PCOS and Pregnancy – How to Manage Polycystic Ovarian Syndrome

In a new webinar, Dr. John Kennedy, Sims IVF talks about Polycystic Ovarian Syndrome (PCOS).  He talks about why PCOS occurs, and how to identify symptoms.  Dr. Kennedy also discusses the types of tests and treatments available for people with PCOS and in particular those who wish to start a family.

PCOS is the most common cause of infertility in women.    About 40% of women have some degree of  polycystic ovaries (PCO).   Many women with PCO do not have trouble conceiving.  However, some do have small follicles on their ovaries, which get stuck at a certain stage of development before they can get to the stage of producing an egg.  This condition is known as polycystic ovarian syndrome (PCOS).  PCOS is due to a hormonal imbalance, especially raised Luteinising Hormone (LH).

Symptoms of PCOS

Any or all of these symptoms may indicate that PCOS is present.   PCOS is a spectrum and not a diagnosis w2hich leads to a lot of confusion about whom exactly has it.

• Amenorrhea – Lack of periods
• Longer period cycles
• Extra facial hair growth
• Acne
• Enlarged ovaries
• Disordered blood tests –  Luteinising Hormone (LH), Follicle stimulation hormone (FSH)
• Raised male hormones - such as testosterone
• Low sex hormone binding globule (SHBG) – sex hormone binding globule

Why does PCOS occur?

We really do not know why PCOS occur but there are a number of theories.  We know there are genetic links but no specific genetic markers.

Dr. Kennedy talks about the two cell gonadotropin theory to explain why PCOS occurs.

Dr. Kennedy also talks about hyper-insulinaemia.  High insulin in the body leads to higher male hormones and decreased oestrogen.

How does PCOS affect fertility?

PCOS isn’t usually a problem unless you are trying for a family.  PCOS often means that a woman doesn’t ovulate regularly which leads of difficulty conceiving.  Egg quality can also be an issue in a minority of women with PCOS.

What are the next steps that you can take?

If you are not trying for a family, then management of PCOS will be your priority.  Aim to:

• Manage your BMI – weight management can improve the symptoms of PCOS
• Adopt a low GI diet – this will help to manage your insulin levels and alleviate symptoms of PCOS
• Many people go on the pill, when experiencing PCOS, until they want to start a family.  This can normalize the oestrogen levels in the body, reducing the risk of osteoporosis and diabetes.

If you are trying for a family and you suspect that you may have PCOS, then get blood tests.  These tests will check your FSH, LH, Androgen levels, as well as SHBG and Insulin.

The main blood test is the AMH, which is performed by Sims IVF.  A woman usually uses up her store of eggs by the age of 44.  People with PCOS often have a higher AMH because they retain their eggs and this is judged to be a good measure of the impact of PCOS.

What are the fertility treatments for PCOS?

• Surgical – ovarian drilling is the term used for surgery.  It is relatively rare to use ovarian drilling.  It may  only last for about 6 months or so and isn’t a first line treatment.
• BMI – Modifying lifestyle and managing weight loss is a positive way to manage PCOS, when trying for a baby.
• Metformin – a medication for Type 2 diabetes and it treats high blood sugars.  It is good for because it creates a regular menstrual cycle, decreases the severity of PCOS and aids weight loss.
• Ovulation induction agents – these include Clomid.  Clomid develops follicles so that they grow and TSI (timed sexual intercourse) is introduced.  The downside is that you run the risk of recruiting a number of follicles – so regular scans are important.
• IUI – a cost-effective treatment.   May run the risk of multiple pregnancy – so scans are important/
• IVF – Involves higher doses of medication than IUI.  On average, 6-20 of the eggs are removed.  Eggs are combined with sperm and the embryos are created and grown before being implanted 1 or 2 at a time into the uterus.  The advantage is that embryologists get to see the kind of eggs and embryos that are produced.
• Ovarian Hyperstimulation Syndrome (OHSS) - is a critical medical condition that can affect people with PCOS.  While receiving fertility injections, some women may over-respond and produce too many follicles.  OHSS occurs due to over sensitivity of the ovaries of some women to fertility drugs and it is more frequently associated with women who suffer from PCOS.

Fertility Outlook for those with PCOS

It is important to say that most women with PCOS will succeed in having a baby.  However, PCOS does complicate the process and it is important to seek help early on.

If you would like to see a recording of the PCOS webinar by Dr. John Kennedy, Consultant at Sims IVF then click here.