For many, the journey to parenthood can be difficult, especially for those facing infertility. PCOS (polycystic ovarian syndrome) affects about 10% of women, and around 80% of them will experience infertility. Although some women with PCOS conceive naturally, others require medical assistance.
Recent research has deepened our understanding of PCOS, revealing that it’s not just a reproductive disorder but a complex condition involving hormonal imbalances, genetic factors, and metabolic disturbances. Key findings include:
- Hormonal Imbalances: Women with PCOS often have elevated levels of androgens (like testosterone and DHEA), which affect hormone receptor function.
- Beyond the Ovaries: PCOS is a lifelong condition that impacts mental health and metabolic function, not just the ovaries.
- Genetic Factors: Genetic changes in insulin function, adrenal glands, and androgen production contribute to the condition’s complexity.
- A Lifelong Condition: PCOS persists even if the ovaries are removed and requires ongoing management.
- Family Ties: PCOS tends to run in families, indicating a genetic predisposition.
Understanding the multifaceted nature of PCOS encourages a holistic approach to treatment, focusing on both reproductive health and overall well-being.
The Physiology of PCOS
PCOS is marked by genetic differences in hormone levels, cell receptors, and metabolic processes, which contribute to its diverse symptoms. Insulin resistance is a key factor for around 70% of women with PCOS, leading to elevated insulin levels, which affect hormone balance. This disruption contributes to symptoms such as:
- Abdominal weight gain
- Acne
- Excessive hair growth
- Scalp hair loss
- Irregular or absent periods
High insulin also increases the risk of conditions like fatty liver disease, high blood pressure, and Type 2 diabetes.
Insulin and Fertility
Elevated insulin levels and high androgens interfere with ovulation, leading to immature ovarian cysts and lower-quality eggs. This reduces the chances of conception. While many women with PCOS do achieve pregnancy on their own, others may need treatments like ovulation stimulants or IVF. Medications like letrozole or clomiphene can help stimulate ovulation and improve egg quality.
GLP1 Medications and Fertility
GLP1 medications, commonly used for diabetes, have shown promise for women with PCOS struggling with weight loss. Many women have reported spontaneous pregnancies after starting these medications, even following unsuccessful IVF attempts. These medications may improve fertility by lowering insulin levels and improving egg quality.
Oral Contraceptives and Fertility
Many women with PCOS use oral contraceptives to regulate their cycles and manage elevated testosterone levels. While these pills help control symptoms like acne and hair growth, they can mask fertility challenges. When women with PCOS stop taking birth control, they may experience an immediate surge in fertility. For women hoping to conceive, trying for pregnancy right after discontinuing the pill may be the most effective approach.
Pregnancy Considerations
Women with PCOS are more likely to develop gestational diabetes, so it’s essential to monitor blood sugar and insulin levels during pregnancy. Elevated insulin levels can lead to complications such as larger babies, hypertension, and premature delivery. A balanced diet rich in protein and fiber can help manage these risks and support a healthy pregnancy.
Despite the challenges, most women with PCOS can conceive with the right support and treatment. The next blog will delve into lab testing and further treatment options for managing PCOS.
Related Tests:
Menstrual Cycle Mapping Test (One Month)
Note: The original blog By Dr. Alison McAllister was published and can be found on ZRT Laboratory website.