Polycystic ovary syndrome, or PCOS for short, is a common hormonal disorder affecting women of reproductive age, and it’s one of the main causes of female infertility. Up to 15% of women around the globe have this condition. Many don’t realize that they have it until they aren’t able to conceive a baby. If you suspect you could have PCOS, it’s helpful to know early so that you can start therapy and get your fertility back on track. Read our factsheet to get the lowdown on this condition and how to get pregnant with PCOS.
What is PCOS?
Polycystic ovarian syndrome is actually a bit of a misnomer, because polycystic ovary means having “many small ovarian cysts”. In fact this doesn’t accurately describe the effect of PCOS on the ovaries.
Here’s what really happens: PCOS causes an imbalance of the reproductive hormones FSH (follicle stimulating hormone) and LH (luteinizing hormone), which stops eggs from maturing and getting released during ovulation. So rather than cysts, in reality these are fluid-filled sacs (follicles containing immature eggs) stuck to the ovaries.
PCOS usually also causes an excess of male sex hormones (androgens such as testosterone), which is another condition called hyperandrogenemia.
Symptoms of PCOS
PCOS doesn’t look the same for everyone who has it. Symptoms can vary and also range in severity from person to person. Some women don’t notice anything at all until they have trouble conceiving. But not every woman with PCOS has fertility struggles.
Here are the most common signs of PCOS:
- Irregular cycles with long breaks in between periods or no periods at all (amenorrhea)
- Male pattern of hair growth (hirsutism)
- Hair loss
- Weight gain
- Dark patches of skin
Causes and risk factors for PCOS
Medical experts aren’t sure what exactly causes someone to get PCOS but believe that genetics, bodily inflammation, and environmental factors may play a role.
This condition could also develop as a result of insulin resistance, and studies show that over half of women with PCOS are resistant to insulin. This is when the body doesn’t respond well to insulin, and can’t use glucose from food for energy, so blood sugar levels can’t be properly regulated. This causes the body to produce even more insulin, which in turn leads to the production of male sex hormones.
Lifestyle factors and genetics contribute to insulin resistance. Eating an unhealthy, unbalanced diet, not exercising, and obesity increase the risk to develop a resistance to insulin.
How doctors diagnose PCOS
There’s no one definitive test to diagnose PCOS. Often, a combination of checks are used.
- Physical examination: a doctor will check for signs of extra hair growth, insulin resistance and acne.
- Medical history: you will likely discuss your health background and family history.
- Blood tests: this checks for excess androgens and blood sugar levels.
- Ultrasound: your doctor will examine your ovaries.
A final diagnosis is made based on the Rotterdam criteria, which states that if two of the following three factors are present, a woman has PCOS:
- Cycle disturbances
- Polycystic ovaries
Because of the complexity of PCOS and the range of symptoms, it can take ages for someone to receive a diagnosis. Many women have to go to multiple doctors over several years before they’re finally diagnosed with this condition. The average time to diagnose PCOS is 4.5 years, which is really problematic if you’re trying to conceive because time is one of the most important factors for female fertility. At LEVY Health, we reduce the diagnosis from years to a matter of weeks with our medically certified diagnostic tool, the LEVY Fertility Code.
How PCOS impacts fertility
In a normal menstrual cycle, FSH causes several follicles to mature. In the middle of the cycle, LH spikes, triggering the ovaries to release an egg in ovulation. The egg then travels down the fallopian tube towards the uterus, during which time it can get fertilized by sperm. If fertilization occurs, the embryo implants into the uterine lining.
PCOS disrupts this process. The condition causes the body to make too little FSH and too much LH and testosterone. Due to this imbalance, ovulation only rarely takes place, or may not happen at all, and the eggs remain in the ovary. Without ovulation, it’s not possible for an egg to be fertilized, and pregnancy isn’t possible.
Potential side effects of PCOS
PCOS increases the risk to develop other health conditions:
Metabolic syndrome is an umbrella term for obesity, high body fat and cholesterol, high blood pressure, and high blood sugar. People who have metabolic syndrome have a higher risk of developing diabetes and heart disease.
If menstruation occurs infrequently or not at all, the lining of the uterus (endometrium) gets too thick and may lead to cellular changes that develop into cancer.
PCOS not only has physical effects, but can take a psychological toll too. Symptoms like excess hair growth, balding, and acne can have a detrimental effect on self-esteem.
If you are living with PCOS, it’s important not only to take care of your physical health, but your mental health as well. Don’t hesitate to seek support if you feel depressed, help is out there. Many women around the globe have this condition, so you’re not alone! There are lots of support groups where you can connect with others and share your experience. Try to be open about your condition with your partner and friends – talking about it can help deal with any challenges you’re experiencing.
Therapy Options for PCOS
There’s not a singular therapy option to treat PCOS. Rather, it’s often a mixture of lifestyle changes and at times medications to reduce the symptoms of PCOS and improve fertility. If you are diagnosed with PCOS while testing your fertility with LEVY, we will coach you 1:1 on how to manage your condition and the best options to help you conceive.
Weight loss, dietary changes, and exercise are often the first step to treat PCOS. A 2010 study published in the BMC Medical journal found that for women who are overweight, losing 5 to 10 percent of body weight can help regulate the menstrual cycle and improve PCOS symptoms like metabolism and excess hair growth. Check out our article on a PCOS-friendly diet for science-backed nutritional tips that can reduce symptoms.
Beyond that, medications are available to reduce the body’s insulin resistance, stop unwanted hair growth, and induce ovulation. One study found that 80% of women with PCOS who were treated with the drug clomiphene citrate ovulated successfully, and half of those got pregnant naturally within six cycles.
When the ovaries don’t respond to hormonal medication, a minimally invasive procedure called ovarian drilling is another option to help with ovulation, and it has high rates of success. If those treatments don’t work, artificial insemination (IVF or ICSI) may be recommended to help you conceive. LEVY’s fertility doctors are happy to consult you on all of your options to give you the highest chances of conceiving.
It can be scary to find out that you have PCOS. Symptoms can have a big impact on your life and the condition can make it more difficult to conceive. But with the right combination of lifestyle changes and other therapy options, you can greatly improve your chances of having a baby!
Do you suspect you have PCOS? Test your fertility with LEVY to find out. If you’re diagnosed, our fertility doctors will guide you and design and a custom therapy plan to improve your symptoms and chances of conceiving.
Deswal R et al.: The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020;13(4):261-217.
Teede H et al.: Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41.
Frankfurter D. Getting Pregnant with PCOS. In: Davies, T. (eds) A Case-Based Guide to Clinical Endocrinology. Springer, New York, NY. 2015.
Hoeger KM et al.: Update on PCOS: Consequences, Challenges, and Guiding Treatment. The Journal of Clinical Endocrinology & Metabolism. 2021;106(3):e1071–e1083.
Polycystic Ovary Syndrome (PCOS). American Society for Reproductive Medicine. Accessed 03 June 2022.
International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS). European Society of Human Reproduction and Embryology. 2018.
Ovarian Drilling for Infertility. ReproductiveFacts.org from the American Society for Reproductive Medicine. Accessed 05 September 2022.
Teede HJ et al.: Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fert Stert, ASRM Pages. 2018. 10;3:364-379.
Mercorio A et al.: Ovarian Drilling: Back to the Future. Medicina. 2022. 58;1002.
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