menopause at a slightly later age than the average of 51.  Whether this translates to a longer time frame to try and conceive remains to be seen.

Janet Choi

Janet Choi

Janet Choi, MD is the medical director of CCRM New York. Board certified in both Ob/Gyn and Reproductive Endocrinology and Infertility, she has been helping women and men build families for over 15 years.

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