What PCOS Means and Its Impact on Fertility
PCOS stands for Polycystic Ovarian Syndrome. It is also known as PCOD (Polycystic Ovarian Disease) and Stein-Leventhal Syndrome.
The name of the condition is a bit of a misnomer because PCOS is a broad diagnosis for a host of problems, which may or may not actually involve cysts. PCOS is the most common endocrine disorder and affects as many as 1 in 10 women. The cause of PCOS is unknown. There is no cure for it and there are a host of symptoms. PCOS is treatable through diet, exercise and medication, most often a combination of the three.
"In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if 2 out of 3 criteria are met: (1) oligoovulation and/or anovulation, (2) excess androgen activity, (3) polycystic ovaries (by gynecologic ultrasound), and other causes of PCOS are excluded" (from Wikipedia).
The most common manifestation is anovulation (no ovulation) or oligoovulation (infrequent or irregular ovulation). Women with PCOS often establish normal cycle routines only with chemical induction.
Other symptoms include dark hair growth on the face and body, excessive weight and weight gain, especially around the midsection, acne, oily skin and hair, thinning hair, and in some cases, more serious health risks such as high blood pressure and high cholesterol.
PCOS is often accompanied by insulin resistance, and for unknown reasons, can eventually lead to Type II diabetes.
Because of the frequently associated ovulation problems, PCOS is one of the most common causes of infertility in women because the patient does not have the advantage of time, predictability or statistics. Fortunately, if the symptoms of an individual's case are treatable, often this resolves the fertility issues.
Medication, diet and exercise can all assist the body in ovulating and with a combination of the three, PCOS women are frequently able to achieve pregnancy. It should be noted that PCOS women do have an increased risk of miscarriage and as such, your doctor will likely keep you on Metformin through your first trimester of pregnancy.
It is important to note that because of its increased risk factors for more serious health problems, PCOS should be diagnosed and treated regardless of whether or not a woman is trying to achieve pregnancy.
While PCOS is often an umbrella diagnosis for a host of manifestations, it does require specific tests for diagnosis. Your doctor will conduct a full medical history (including menstrual history) and physical, as well as a complete blood panel to check various hormone, glucose and insulin levels. Your physician may also order a pelvic ultrasound to check for cysts on the ovaries, especially if you have been experiencing abdominal pain. Cysts may eventually disappear on their own or may be treated with hormones and medication, and in other cases, may require surgical removal. Provided that the cyst is relatively small in size and not tangled in anything, this surgery can usually be done laparascopically, resulting in little discomfort or recovery time for the patient. In the case of women who do experience a semi-regular cycle, your doctor may ask you to chart your cycle before and after diagnosis to search for detectable ovulation signs.
Your doctor will likely complete a metabolic panel on you once a year after diagnosis, to ensure that your glucose and insulin levels are normal and kidneys are unaffected. This is done through a simple blood draw and lab analysis.
While PCOS has no cure, it is a very manageable condition. The effects of PCOS are often worsened by excessive weight or weight gain. Though the hormonal abnormalities of PCOS make weight loss more difficult, losing weight statistically shows overwhelming improvement in PCOS symptoms, including ovulation related symptoms.
Your doctor may recommend a diet that is high in fiber, protein and fruits and vegetables and low in carbohydrates and sugars, especially if your PCOS is accompanied by insulin resistance. Tailoring your dietary habits may help with weight loss, insulin levels, and gastro-intestinal response to medications.
Through the combination of diet and exercise, PCOS women can often reduce their symptoms to a point of not needing medical regulation.
Regular cycles (and at least 4 a year) are essential for total wellness and long term health maintenance. There are two primary courses of medication to assist in producing regular cycles. If a woman is trying to avoid pregnancy, a doctor may prescribe hormonal birth control.
If a woman is seeking pregnancy, her doctor will often prescribe Glucophage/Metformin to help induce ovulation. Often Glucophage/Metformin is introduced at a small dose, and increased if the body is unresponsive. If Metformin is not enough to induce ovulation, a doctor may pair it with Clomid or Femara. Metformin often produces unfavorable gastro intestinal reactions but is often managed by switching to an extended release version, and/or changing dietary habits. Often the body adapts gradually, resulting in less complications. Some patients (this author included) experienced relief or reduction from GI problems by taking over the counter acidophilus tablets (available at any health food store) along with the Metformin.
Not only is the Metformin and/or Clomid route helpful for stimulating cycles as beneficial in their own right, this also often leads to increased fertility as patients begin to ovulate regularly.
If inducing ovulation is not enough to help you achieve pregnancy, there may be other factors at play, such as suppressed egg release (eggs are produced but not released in to the system so your body thinks it is cycling regularly but eggs never actually drop), blockage from cysts and/pr scar tissue and other various problems. In some cases, injection FSH and LH drugs are introduced along with the Metformin and Clomid.
If fertility problems persist despite improvements in PCOS conditions, your doctor may order additional pelvic ultrasounds to check for new cysts, and/or a Hysterosalpingogram to investigate for additional complications related to other conditions.
PCOS is a fairly common disorder and can often be diagnosed and managed in its beginning stages by an OB/GYN. However, if normal course of treatment does not help, seek out the care of a Reproductive Endocrinologist.
My PCOS came as a surprise because I'd always had regular (though long) cycles. We discovered that my cysts result from suppressed egg release so each month the follicle dies and attaches itself to the previous month's follicle. The suppressed release explained why I still had regular cycles. I did produce eggs regularly and my body knew that (hence its response and my cycle)—the eggs just never successfully dropped down. I had a 4cm ovarian cyst removed 2 years ago, detected after increasing, regular pain on my lower right abdomen and confirmation through a pelvic ultrasound. I initially responded very poorly to the Metformin (frequent trips to the bathroom, especially following any meal) to the point where I stopped taking it. I have begun a new diet and exercise routine and have found that even with moderate weight loss and the new programs, I can tolerate the medication much better and need a much lower dose to produce the same results. We have not successfully conceived due to other fertility problems, but we have seen significant improvement in my PCOS symptoms, and in my insulin levels, with the combined treatment approach.
In the early stage of my diagnosis I did a lot of reading and research and found the following websites to be invaluable:
SoulCysters Website: http://www.soulcysters.com
SoulCysters Message Board: http://www.soulcysters.net
PCOS Association: http://www.pcosupport.org/
US Department of Health & Human Services PCOS Site: http://www.4woman.gov/faq/pcos
"I am currently on Actos which did more that the Met in helping with the symptoms."--Tammy