Polycystic Ovary Syndrome & Fertility

For approximately 8-13% of women of reproductive age, fertility is a challenge due a syndrome called Polycystic Ovary Syndrome (PCOS), but our team of experts at OU Health stands ready to help women achieve the dream of motherhood despite a PCOS diagnosis.

“Patients with PCOS come in feeling very alone sometimes, but we want them to know that they aren’t alone,” said OU Health fertility specialist Dr. Heather Burks, M.D., Associate Professor in the Section of Reproductive Endocrinology and Infertility at the University of College of Medicine. “PCOS is very common with at least 8% to 10% of women in their reproductive years affected. I always encourage people who may have PCOS to talk to their doctor about it, because there are treatments.”

What is PCOS and How Common is It?

PCOS is a common hormonal condition that affects women of reproductive age, usually starting during adolescence. Symptoms may fluctuate over time and can cause hormonal imbalances, irregular periods, excess androgen levels and cysts in the ovaries.

Though the cause is unknown, this chronic and uncurable condition affects women with a family history of Type 2 diabetes at a higher rate. The disorder also creates issues with fertility due to irregular periods and lack of ovulation; however, some symptoms can be improved through lifestyle changes, medications and fertility treatments.

Basically, PCOS can cause ovaries to fail to release an egg halfway through the menstrual cycle, leading to difficulty becoming pregnant.

Key Facts About PCOS

• Polycystic ovary syndrome (PCOS) affects an estimated 8–13% of reproductive-aged women.
• Up to 70% of affected women remain undiagnosed worldwide.
• PCOS is a leading cause of infertility.
• PCOS is associated with a variety of long-term health problems that affect physical and emotional well-being.
• PCOS runs in families, but there are ethnic variations in how PCOS manifests itself and how it affects people.
• The prevalence of infertility in women with PCOS varies between 70 and 80%, according to the American Society for Reproductive Medicine

Women who have mild symptoms of PCOS often only realize they have the disorder when they start trying for a baby, particularly if their weight fluctuates. Using oral contraceptive (“the pill”) can often hide symptoms of polycystic ovary syndrome, but common symptoms include:

• Heavy, long, intermittent, unpredictable or absent periods
• Infertility
• Acne or oily skin
• Excessive hair on the face or body
• Male-pattern baldness or hair thinning
• Weight gain, especially around the belly.

“PCOS is a syndrome, which means there are a number of different symptoms, and not everyone who has PCOS has the same combination of symptoms,” said Dr. Burks. “It’s also tricky to diagnose because there is not a single test that tell you if you have it or not. It’s not uncommon for women to see multiple doctors before they get a diagnosis.”

People with PCOS are more likely to have other health conditions as well, like obesity, Type 2 diabetes, high cholesterol, heart disease, cancer of the inner lining of the uterus and hypertension.

Women with PCOS should have blood sugar levels (including a two-hour oral glucose tolerance test if possible), weight, BMI, waist circumference, blood pressure, hormone, vitamin levels and cholesterol checked and monitored regularly, added Dr. Burks.

In addition to the serious medical consequences, the disorder goes much deeper, causing anxiety, depression and a negative body image. Some symptoms such as infertility, obesity and unwanted hair growth affect other life areas such as family planning, relationships, work and involvement in the community.

Pregnancy and PCOS

The main symptom of PCOS is irregular menstruation, which means the patient is not ovulating properly, said Dr. Burks. In turn, that leads to issues with fertility.

“But pregnancy is absolutely an option for women with PCOS,” Dr. Burks said. “There are a few different options to help people with PCOS to ovulate, and they tend to be fairly successful. Again, do not be afraid to talk to your provider about what those options are. As a fertility specialist, I am always willing to talk to my patients about their concerns and explore options that work for them so we can achieve the result they dream of.”

Lifestyle change is usually one of the first-line treatments for infertility in women with PCOS, particularly those who have excess weight. According to the National Institutes of Health, a 5 to 10% loss in body weight over a period of six months regardless of body mass index has been associated with improvement in ovulation rate.

However, a doctor may also prescribe medications that will help women with PCOS conceive. These medications include clomiphene citrate to stimulate ovaries to release eggs, metformin to correct insulin resistance or a combination of both. Letrozole is a cancer medication that may be more effective than Clomid at stimulating ovulation in people with PCOS. If initial efforts are not successful, a doctor may recommend other therapies such as IUI (intrauterine insemination). IUI involves placing specially washed semen from a partner or a donor directly into the uterus using a catheter. In some cases, other options are discussed.

Many women with PCOS have had success with IVF (in vitro fertilization). IVF uses injectable fertility drugs to stimulate the ovaries so they will produce mature eggs to be retrieved from the ovaries. Those eggs are then placed together with sperm into Petri dishes. If all goes well, the sperm will fertilize some of the eggs, and one or two of those fertilized eggs are transferred back into the uterus during an embryo transfer.

“IVF can be a good option where medication or other options fail, but insurance sometimes doesn’t cover this,” said Dr. Burks.

In some cases, surgeries like ovarian drilling or ovarian wedge resection to treat PCOS may lower ovarian reserves; in this case, an egg donor may be necessary.

With all procedures, risks are present. One of the biggest risks with all fertility treatments for women with PCOS is ovarian hyperstimulation syndrome (OHSS). OHSS causes the ovaries to overreact to the fertility medication. If untreated or severe, the syndrome can be dangerous. People with PCOS are at a higher risk of developing OHSS.

In addition to standard treatment options, OU Health also offers access to clinical trials regarding PCOS. Participation in a clinical trial can provide access to new treatments, contribute to medical knowledge, and offer close monitoring by experts.

“Our team at OU Health is dedicated to helping individuals grow their families, and while PCOS may present some challenges, it is a joy to be able to help individuals reach pregnancy,” Burks said. “You are not alone in your journey, and our team is here for you every step of the way.”

Learn more about Fertility Services and Reproductive Medicine at OU Health or speak with one of our experts about PCOS and fertility at (405) 271-1616.