The chances are you already know someone with PCOS, or even several of your friends, as it affects 1 in 10 women. Here is some more about PCOS and how it may affect fertility.
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-Polycystic ovaries are larger than normal ovaries and have twice the number of follicles, which are the precursor of eggs. Not everyone with polycystic ovaries has PCOS
-PCOS is a condition that involves polycystic ovaries as well as a hormone imbalance that can have a range of effects including:
-irregular or absent periods
-increase facial or body hair
-loss of hair on head
-being overweight or difficulty losing weight
-oily skin, acne
-reduced fertility
π³The range of symptoms vary – some women have none at all, and some have the whole lot
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PCOS is diagnosed if you have any two of the following:
- Irregular, infrequent periods or no periods at all
- An increase in facial or body hair and/or blood tests that show higher testosterone levels than normal
- An ultrasound scan that shows polycystic ovaries.
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These symptoms can be treated individually but the condition as a whole cannot be cured:
-laser for hair removal
-topical treatments for skin problems
-the pill can be used to regulate periods
-medications such as clomidene citrate can help to promote ovulation to improve fertility
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There is an increased risk of insulin-resistance and diabetes, as well as blood pressure issues.
5% weight loss can help restore regular periods and halve risk of diabetes, so lifestyle changes such as regular exercise are vital. Itβs not easy, and results may not be quick but it can be done and support is out there!
PCOS and fertility
30% of women have polycystic ovaries, but the syndrome itself is less common, affecting around 15% of all women depending on criteria applied. With something so common, it is certainly not talked about nearly enough!
Why does PCOS affect fertility?
*Polycystic ovaries contain many small follicles which each contain an egg and have started to grow, but do not reach a mature size and remain small.
*The ovaries are also slightly enlarged and their central hormone producing tissue (stroma) is also thickened
*This results in raised levels of hormones such as LH and FSH and can contribute to infrequent or absent menstrual cycles
*Women with PCOS who have infrequent ovulation may take longer to conceive.
*Fertility is adversely affected by an individual being overweight, having higher androgens (male sex hormones) and having an elevated serum concentration of luteinising hormone (LH)
Will I be able to conceive?
A Finnish study showed that whilst women with PCOS may take longer to become pregnant their lifetime fertility is not impaired.
Factors that affect fertility include age, BMI, hirsutism index (hair growth) and duration of trying to conceive.
This means that even if you know you have PCOS you should try to conceive as normal.
If after 6 months of irregular menstrual cycles, or 1 year of regular cycles, you should see your doctor for assessment.
This post covers more about Ovulation Prediction Kits for when you are trying to conceive.
What can be done if I have irregular periods in PCOS?
Step 1: Optimize health before treatment. If obese, weight loss improves the hormone profile, likelihood of ovulation, both naturally and in response to ovulation induction therapy.
Step 2: Medications to improve ovulation
The first option is clomifene citrate (Clomid) which results in pregnancy in 50-60% within 6months
Other medications may be used eg metformin.
Step 3: Further treatments like ovarian drilling may be recommended on an individual basis.
What about Inositol?
A 2019 cochrane review found no clear benefit of taking this to improve fertility
For further reading this leaflet from The Fertility Network is really helpful.