PCOS and Fertility: A Comprehensive Guide

Understanding Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. It is estimated to affect between 8% and 13% of reproductive-aged women, yet a significant number remain undiagnosed. PCOS is not just a fertility issue; it is a complex hormonal and metabolic condition that can affect a woman's overall health throughout her life.

At GEM Hospital & IVF Centre, we specialize in managing PCOS-related infertility. We understand that PCOS can be a frustrating and emotional diagnosis. Our approach is holistic—we don't just treat the symptoms; we address the underlying hormonal imbalances to help you regulate your cycles, improve your health, and ultimately achieve a successful pregnancy.

What Exactly Happens in PCOS?

In a normal menstrual cycle, several small follicles (fluid-filled sacs containing eggs) begin to develop in the ovaries. Eventually, one becomes dominant and releases a mature egg (ovulation). In women with PCOS, the hormonal signals are disrupted. The ovaries produce higher-than-normal levels of androgens (male hormones), which interferes with the development and release of the egg.

Instead of a mature egg being released, many small, immature follicles remain in the ovaries, often appearing like a "string of pearls" on an ultrasound. This lack of regular ovulation (anovulation) is the primary reason why PCOS causes infertility.

The Three Key Pillars of PCOS Diagnosis:

Most experts agree that a diagnosis of PCOS is made if you have at least two of the following (often called the Rotterdam Criteria):

• Irregular Periods: This is the most common sign. Examples include menstrual cycles that occur at intervals longer than 35 days; fewer than nine periods a year; failure to have a period for four months or longer; and periods that are very heavy.
• Excess Androgen: Elevated levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
• Polycystic Ovaries: Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

The Link Between PCOS, Insulin, and Fertility

A major factor in PCOS is insulin resistance. Insulin is a hormone produced in the pancreas that allows cells to use sugar, your body's primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin.

Excess insulin might increase androgen production, causing difficulty with ovulation. It also makes it harder to lose weight, and obesity can further worsen the symptoms of PCOS. This creates a cycle that can be difficult to break without medical and lifestyle intervention.

Symptoms Beyond Infertility

While infertility is often what brings women to our clinic, PCOS presents several other symptoms that we manage concurrently:

• Weight Gain: Especially around the abdomen (central obesity).
• Skin Changes: Darkening of the skin in creases (acanthosis nigricans), acne, and skin tags.
• Hirsutism: Unwanted hair growth on the face, chin, chest, or back.
• Mood Changes: Increased risk of anxiety and depression.
• Sleep Apnea: Linked to insulin resistance and weight.

Management and Treatment at GEM Hospital

PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.

1. Lifestyle Modifications (The Foundation)

This is the first and most crucial step. Even a 5% to 10% loss in body weight can significantly improve your symptoms and regulate your menstrual cycle. We provide guidance on:

• Low Glycemic Index (GI) Diet: Focusing on whole grains, legumes, and high-fiber foods to manage insulin levels.
• Regular Exercise: Combining cardio and strength training to improve metabolic health.

2. Medications to Induce Ovulation

To help you conceive, we may prescribe medications that stimulate the ovaries:

• Letrozole (Femara): Now often the first-line treatment for PCOS, it helps stimulate ovulation with fewer side effects than other drugs.
• Clomiphene Citrate (Clomid): An oral medication taken during the first part of your menstrual cycle.
• Metformin: Often used for type 2 diabetes, it improves insulin resistance and can help regulate ovulation in women with PCOS.
• Gonadotropins: These are hormone medications given by injection.

3. Assisted Reproductive Technology

If medications alone don't lead to pregnancy, we offer advanced options:

• IVF (In Vitro Fertilization): IVF offers the highest success rates for women with PCOS. Because women with PCOS often have a high "egg reserve," they typically respond very well to IVF stimulation, though care must be taken to avoid Ovarian Hyperstimulation Syndrome (OHSS).
• Laparoscopic Ovarian Drilling: A surgical procedure where a doctor makes tiny holes in the ovary using a laser or heated needle. This can lower androgen levels and help with ovulation.

Pregnancy with PCOS

Women with PCOS have a higher risk of certain complications during pregnancy, such as gestational diabetes and preeclampsia. At GEM Hospital, our care doesn't stop once you conceive. We provide specialized monitoring throughout your pregnancy to ensure the health of both mother and baby.