Does PCOS cause infertility?

In this article below, Dr Giada Frontino, a highly regarded and experienced consultant obstetrician and gynaecologist, provides us with a comprehensive insight into polycystic ovary syndrome.

What is polycystic ovarian syndrome?

Polycystic ovarian syndrome (PCOS) is a condition that has both hormonal and metabolic causes, with a wide and variable range of symptoms. PCOS can occur at any age after puberty and before menopause.

Are my symptoms caused by PCOS?

Having cysts on the ovaries does not mean you have PCOS. Ovarian cysts are actually fluid or solid-filled sacs that do not contain eggs. In PCOS, on the other hand, there are small multiple follicles (small round fluid-filled sacs containing an immature egg) which ovulate irregularly.

PCOS can cause symptoms starting from the very first periods, or can appear later on due to weight gain. Symptoms can be very different from one patient to another, and there is no single test that can diagnose PCOS. 

Having at least two of the following signs is often enough to confirm PCOS:

1. A pelvic ultrasound scan that shows specific ultrasound features;
2. Menstrual cycles are irregular (there are over 35 days between each period);
3. Excess facial and body hair, severe acne, and partial/complete loss of hair in the top part of the head (androgenetic alopecia).

All of these symptoms become more severe in overweight or obese women. 

What causes PCOS? 

The exact cause of PCOS is unknown, although insulin resistance has a key role in causing this condition. Chronic stress and obesity can both cause insulin resistance. Insulin resistance then stimulates the ovaries to produce male hormones (androgens) which can block ovulation and cause additional PCOS symptoms such as irregular cycles, acne, excess facial and body hair. Having PCOS and leaving it untreated increases the chances of developing diabetes.

Are there any tests that can diagnose PCOS? 

There is actually no single test that can diagnose PCOS. Your doctor will accurately collect your history and examine you in order to understand if there are signs of insulin resistance, androgen excess, and acne. A pelvic ultrasound scan will assess whether there are typical ultrasound signs that are unique to PCOS. Specific blood tests will rule out other hormonal issues and assess your glucose and lipid metabolism. 

Does PCOS cause infertility? 

Having PCOS does not mean you cannot get pregnant, as PCOS is a treatable cause of infertility. PCOS can make it difficult to conceive a pregnancy due to ovulatory dysfunction. In cases where obesity causes PCOS, the resulting hormonal imbalances can block ovulation. Reaching a normal weight in these cases of PCOS is necessary to improve fertility.

Which are effective treatments for PCOS?

Treatment for PCOS varies depending on the symptoms involved and may include a combination of the following:

• Nutrient intake and body weight: reaching your healthy weight is always effective in treating PCOS symptoms such as irregular cycles, acne, unwanted hair and ovulation dysfunction, and will improve the effectiveness of drug treatments used for PCOS. Along with cutting sugars out of your diet, it is extremely important to have daily portions of vegetables, wholegrain carbs, berries, pulses, mixed nuts, fish and seafood, and lean meats.
• Inositol may improve PCOS symptoms, ovulation, and fertility outcomes. Inositol can be found in fresh citrus fruits, fresh cantaloupe, beans, brown rice and nuts.
• Regular and moderate physical exercise: this reduces your sugar levels and prevents insulin resistance. 
• Mindfulness, meditation, and counselling: these can support you by reducing stress and improving insulin resistance.
• Hormonal contraception: the pill, mini-pill, contraceptive patch or vaginal ring can all reduce androgen production and can therefore improve acne as well as excess facial and body hair. 
• Hormonal treatments that promote ovulation such as Clomiphene, Gonadotropins and Metformin can be used in some cases, the latter of which is also effective to aid weight reduction.
• Spironolactone: this medication blocks the effects that androgens have on the body.
• Eflornitine: this cream slows down hair growth.
• Electrolysis and laser treatments permanently reduce thick and dark facial and body hairs.

Dr Giada Frontino treats women with PCOS struggling with acne, irregular periods, and weight gain. Dr Frontino collaborates with the Centre for Integrated Research in Life and Health Sciences at the University of Roehampton, London on research studies regarding PCOS and insulin resistance. To book an appointment with her today, visit her Top Doctors profile.