Polycystic Ovary Syndrome: cause of infertility in women

Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects women of child bearing age. In PCOS, many cysts which are fluid filled sacs grow in the ovaries. The ovaries are responsible for producing eggs, which if fertilized develop into a mature baby. They also produce the female sex hormones; progesterone and estrogen which help regulate the menstrual cycle and a little amount of the male sex hormone or androgen (testosterone). These eggs are released during each menstrual cycle. This process is called ovulation. A gland in the brain called the pituitary gland also produces two hormones that are also involved in the menstrual cycle, the follicle stimulating hormone (FSH) and Luteinizing hormone (LH). FSH stimulates the development of eggs in the ovaries while LH activates the secretion of mature eggs. If a woman has PCOS, excess androgen is produced and this affects the levels of all these other hormones. Many cysts (sac) grow in the ovaries, the eggs do not mature enough to be secreted and ovulation does not occur and as a result, pregnancy cannot take place. Also, the menstrual cycle is affected and the woman’s period becomes irregular.

The exact cause for these hormonal fluctuations is unknown but genetics and obesity are risk factors. Early diagnosis and treatment are important to reduce complications.

Symptoms

  • Inability to get pregnant
  • Male pattern hair growth e.g. on the chin and chest
  • Male pattern baldness
  • Irregular and heavy menstrual periods
  • Acne
  • Darkskin patches

Complications

PCOS can cause the following health complications;

  • Infertility due to lack of ovulation
  • Miscarriage or premature birth
  • Type 2 diabetes.
  • Most women with PCOS have resistance to insulin, the hormone that helps regulate blood sugar. This puts them at a risk of developing type 2 diabetes and
    Gestational diabetes (diabetes during pregnancy)
  • Heart disease
  • Endometrial cancer. Irregularities in menstrual period can cause build-up of endometrial tissue (lining of the womb) which normally should be shed out during menstrual flow. This can predispose to endometrial cancer
  • Obstructive sleep apnea. A condition where breathing is interrupted during sleep. It can affect the quality of sleep and increases the risk of various health conditions
  • Depression. This can occur due to the hormonal imbalance and the chronicity of PCOS.

How is it diagnosed?

Diagnosis is based on blood androgen levels, presence of cysts in the ovaries and irregular periods. Your doctor will take a medical history, carry out blood tests, perform a pelvic exam, and a pelvic scan.

Treatment

  • PCOS can be managed with lifestyle modifications and medications.
  • Weight loss can help improve ovulation in obese women who have PCOS as obesity tends to increase androgen levels in women.
  • Some birth control medications containing estrogen and progesterone can help regulate hormonal balance and restore ovulation and a regular menstrual period thereby reducing the risk of endometrial cancer.
  • Diabetes medications like metformin can be used to improve insulin sensitivity and reduce the level of androgen thus improving ovulation.
  • Your doctor might also recommend medications like clomiphene or letrozole to treat infertility.
  • In vitro fertilization can be done for women who wish to get pregnant
  • Surgery can be performed where other treatment plans failed. Although this is not common, tiny holes can be drilled into the ovaries to stimulate ovulation.

 

FURTHER READING

FOR WOMEN: POLYCYSTIC OVARIAN SYNDROME

LIGHT OR IRREGULAR MENSTURAL FLOW