PCOS 

Q: What is PCOS? 

A: Polycystic ovary syndrome (PCOS) is one of the most common endocrine system disorders, affecting one in 10 women of reproductive age and as many as five million women in the US. In a normal monthly cycle, follicles (immature eggs) develop and one egg is released into the fallopian tube during ovulation. In women with PCOS, the hormones needed for an egg to fully mature are not present, preventing ovulation from occurring and causing cysts to form on the ovaries.

Q: What are the symptoms of PCOS? 

A: Common symptoms of PCOS include irregular or no menstrual periods, acne, obesity/weight gain/inability to lose weight, breathing problems while sleeping, depression, oily skin, infertility, skin discolorations, high cholesterol levels, elevated blood pressure, excess or abnormal hair growth, and distribution, pain in the lower abdomen and pelvis, multiple ovarian cysts, and skin tags. Some women have only a few symptoms while others have several.

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Q: How does PCOS affect fertility? 

A: Not all women with PCOS have difficulty becoming pregnant. For those that do experience difficulty, infrequent ovulation is a common cause. Ovulation is required to achieve pregnancy and can be induced through medication.

Q: How is PCOS diagnosed? 

A: There is no specific test to definitely diagnose PCOS, which is why it is commonly misdiagnosed. In addition to assessing common PCOS symptoms, a doctor will do a blood test to measure male hormone levels for irregularities and an ultrasound offers a closer look at the ovaries to see if they meet PCOS criteria. Based on a careful evaluation of these factors, a doctor can diagnose PCOS, if the adrenal disease is also ruled out.

Q: Are some ethnicities more prone to PCOS? 

A: PCOS is found among all ethnicities of women, but is more common in Hispanic women, with an incidence rate of 13-14 percent compared to 5 percent in Caucasian women. Outside of ethnic predispositions, there are also medical diagnoses such as sleep apnea, cardiovascular disease, diabetes, and issues with insulin resistance, metabolism, and glucose tolerance that can increase the likelihood of a PCOS diagnosis.

Q: If I have PCOS, should I see a fertility doctor before trying to conceive? 

A: If you are not ovulating regularly each month, it is best to seek the help of a specialist immediately. By taking medication and making lifestyle changes, regular ovulation can be induced, allowing for conception to occur.

Q: What can I do on my own to lessen PCOS symptoms?

A: Diet, exercise, and lifestyle modification can make a huge difference in decreasing symptoms, spurring ovulation, losing weight, and making you feel better than you’ve ever felt. The optimal Body Mass Index for fertility is 20-25. If your BMI falls above 30, the good news is that as little as 5-10 percent weight loss will significantly improve pregnancy rates. Getting active for 30 minutes at least three times a week is a great start. Nutrition tips include drinking lots of water and avoiding sugary drinks, opting for 100% whole grain, eating more unsaturated vegetable oils such as walnuts and avocado, choosing berries with antioxidants instead of sweets, eating plenty of greens rich in folate such as spinach, incorporating one ½ cup of beans per day into your diet and drinking whole milk (skim milk is associated with infertility). The real key is eating low carbs and ‘good’ carbs.

Q: How is ovulation stimulated? 

A: Ovulation is often stimulated through oral medications such as clomiphene citrate and Letrozole. Medication is commonly taken once a day for 5 days but can be taken for more or less time dependent upon how a patient responds. Intrauterine inseminations (IUI) are often done in conjunction with these medications to improve pregnancy rates. If these medications don’t work, injections of FSH hormone or better yet, IVF will significantly improve pregnancy rates.

Q: Will my chances of multiples go up because of the medication? 

A: When taking ovulation medication, it is possible that more than one egg may develop and drop into the fallopian tubes during ovulation. Due to this possibility, it is always best to work with a fertility specialist when taking ovulation medication to ensure additional eggs are detected and a patient is made aware of a chance of multiples or canceling the cycle. Completing IVF and undergoing a single embryo transfer is the best way to avoid multiple pregnancies during fertility treatment.

Q: What is a common fertility treatment protocol for a PCOS woman? 

A: The first steps are to implement lifestyle changes that can lessen symptoms and induce ovulation through medication. Should ovulation be induced properly through medication, an intrauterine insemination (IUI) cycle, where washed sperm is placed into the uterus during ovulation, will be completed. Should a patient not achieve pregnancy after three IUI cycles, treatment such as in vitro fertilization (IVF) will be necessary, with far better results.