Polycystic ovary syndrome (PCOS)

The medical condition known as polycystic ovary syndrome (PCOS) causes your ovaries to act abnormally and leads to irregular or lack of menstrual periods, abnormal or absent ovulation, and, therefore, infertility. PCOS is a common cause of infertility and occurs in about 5 to 10 percent of reproductive-age women. Symptoms of PCOS do not typically show up until after puberty, when menstruation begins. In some women, hormonal changes may begin as early as the very first menstrual cycle. In most women with PCOS, changes occur gradually, over time.

Symptoms of PCOS may include:

1. Increased body and facial hair (also known as hirsutism)
2. Acne
3. Darkened color of the skin along the neck, armpits, groin, and inner thighs
4. Obesity
5. Irregular menstrual periods or no periods
6. Vaginal yeast infections

What Does PCOS Do? How Does It Affect My Fertility?
The circumstance that causes PCOS usually originates in your pituitary gland. The pituitary gland is considered your body’s master gland because it triggers the release of hormones for your entire body. Instead of the normal reproductive hormonal balance, PCOS causes your hormones to become out of sync. PCOS also causes higher concentrations of male hormones (androgens). The result of this complex hormonal imbalance is that ovulation occurs irregularly, if at all.

In a normal ovary with normal ovulation function, one follicle matures and an egg is released each month, and this corresponds to rising progesterone levels. In a polycystic ovary, there are many follicles, but they do not mature and, therefore, no egg is released. Because the eggs are not released, progesterone levels remain low and out of sync with the other hormone counterparts, androgen and estrogen. This results in irregular periods and continues the cycle of PCOS hormonal imbalance.

In addition, many women with PCOS produce too much insulin or the insulin they produce doesn’t work properly. Insulin is a hormone that controls your body’s use of sugar (glucose) but also usually plays a role in PCOS. Insulin interrupts the normal growth of the follicle in the ovaries. The affected ovaries contain such a large number of immature egg
follicles; that they become abnormally enlarged and function abnormally.

Who Is at Risk? What Causes Polycystic ovary syndrome (PCOS) ?
Women with PCOS often have a family member with the condition. In fact, PCOS is considered a genetic disorder. This means that if you have PCOS, most likely you were born with the condition. Remember that PCOS might also be passed to your female children.

How Is PCOS Diagnosed?
To diagnose PCOS, your doctor will ask you questions about your health, your menstrual cycle, and your family history. The doctor will also perform a physical examination and order blood tests to check your hormone levels. If PCOS is suspected, a pelvic ultrasound may be performed to closely view your ovaries.

How Is PCOS Treated?
Treatment depends on your symptoms and your desire for pregnancy. A low carbohydrate diabetic diet along with regular exercise may be prescribed to lower your insulin levels. Additionally, research has shown that approximately 75 percent of women with PCOS respond well to fertility medication. In some cases, laparoscopic surgery is required to remove ovarian cysts that resulted from PCOS. Women with PCOS should be aware of potential long-term health risks. They are at an increased risk of developing uterine cancer and are at risk of developing diabetes. PCOS has also been linked to heart disease, abnormal lipid profi le, and high blood pressure. Because of these increased health risks, women with PCOS should be evaluated carefully by their doctor on an annual or more frequent basis. PCOS is a condition that you are born with, so you can never truly be cured. However with proper treatment, your symptoms can be relieved and you can live a healthy and normal life. Becoming pregnant is certainly possible but may require some advance planning and treatments to be determined between you and your doctor.

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Causes of Infertility: Health and Lifestyle Concerns for Women

• NUTRITION

What you eat may affect your menstrual cycle, ovulation, and overall hormonal balance. That’s why you should consume a healthy and well-balanced diet. Plus, diets that are either too high or low in calories can signifi cantly affect your overall body weight. Extreme weight loss or weight gain may affect your menstrual cycle and fertility.

• EXERCISE

Regular and vigorous exercise can change your menstrual cycle. In extreme cases, your menstrual periods may stop completely. This problem seems to be especially common among long-distance runners. However, women who exercise to excess and dramatically reduce their body weight and fat content may also experience a lack of menstrual periods. And without your menstrual cycle, you will not be able to ovulate and conceive.

• BODY WEIGHT

Being overweight by even 10 to 15 percent above normal can overload your body with estrogen. This extra estrogen is produced within the fatty tissue and can dramatically change your hormone balance. In many cases, obese women ovulate irregularly, if at all. Lack of body fat may also result in irregular periods and infertility. A woman who is underweight by 10 to 15 percent has less fat storage and therefore less estrogen. Although it may vary from woman to woman, most medical experts agree that a woman needs a body fat content of approximately 22 percent to allow for the normal hormonal balance and subsequent ovulation process.

• CHRONIC DISEASE

Medical conditions such as lupus, diabetes, thyroid disease, and rheumatoid arthritis have been shown to reduce your fertility. If you have one of these medical conditions, it’s imperative that you take your prescribed medication and be under the care of a qualifi ed health care provider. This is especially true when you are trying to become pregnant. Cancer may or may not affect fertility. However, the cancer treatments, such as chemotherapy or radiation, almost always will. If possible, talk with a fertility expert before starting your chemotherapy or radiation. It’s often possible to work with your team of doctors and come up with a plan to safeguard or at least improve your future fertility.

Effect of recent or past use of contraception on Fertility

Many women are concerned about how past use of contraception might affect their future fertility. In almost all cases, your fertility is returned to normal within a short time of discontinuing the contraception. Birth control pills prevent pregnancy by stopping the ovulation process. Almost always, birth control pills do not affect your future fertility. That’s especially true if your menstrual periods were normal prior to beginning the pill. However, a few women who stop taking birth control pills experience some diffi culty getting pregnant.

A medical investigation may be a good idea if you have gone off birth control pills and still don’t have normal menstrual periods within six months. Another type of contraception is the Depo-Provera hormone injection, which works by stopping ovulation. One shot is supposed to prevent pregnancy for three months. Unfortunately, many women who want to become pregnant often fi nd that it takes between 6 and 16 months for their menstrual cycle and ovulation process to return to normal