Does PCOS Mean Infertility? Here’s What You Need To Know
PCOS, or polycystic ovary syndrome, affects approximately one in 10 women. This prominent condition results in imbalanced levels of hormones and accounts for nearly a third of all infertility cases.
However, managing PCOS is possible, and it is possible to become pregnant depending on the severity of the condition. This post will cover:
- What is PCOS and its symptoms?
- What does this condition mean for fertility options?
- What are treatment options?
- Can the Ava bracelet be useful for women with PCOS?
What is PCOS?
PCOS stands for polycystic ovarian syndrome, and while the name implies that there are multiple cysts on the ovary, the name is actually a misnomer with PCOS being different from ovarian cysts.
A cyst refers to a fluid-filled sac that can grow anywhere on the body, including on the ovary. These ovarian cysts often don’t require intervention unless they rupture nor are they problematic when trying to get pregnant. However, in PCOS, the so-called “cysts” are actually follicles that are growing abnormally, leading to a hormone imbalance and fertility challenges.
More importantly, abnormal follicle growth isn’t always observed in PCOS, so it’s possible to have this condition without the growths.
In fact, having two of three of the following symptoms can be indicative of this hormone condition:
- Enlarged ovaries with multiple follicle growth
- Excess androgen production (the primary androgen is testosterone)
- Irregular or absent menstrual cycles
What are the symptoms of PCOS?
PCOS symptoms vary considerably between women. For some, symptoms arise shortly after beginning to menstruate, while others experience symptoms later in the teen years or early adulthood. Symptoms can also vary in severity with many women experiencing subtle signs and not aware of the symptoms while some may experience more obvious symptoms. The following are symptoms associated with this hormone condition:
- Irregular or absent menstrual periods
- Hirsutism aka excess hair growth in unexpected places, like face, back, thumbs, toes, chest, abdomen.
- Hair loss
- Weight gain
- Mood disruption
- Pelvic pain
- Sleep issues
How do I know if I have PCOS?
Currently, medicine does not have one test that definitively tells a patient whether or not they have PCOS, but doctors can perform one or more of the following tests to assess the likelihood of the condition:
|Test||What it can tell you about PCOS|
|Ultrasound of lower abdomen||Abnormal growths on the ovaries, which typically look like a string of pearls, can be visualized via ultrasound scan|
|Blood levels of hormones||Blood levels of hormones can indicate whether hormone imbalance is present. The ovaries produce estrogens, progesterone, and low levels of testosterone, and higher levels of testosterone can be indicative of PCOS.|
|Blood glucose levels||Insulin resistance and abnormal blood glucose levels are implicated in PCOS|
|Family History||Genetics play a role in this disease, so your doctor will ask you if women in your family history experience similar problems|
|Physical Exam||Hormone imbalance can result in the physical symptoms like excess hair growth, acne, and weight gain.|
|Pelvic Exam||Assess the presence of growths on ovaries and observe whether uterine lining is thicker than normal (if you’re not menstruating regularly, then this could be apparent in the uterine lining building up.|
What are risk factors for PCOS?
While researchers are still trying to understand why PCOS happens, research points to two main risk factors:
- Genetics: if you have an immediate family member (mother or sister) with PCOS, this increases the risk of a woman experiencing the condition herself.
- Weight: Obesity can slightly increase risk for PCOS. While researchers hypothesize that increased body fat can interfere with hormone production, it appears to be more complex than a direct relationship of risk increasing with excessive weight gain. A study of 675 women observed the following PCOS prevalence rates based on weight [1. https://www.ncbi.nlm.nih.gov/pubmed/17925334] :
|Underweight (BMI < 18.9)||8.2%|
|Normal (BMI 19.0 – 24.9)||9.8%|
|Overweight (BMI 25.0 – 29.9)||9.9%|
|Mild obesity (BMI 30.0 – 34.9)||5.2%|
|Moderate obesity (BMI 35.0 – 39.9)||12.4%|
|Severe obesity (BMI > 40.)||11.5%|
What is happening with hormones in PCOS?
PCOS is characterized by an overproduction of luteinizing hormone (LH), which in turn causes the ovaries to produce an excess of testosterone (normally, they produce very little). Excess amounts of LH and testosterone disrupt ovarian function and prevent women with PCOS from ovulating regularly.
