PCOS (Polycystic Ovarian Syndrome) is a common gynecological diagnosis that causes great alarm in women, especially those who wish to conceive. The condition, which is the most common endocrine (hormonal) disorder in women of reproductive age, with its increasing prevalence, has as many misconceptions as it has acquired awareness. One of them is the misconception that ‘a woman with PCOS cannot get pregnant’.
This is not true. Of course, PCOS is one of the leading causes of subfertility resulting from ovulation disorders. But being a victim of this syndrome does not mean that the woman cannot conceive at all.
As I mentioned earlier, the syndrome is a cause of subfertility but not sterility. Subfertility means a decreased ability to conceive and have a child, while infertility is the absolute and irreversible inability to conceive.
PCOS presents with a variety of symptoms. If you are diagnosed with this condition, your symptoms do not need to match those of another woman with PCOS. Similarly, your fertility level also depends on whether or not you ovulate, your age, any co-existing medical conditions, the presence of other causes of infertility, etc. Some women with this syndrome may have regular and intermittent fertile cycles, but usually menstrual irregularity is a common symptom of this syndrome. Studies report that of all women diagnosed with PCOS, 2/3 of them do not ovulate regularly. If your doctor discovers that you are not ovulating, he will intervene to regularize your cycles and induce ovulation, which means that you can devise an appropriate intervention or treatment. The intervention could be a lifestyle change: weight reduction if you are obese, diet modification, or medical treatment.
How is obesity related to polycystic ovary syndrome?
Studies consistently show a higher prevalence of PCOS in obese women. Although obesity is not a cause of this syndrome, it is considered to be a major environmental trigger for the onset of symptoms. However, it is observed in many parts of the world that women who are in the normal range of BMI (body mass index) are also diagnosed with PCOS. However, weight gain is common with this condition and vice versa and there are studies showing that obesity substantially affects fertility and response to infertility treatment, regardless of the cause of infertility.
How does obesity affect your fertility?
Obesity causes insulin resistance in the human body. This means that the body does not respond well to insulin and therefore increases the level of glucose in the body. To compensate for this increased glucose level, the pancreas secretes more insulin which leads to hyperinsulinemia (excess insulin level in the blood). The ovary is a target organ for insulin; stimulates the ovary to produce excess androgens (male sex hormone). Although the ovary normally produces a small amount of androgens (testosterone) along with the female sex hormone (estrogen), excessive androgen production is unfavorable and interferes with ovulation.
How to improve your fertility?
If you are obese, even a small amount of weight loss can regain your ovulation because weight loss improves the body’s insulin sensitivity, thereby decreasing insulin secretion and in turn controlling hormonal imbalance. Losing just 5-10% of body weight can make it easier for you to get pregnant. Studies show that losing body weight through lifestyle changes can restore ovulation and improve pregnancy rates in up to 60% of women with PCOS. Although losing weight for a woman with PCOS is not as easy as claimed, the positive effect it has on resuming fertility should in itself be motivating. Hormonal disruption in your body along with psychological changes will represent the greatest challenge in your mission to reduce weight, and your success lies in adhering to lifestyle changes. Additionally, weight reduction also helps prevent complications such as miscarriage and gestational diabetes (diabetes during pregnancy), if you become pregnant.
Weight loss is extremely rewarding when trying to combine physical exercise with diet modification. Physical exercise does not mean vigorous physical activity. Moderate physical exercise with reduced sedentary behavior works well.
Diet modification includes a balanced, low-calorie, low-glycemic (low-carbohydrate) diet. Diet changes help reduce weight, as well as prevent diabetes mellitus and cardiovascular disease, which are dreaded long-term complications in women with PCOS.
If you do not ovulate normally or even with lifestyle changes, medications for ovulation induction may be needed. These medications have been found to stimulate ovulation in up to 85% of women with PCOS. Clomiphene citrate is the first-line medical treatment in the management of infertility in women with PCOS. Makes the eggs mature and release. Women who do not respond well to clomiphene or who are obese are given metformin. Metformin may help women ovulate on their own or respond well to treatment with clomiphene. Studies report that a good response to metformin is also seen in non-obese women. Gonadotropin analogs form the next line of intervention, if treatment with clomiphene and metformin fails. Women who do not respond to medical treatment will need laparoscopic surgery (ovarian drilling to facilitate ovulation) or in vitro fertilization. Most women show positive results with medical treatment but, of course, with continuous and effective lifestyle change.
All of the above facts answer the title question: “Does PCOS mean you can’t conceive?” in one dimension: ‘How is pregnancy with PCOS possible?’ There is another dimension to address. There are women with PCOS who want to delay conception. If you are one of them, do not consider this syndrome to be a natural contraceptive. Studies report that some women with PCOS conceive naturally without any intervention. As I mentioned earlier, your fertility level depends on whether or not you ovulate and, if you do, how regularly you do it. Therefore, you must use adequate contraception if you are not prepared for pregnancy.
