Ask the expert: 5 things to know about Polycystic Ovary Syndrome (PCOS) and fertility
Polycystic ovary syndrome (PCOS) affects 10 percent Irish women of reproductive age.
Due to the absence of a regular menstrual cycle, some women suffering from PCOS may find it difficult to conceive naturally. In fact, PCOS is the most common cause of infertility in women.
We recently caught up with Mikey O’Brien, Clinic Manager at Rotunda IVF, and asked him to share five things we all should know about PCOS and fertility during PCOS Awareness Month.
1. What is PCOS?
Polycystic ovary syndrome (PCOS) is a complex hormonal condition affecting up to one in five women of childbearing age, where they may have high levels of insulin and/or male-type hormones called androgens. In some women, PCOS runs in the family, and the condition can be worsened by being overweight.
2. What are the symptoms of PCOS?
PCOS is a spectrum and not a diagnosis which leads to a lot of confusion. Any or all of these symptoms may indicate that PCOS is present:
· Amenorrhea – Lack of periods
· Longer period cycles
· Extra facial hair growth
· Enlarged ovaries
· Disordered blood tests – Luteinising Hormone (LH), Follicle stimulation hormone (FSH)
· Raised male hormones - such as testosterone
· Low sex hormone-binding globule (SHBG) – sex hormone binding globule
3. How does PCOS affect fertility?
PCOS often isn’t a problem that can be managed by diet alone, unless you are trying for a family. PCOS often means that a woman does not ovulate regularly which leads to difficulty conceiving. Egg quality can also be an issue in a minority of women with PCOS.
4. What should you do if you have/suspect you have PCOS and want to start a family?
If you are trying for a family and you suspect that you may have PCOS, you should consider a blood test to check your Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Androgen levels, as well as Sex hormone-binding globulin (SHBG) and Insulin.
Pending the results of a blood test, an AMH test should then be carried out, which indicates the number of eggs remaining in the ovaries. People with PCOS often have a higher AMH because they retain their eggs, and this is considered to be a good measure of the impact of PCOS.
5. PCOS And Getting Pregnant
For women with PCOS, the concept of starting a family can feel like it comes with extra challenges. Many women with PCOS struggle to conceive naturally – or experience a significant delay – due to the absence of a reliable, trackable menstrual period as a consequence of a reduction in ovulation, which is why seeing a specialist early on in your fertility journey is key.
Often the first step is a simple ovulation check with a fertility expert which may include a blood test done at a clinic during the second half of a woman’s cycle to determine whether ovulation is occurring.
If ovulation is erratic or non-existent an ovulation-inducing drug may be prescribed, or a doctor may choose to use a closely monitored injectable. In more difficult cases, intrauterine insemination (IUI) or In-vitro fertilisation (IVF) may be considered.
O'Brien advises people to take early action and educate themselves about PCOS and how it can affect fertility. While the chances of getting pregnant naturally (and quickly) may be lower for those with PCOS, lifetime fertility is not impaired. Most women with PCOS will succeed in having a baby. However, PCOS does complicate the process and it is important to seek help early on.