These hormonal imbalances prevent the developing follicles in the ovaries from maturing properly. Instead of one egg dominating each month and eventually bursting out in ovulation, the developing follicles stay trapped inside. After time, so many follicles collect in the ovary that cysts begin to form. Eventually, a shell also forms around the outside of the ovary, causing further disruptions to ovulation.
What are treatment options for PCOS?
Unfortunately, to date, there is no cure for PCOS. Managing this condition is important for preserving reproductive health, but because symptoms do not subside with menopause, symptom management is important over the entire lifespan, not only during the reproductive years.
For managing the physical symptoms, here are available treatments and what they mean for your physical health:
- Lifestyle changes: To reduce weight gain and insulin resistance, your doctor may recommend increasing amount of moderate, physical exercise and reducing caloric intake. For some women, improving issues with insulin resistance is sufficient to mitigate symptoms although not all women may experience this full benefit.
- Hormone intervention: To treat hormone imbalances, your doctor may prescribe the combination birth control pill or progestin therapy.
- Anti-androgen treatments: To mitigate excessive hair growth, your doctor may prescribe medications the block the effects of androgens. This could be an oral medication or a topical one. Also, the birth control pill can also reduce androgen production and control excessive hair growth.
It’s important to note that both hormone interventions and anti-androgen treatments will prevent pregnancy, so if you’re trying to conceive and have PCOS, the following section will cover treatment options that preserve fertility.
Can I still get pregnant if I have PCOS?
The answer is YES! Even though PCOS is the leading cause of female infertility, it is still very much possible to get pregnant with this condition. If you’re struggling to conceive and have this condition, the likely issue is anovulatory cycles, or menstrual cycles with no ovulation and breakthrough bleeding.
To resume ovulation, here are possible treatment interventions to induce ovulation:
- Clomid is an oral medication that acts on the estrogen system and increases the release of GnRH to induce ovulation.
- Letrozole is also an oral medication that blocks estrogen production, which helps signal the hypothalamus to increase follicle stimulating hormone (FSH), which can increase ovulation.
- Metformin is used to manage diabetes and can help mitigate insulin resistance.
Can exercise improve my fertility odds if I have PCOS?
The answer is potentially yes. A clinical trial from 2015 studied 149 women with PCOS and randomly assigned them to exercise intervention, birth control pill, or a combination of both treatments. After four months, the women went through ovulation induction, and timed intercourse to conceive. Of those three treatment options, the ovulation rate was significantly higher in women who exercised alone (60% of women) or in combination with the pill (67%) in comparison to the pill alone (46%). Live birth rates were also higher in women who had exercised but this did not reach statistical significance [2. https://www.ncbi.nlm.nih.gov/pubmed/26401593].
However, while exercise seems to have positive benefits on ovulation and fertility, it doesn’t always seem to work in every case. Talk to your doctor about whether exercise is the right option for you if you’re trying to conceive.
Is PCOS a pregnancy complication?
There is an increased risk of miscarriage, preeclampsia, and gestational diabetes with PCOS. If you have this condition and are pregnant, talk to your obstetrician about how to safely manage your pregnancy.
Can Ava help me if I have PCOS?
Many women with PCOS have asked if they can use Ava to help them get pregnant. We understand why they’re asking: the current options for tracking fertility are difficult to use when you have this condition, and a device that could tell you when you’re fertile without taking your temperature every morning or going through tons of ovulation tests and sticks would be really exciting!
However, we want to be very clear that the Ava bracelet has not been clinically tested among women with PCOS, and so we cannot make any claims about whether it will be effective for the condition. Ava’s clinical study for PCOS and irregular cycles is currently underway at the University Hospital of Zurich. We know that having a reliable way to track the cycle is important for women in this situation. We hope to release an update to Ava’s algorithm for PCOS/irregular cycles soon.
Depending on your case of PCOS, the data from the Ava bracelet can be informative for your cycles. Ava’s fertility detection feature is only accurate for menstrual cycles between 24 – 35 days, so if your cycles still fall in this range or if you are using fertility treatments to help with ovulation, then Ava might work for you, and we hope to have better data and features for different cases of PCOS soon.