A PCOS diagnosis can come with a slew of symptoms and anxieties to manage, not the least of which is the big F word: fertility. But if you’re facing this hormonal condition with worry over future family planning, take heart. The prognosis for women with PCOS to conceive a healthy pregnancy is bright, and even when medical assistance is required, there are many options for those navigating hormonal imbalances.
We chatted with renowned OB/GYN, reproductive endocrinologist and infertility expert, Dr. Andy Huang, MD, FACOG, to dig deeper into how PCOS impacts our ability to conceive, how you can tweak your lifestyle to boost fertility, and what fertility treatments patients with PCOS can consider.
Keep reading for your complete guide.
But First: What Is PCOS?
For starters, it’s important to understand that, PCOS, or Polycystic Ovary Syndrome, is one of the more common hormonal conditions for women—affecting as many as 5 million women of reproductive age, according to the CDC.
"The definition, by textbook, is women with very irregular cycles in conjunction with either high levels of testosterone, or normal hormone levels but clinical signs of high testosterone levels—including acne, oily skin, or excess hair growth,” Dr. Huang says.
PCOS
polycystic ovary syndrome
A condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. The name polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form in the ovaries.
“The diagnosis of PCOS isn't just about infertility,” notes Dr. Huang. Women with PCOS also have an elevated risk of diabetes.” That’s because one of the tell-tale markers of PCOS is insulin resistance—an inability to effectively utilize insulin, a hormone that balances blood sugar. This causes the body to produce more insulin, which can cause the ovaries to produce too much testosterone and other androgens. This can result in skipped ovulation and therefore, irregular menstrual cycles.
One last thing to keep in mind, according to Dr. Huang: “Having irregular periods—to the point of no periods—increases the risk of certain endometrial cancers.”
How Does PCOS Affect Fertility?
Since PCOS can affect the function of ovulation for some women, it can be harder to get pregnant. How does that excess testosterone impact ovulation, specifically? To start: When there are elevated testosterone levels in the body, testosterone gets converted to estrogen. “When you have elevated levels of estrogen, your body doesn’t know what to do, and as a result, it prevents you from ovulating,” says Dr. Huang. “Having high levels of estrogen is kind of like taking birth control pills, it breaks the feedback loop of a woman’s ovulatory cycle.”
More specifically, there are two types of ovulatory dysfunction. First, “there’s anovulation, which means a woman does not ovulate,” says Dr. Huang. She might get her period just once every three to six months.
“Just by having no periods, you know that this woman with PCOS is probably not ovulating,” Dr. Huang explains.
anovulation
Anovulation happens when an egg (ovum) doesn't release from your ovary during your menstrual cycle.
However: “Having periods doesn’t mean you’re ovulating either,” he continues. “Sometimes it’s not black and white. Sometimes it’s oligoovulation. Oligoovulation is when you ovulate every two to three months instead of every month. Some women will have a period one month, then no period for two months, then a period for one month, then no period for three months. That’s somebody who is oligoovulatory.”
oligoovulation
Oligoovulation is a condition that causes irregular or infrequent periods.
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What Lifestyle Changes Should a Woman With PCOS Consider?
If you’ve been diagnosed with PCOS, your first step is learning how to manage your symptoms with some lifestyle changes, Dr. Huang suggests. Specifically, it is important to “hit an ideal body weight—not over- or underweight,” he says. “People associate PCOS with weight gain, but there is a subset of women with PCOS that are underweight. When you hit that ideal body weight, the body says: Okay, I’m in a good place, I can ovulate.”
How can women best do this? “By maintaining a healthy lifestyle—one that’s not overly aggressive in terms of exercise routine, and also includes eating a well-balanced diet full of antioxidants,” says Dr. Huang. “Somewhat low-carb, because with PCOS you can be a little bit insulin resistant.”
What Fertility Treatments Can Help Women with PCOS?
If you’ve established a routine with low-impact exercise, a healthy diet, and weight management, and you’re still experiencing irregular menstrual cycles, it might be time to venture to a fertility specialist.
"For women with PCOS who are not ovulating—we just need to get them to ovulate,” Dr. Huang says. To do that, your physician might use a certain set of oral medications that are utilized for ovulation induction.
“Some of these medications include Clomid, which we have been using for decades, and Letrozole, which we’ve been using for a decade,” says Dr. Huang. “When those fail, then we use Gonadotropins, specifically FSH, which we can inject into a woman to get her to ovulate.” (Gonadotropins are peptide hormones that regulate ovarian function.)
These medications essentially work by “tricking” the brain. “They make the brain think that the woman has no estrogen, and then it steps on the gas a little bit by making FSH to get a woman to ovulate,” Dr. Huang explains.
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What Should Women Know About These Drugs?
As with any medication, there is context to consider. “Clomid will help a woman ovulate better, but sometimes it will negatively affect cervical mucus so the sperm doesn’t get past the cervix—which might mean that we have to do insemination,” says Dr. Huang. “And sometimes Clomid will thin your uterine lining, making it harder for implantation to occur.”
That said, “recent studies have shown Letrozolel has less side effects,” he says. “The other side effects that come with any type of pill are heachaches and hot flashes. But overall, oral medication side effects are low.”
“Inevitably, some women are very sensitive to Clomid and Letrozole, and the body’s natural response to more FSH is to ovulate two or three eggs. So, the risk of twins and triplets does increase a tiny bit any time you take medication,” Dr. Huang explains. To put a number on it: Clomid and Letrozole increase the risk of twinning to about seven percent.
"So, 93 percent of the time when you get pregnant with Clomid or Letrozole it will be a singleton,” says Dr. Huang. “Twins do bear increased risk in pregnancy, so it is something to be mindful of."
But let’s say Clomid and/or Letrozole still don’t result in a healthy pregnancy. “If you move onto injections, now it’s stronger, more expensive, and a direct stimulation,” says Dr. Huang. “So a patient makes more eggs, but that means the chance of having twins goes up to about 15 to 20 percent. So that’s why we like to try Clomid and Letrozole before we move on to more aggressive shots.”
A final note: “Some women with severe PCOS are resistant to these oral medications,” says Dr. Huang. In that case, you should work with your doctor to determine other options, like IVF.
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Written by Jessica Lopez. Jessica Lopez is a freelance writer, digital content creator, and mother. You can follow her @Jessica.H.Lopez.
This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and we recommend that you always consult with your healthcare provider. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Perelel.
