Whilst some women fall pregnant very quickly, others can spend years struggling to conceive. Sometimes there is no way of knowing which category you will fall into, until your start trying. There are a whole range of conditions that affect a couple’s ability to get pregnant. One of the most common fertility issues facing women is Polycystic Ovary Syndrome (PCOS), a hormonal disorder that affects up to 12-18% of women in their child-bearing years.
What is PCOS?
PCOS develops when a woman’s body produces too many male hormones, known as androgens. Whilst a certain level of androgen production is normal, too much can prevent ovulation and affect the regularity of a woman’s menstrual cycle, making it more difficult for her to fall pregnant naturally. PCOS is a complex condition because it is not entirely clear why some women have such high androgen levels. What is clear is that many women with PCOS also have issues relating to obesity, insulin resistance (a condition where insulin is not effective in lowering blood sugars) and diabetes.
The complexity of PCOS is compounded by the fact that some women with PCOS do not have visible cysts on their ovaries, and some women with cysts in their ovaries do necessarily have PCOS.
What are the symptoms of PCOS?
The symptoms of PCOS can vary in severity from woman to woman, and not all women will have the same symptoms. In many cases the symptoms can come and go or disappear altogether. Some of the most common symptoms include:
- Period problems – eg heavy or irregular periods, or no periods at all
- Excessive hair growth – thick or dark hair on the face, arms or other parts of the body
- Acne – excess oil production can lead to pimples or acne
- Hair loss
- Weight gain
- Depression or anxiety
PCOS and Fertility
Not all women with PCOS will have problems falling pregnant. However, a large proportion of known fertility issues do relate to PCOS. This is because PCOS makes a woman’s reproductive cycle unpredictable – ovulation may not occur at all, or it may occur erratically. The chances of miscarriage are also much higher in women who have PCOS.
The symptoms and side-effects of PCOS are increased when a woman is overweight. Many women are able to regulate their periods and improve their fertility once they are in a healthy weight range that is managed through diet and exercise.
Some PCOS sufferers may require medication to induce ovulation, while others may benefit from assisted reproductive technologies (ART) or surgery to increase their chances of falling pregnant.
Medication to induce ovulation
There are several medicines available to stimulate egg production in the ovaries. Many of these drugs have side-effects and need to be administered under careful medical supervision.
Some of these drugs include:
- Clomiphene Citrate (Clomid) – this is the most common drug used to induce ovulation and can be very effective for women who do not ovulate on their own. Clomid may be used in conjunction with other drugs to increase the chances of ovulation and pregnancy.
- Metformin – Most commonly used to treat insulin resistance or diabetes. Metformin is also sometimes used in conjunction with other drugs to achieve ovulation and pregnancy.
- Gondatrophins – These hormones are used to regulate ovulation and are given by injection. Ultrasounds and blood tests are performed regularly on women who are taking gondatrophins to monitor the effect of this drug, and to ensure that the ovaries are not over-stimulated.
Assisted Reproductive Technology (ART)
Sometimes medication alone is not enough to achieve pregnancy, and assisted reproductive technology (ART) needs to be employed.
ART includes treatments such as intrauterine insemination (IUI) or in vitro fertilisation (IVF) by specialist doctors trained is these procedures. Generally, ART is undertaken when less invasive fertility treatments have failed, as it is a costly process and one that can be both physically and emotionally draining.
Sometimes, ovulation can be achieved through a procedure known as ovarian drilling. Through a small cut in the stomach, tiny holes are drilled into the ovary to remove the ‘cysts’ that are producing the excessive amounts of male hormones (androgens). Whilst this solution is not appropriate for all PCOS sufferers, it has been known to restore ovulation for up to 12 months in some women.
Written by Jo Harris for birth.com.au, Australia's on-line destination for preconception, pregnancy and birth from sources including Managing PCOS
Last revised: Tuesday, 10 September 2013
This article contains general information only and is not intended to replace advice from a qualified health professional.