Polycystic ovary syndrome (PCOS) and fertility

Polycystic ovary syndrome (or PCOS, as it’s typically called) is a common condition that affects women in their reproductive years. Because the condition influences hormone levels and can prevent ovulation, it can be difficult for women with PCOS to conceive.

Women with PCOS may need medical help to become pregnant

PCOS is a complex hormonal condition that leads to changes in the body’s ovulation cycle. You’re probably familiar with a ‘regular’ menstrual cycle happening around once a month. Well, ovulation is the fertile phase of the menstrual cycle – when an egg is released from one of the ovaries – and should also occur monthly.

However, most women with PCOS don’t get regular periods, and that means that their ovaries are not releasing an egg regularly – in other words, they have irregular ovulation. The medical term for this is ‘anovulation’.

Every time an egg is released from the ovaries, it is a potential opportunity for a pregnancy to begin. So, if this doesn’t happen regularly, it reduces the chances of getting pregnant. Rare (or absent) ovulation is the reason women with PCOS often take longer than normal to conceive.

Most women with PCOS can become pregnant

The good news is that around 60% of women with PCOS become pregnant without medical help. And the even better news is that for women with PCOS who are struggling to conceive, there are ways that fertility specialists can help. Fertility treatments for PCOS work to increase ovulation and can range from lifestyle changes or medications to more invasive procedures.

Losing weight can improve fertility

Maintaining a healthy weight can be difficult for women with PCOS. They may find it easy to gain weight, and really hard to lose it. While this can be challenging, it’s really important for women with PCOS to maintain a healthy weight to improve their chances of getting pregnant. In fact, even losing 5% of body weight can improve the chances of conceiving.

Losing weight should be the first port of call if you have PCOS and are struggling to conceive. The improvements in fertility won’t happen overnight – you should give yourself up to 6 months to see if weight loss alone is enough to help you get pregnant. If it isn’t, rest assured that your efforts to maintain a healthy weight will improve your chances of getting pregnant if you go through fertility treatments. Having a healthy weight will also reduce the chance of many pregnancy complications.

Medication can stimulate or regulate ovulation

To help women with PCOS get pregnant, there is a treatment called ‘ovulation induction therapy’. You can think of this as a way to encourage your body to produce and release eggs. Medication (or a combination of medications) is used to give your body the signals it needs to go through an ovulatory cycle to release an egg.

Generally, a tablet called clomiphene citrate (Clomid) is the first treatment choice. Studies have shown that Clomid can achieve pregnancy rates between 30% and 50% after 6 treatment cycles. One of the limitations of Clomid is that after 4 to 6 months it can lead to thinning of the endometrial lining and subsequently reduce the chance of pregnancy.

If Clomid is unsuccessful, the next treatment step tends to be ovulation induction therapy with hormones known as ‘gonadotropins’. These hormones, such as follicle-stimulating hormone (FSH), luteinising hormone (LH) and human chorionic gonadotropin (HCG), are normally produced by your body during a healthy reproductive cycle. So, to mimic the normal hormonal cycle, one or more of these hormones are injected at specific times during your cycle to stimulate the growth and release of eggs.

Surgery is an option for inducing ovulation

If other treatment options have not been effective, there is a surgical procedure that can help to increase ovulation, which is referred to as ‘ovarian drilling’ or ‘laparoscopy with ovarian surgery’. If you have PCOS, the surface tissue on your ovaries produces excessive amounts of androgens (‘male’ hormones), which reduces your fertility. The aim of ovarian drilling is to remove some of that tissue, by drilling small holes in it, so that you can ovulate more regularly for around 6 to 12 months. Because the surgeon only needs to make a small incision below your belly button, the surgery itself is minimally invasive and the recovery is quick.

IVF is another option for women with PCOS

Some women with PCOS may not be able to conceive naturally, even after using treatments to increase ovulation. In that case, it may be necessary to undergo in vitro fertilisation (IVF) to get pregnant. During IVF, the fertilisation step of pregnancy (joining the egg and sperm together) is facilitated in a specialised laboratory. The embryo is then implanted into the uterus to continue the pregnancy. Women with PCOS are given specific hormonal treatments to increase their chances of achieving a pregnancy through IVF. Interestingly, women with PCOS perform very well with IVF therapy. The high number of eggs in their ovaries usually means that many eggs can be collected and fertilised during IVF.

Do you have PCOS and fertility concerns?

PCOS is a complex condition that can be difficult to manage, particularly when it comes to getting pregnant. If you suffer from PCOS and would like a personal assessment and advice about ways to optimise your chances of conceiving, please call my rooms on (03) 9418 8299 or book online to make an appointment.