Polycystic ovary syndrome (PCOS) is a common health problem experienced by 1 in 10 women of child baring age. It is caused by an imbalance of reproductive hormones and the most common cause of infertility. 

In a normal and healthy menstrual cycle, the ovaries make the egg that is ovulated (released) each month. Because of the hormonal imbalance, the egg may not develop or ovulate during ovulation as it should, causing irregular or missed cycles. 

Bottom line, if you don’t ovulate a healthy egg, or at all, it means you can’t get pregnant. 

Most women won’t know they have PCOS until they begin and fail at trying to conceive.

Some of the symptoms of PCOS include:

  • Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods all together.
  • Development of cysts (small fluid-filled sacs) in the ovaries.
  • Too much hair on the face, chin, or parts of the body where men usually have hair. This is called “hirsutism.” Hirsutism affects up to 70% of women with PCOS.
  • Acne on the face, chest, and upper back
  • Thinning hair or hair loss on the scalp; male-pattern baldness
  • Weight gain or difficulty losing weight
  • Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
  • Skin tags, which are small excess flaps of skin in the armpits or neck area

What causes PCOS?

The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role with the most common two being a high level of androgens or insulin.

Androgens are sometimes called “male hormones,” although all women make small amounts of androgens. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.

Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. Many women with PCOS have insulin resistance,  which over time can lead to type 2 diabetes.

How is PCOS diagnosed?

There is no single test to diagnose PCOS. PCOS is diagnosed by a mix of tests and exams that may include: 

  • Ultrasound to look for a high AFC, enlarged or swollen ovaries, and multiple cysts.
  • Blood tests for your hormonal panel, androgens levels, AMH (higher than normal AMH can indicate PCOS), and diabetes.
  • Physical exam will look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).

What are my treatment options for PCOS if I’d like to get pregnant? 

After ruling out other causes of infertility in you and your partner, the most commonly prescribed treatment is medication such as Clomid or Letrozole to help you ovulate. Fertility medication is often used in conjunction with Metformin, to reduce insulin levels.

IVF may be an option if medicated cycles do not work. Compared to medicine alone, IVF has higher pregnancy rates and better control over your risk of having twins and triplets (by allowing your doctor to transfer a single fertilized egg into your uterus), as those diagnosed with PCOS are more likely to produce multiple eggs with medicated cycles.

The great news for those with PCOS who do choose to undergo IVF treatment, is that you are likely to have more eggs retrieved than average. The question will always be the quality of your eggs, which lifestyle and diet changes can help.