Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting 10-20% of women, though it is estimated that 70% remain undiagnosed. At the 2023 European Society of Human Reproduction and Embryology (ESHRE) conference in Copenhagen, new guidelines were presented, offering important insights into diagnosing and managing PCOS, especially for those struggling with fertility.
What is PCOS and How Does It Impact Fertility?
PCOS is characterized by anovulation (lack of ovulation), high androgen levels (leading to symptoms like acne and excessive hair growth), and insulin resistance. It is a leading cause of anovulation-related infertility. Women with PCOS often have irregular menstrual cycles, making it difficult to track ovulation. Additionally, they may face challenges when trying to conceive, though fertility outcomes are often positive with the right treatment.
Recent updates emphasize that PCOS can affect women of all body types—not just those with a higher body mass index. This reinforces the importance of early detection and regular monitoring to prevent long-term complications like diabetes and heart disease.
Diagnosing PCOS
Diagnosis in women post-puberty requires two of the following three criteria:
• Irregular menstrual cycles (less than 21 or more than 35 days apart, or fewer than 8 cycles per year)
• Clinical or biochemical signs of hyperandrogenism (e.g., acne, excess hair growth, or elevated testosterone)
• Polycystic ovaries on ultrasound or elevated Anti-Müllerian Hormone (AMH) levels
The AMH test is a valuable diagnostic tool, as women with PCOS often have high AMH levels, reflecting a higher ovarian reserve. This can be helpful when assessing fertility potential, as women with PCOS typically have more eggs available for IVF or egg freezing.
Fertility and Treatment Options
For women with PCOS who are trying to conceive, the focus is on restoring ovulation. Lifestyle modifications, including regular exercise and a balanced diet, are crucial for managing the condition and improving fertility. Weight loss, even modest, can help regulate ovulation and increase the chances of conception without other interventions.
If lifestyle changes alone aren’t enough, simple fertility treatments like oral letrozole can help induce ovulation. Letrozole is effective, with a low risk profile and minimal side effects. In cases where letrozole is unsuccessful, gonadotropin injections (used in IVF) can be administered at lower doses to stimulate ovulation. However, this approach increases the risk of multiple pregnancies.
For women who do not respond to medication, ovarian drilling—a surgical procedure that helps restore ovulation by reducing androgens and improving insulin sensitivity—can be considered. IVF is also an option for women with good ovarian reserve, as PCOS often results in a larger number of eggs available for fertilization.
Managing Insulin Resistance and Hormonal Imbalance
In addition to fertility treatments, managing insulin resistance with medications like metformin can help regulate menstrual cycles and improve ovulation. Metformin lowers insulin levels, which can reduce androgen production and help restore hormonal balance. However, it is typically prescribed for women who are overweight or obese. For those who cannot tolerate metformin, inositol may be considered, though it has not been shown to be as effective for improving ovulation.
For women who are not yet trying to conceive, oral contraceptives are commonly used to regulate menstrual cycles and manage hyperandrogenism symptoms like acne and excessive hair growth.
Pregnancy Considerations
PCOS-related pregnancies can have higher risks, including gestational diabetes, hypertension, and pre-eclampsia. Therefore, women with PCOS who become pregnant should be closely monitored throughout their pregnancy. However, with proper care, most women with PCOS will go on to have healthy pregnancies.
Conclusion
While PCOS can pose challenges for women trying to conceive, it is important to know that fertility outcomes are generally positive. Early diagnosis, regular monitoring, and appropriate treatment can greatly improve fertility and reduce the risk of long-term health complications. Women with PCOS should feel reassured that with the right support and treatment, pregnancy is very achievable. For those not trying to conceive, contraception options should be discussed, as ovulation can occur without a period.
Ultimately, the key to managing PCOS and improving fertility is a personalized treatment plan that addresses both the hormonal imbalances and lifestyle factors that impact reproductive health.
More information available at Life Fertility
