The key to understanding how and why polycystic ovary syndrome (PCOS) can affect your fertility is to get to grips with what PCOS is. Unfortunately, it’s quite a complicated answer, but the basics are that PCOS is a metabolic disorder that can cause hormonal imbalance and a whole menu of symptoms including irregular or absent periods, problems with your fertility, acne, hair loss, weight gain, excess facial hair, diabetes, high blood pressure, fatigue and mood swings. Symptoms can be mild or severe, and your symptoms may not be the same as another women with PCOS– as there are so many symptoms you can end up with a combination that’s very particular to you, even if the underlying cause in PCOS cases is the same.
If you’ve got PCOS you’re certainly not alone. Around 10 percent of women have polycystic ovaries, even though many of them may not know it– their symptoms may have been misdiagnosed as PMS or stress, for instance, or they may have PCO which means they have polycystic ovaries on an ultrasound scan but not the symptoms. (When a woman is symptom free, the polycystic ovaries show that she has a built-in predisposition to developing PCOS. If she puts on weight or comes under a great deal of stress she may develop the symptoms.)
THE ROLE OF SEX HORMONES :
Often, the imbalance in the sex hormones that are responsible for symptoms like excess hair or acne is also interfering with your ability to ovulate. You can usually tell if you are not ovulating properly by whether or not you’re having regular periods, as a ‘normal’ menstrual cycle involves ovulation followed by a period.
The Normal Menstrual Cycle:
In a normal menstrual cycle, the first half, called the follicular phase, starts on the first day of your period and lasts for about 14 days. In this phase the pituitary gland releases low levels of FSH(the follicle-stimulating hormone) to stimulate the follicles in the ovary to ripen their eggs and produce the hormone oestrogen, which causes the lining of the womb to start to thicken in preparation for pregnancy. When levels of oestrogen are high enough the pituitary gland produces a large amount of LH (luteinizing hormone) and the dominant matured follicle in the ovary releases its egg into the fallopian tubes towards the womb in a process called ovulation. After ovulation comes the second stage of the menstrual cycle, called the luteal phase. Here the cells from the burst follicle collapse to form a cyst called the corpeus luteum. The corpus luteum now produces progesterone as the main hormone of the second half of the cycle. Progesterone causes the thickened lining of the womb to secrete nutrients ready to receive the fertilized egg. If the egg is fertilized it will implant itself in the womb and the corpus luteum will continue to produce progesterone to protect the pregnancy. If it isn’t fertilized 14 days after ovulation, the corpus luteum stops producing progesterone and estrogen. The thickened womb lining starts to break down and is shed as a period, ready for the whole cycle to start again.
If you’ve got PCOS there is often a problem with the hormones that trigger ovulation every month, which means that not only are irregular or absent periods highly likely but getting pregnant can be harder. On top of that, when ovulation isn’t successful you don’t get the surge of progesterone to balance the hormone oestrogen in the second half of your cycle which is the normal scheme of things– instead, your oestrogen levels stay the same and can cause symptoms such as bloating, fatigue, absent or irregular periods, hot flushes and dizziness, as well as mood swings and depression.
THE ROLE OF INSULIN :
If you have PCOS it’s not only your sex hormones that are out of balance and causing ovulation disturbance. Your body’s hormonal system, known as the endocrine system, is a web of interconnections, so an imbalance in one hormone can affect the balance of others, too. And in PCOS, insulin is a key hormone that can add to the problem. This is because many women with PCOS are insulin resistant, a condition which makes weight gain easy and weight loss hard– and being overweight can also interfere with your body’s ability to ovulate.
Insulin is the hormone that helps cells absorb sugar from the bloodstream. So after a meal, when the blood sugar levels are high and the body wants to store some for energy to use later, the pancreas has to make extra insulin to get the body to store that sugar away. The high surge in insulin means the body goes into sugar storage overdrive and practically clears the bloodstream of any sugar, leading to low blood sugar levels and cravings for more sugary food. This becomes a vicious cycle that can lead to putting on even more weight. If this goes on for years, it can wear out the pancreas’s ability to make any more insulin and increase the risk of diabetes.
WHAT ARE THE ‘CYSTS’?
High insulin levels also somehow increase the body’s output of the sex hormone testosterone, which can cause excess body hair and acne and affect the ovary’s ability to mature and release an egg every month. Even though there’s usually enough follicle-stimulating hormone (FSH) to encourage your egg follicles to develop, there isn’t the right balance of other hormones, such as progesterone or luteinizing hormone (LH) to encourage the egg inside it to mature. And those empty follicles that don’t release an egg are the ‘cysts’ you may have seen on your ultrasound when you were diagnosed. (These cysts are thought to be follicles that have failed to develop completely to release an egg. They are not the same as ovarian cysts, which are normally bigger and found within the ovary.)
These ‘cysts’, then, are just another symptom of the hormonal imbalances you get when you have PCOS. They are not the cause– and it’s interesting to note that in many women who get their diet and lifestyle back on track, or use medication to help deal with their PCOS, the ‘cysts’ often reduce in size and number in the same way as any other symptom, such as acne, might.
So, PCOS is a metabolic disorder that triggers a series of hormonal imbalances, including raised testosterone, lack of LH and potential insulin resistance, all of which can have an effect on your body’s ability to ovulate regularly. And this is how PCOS, and not the ‘cysts’ on your ovaries, can affect fertility.
What’s the difference between PCOS, Syndrome X and Syndrome O?
You mayalso have heard this group of symptoms described as Syndrome X and Syndrome O. Syndrome X is a term coined by a group of researchers at Stanford University, to describe a cluster of symptoms, that, when occurring together, increase a person’s risk of diabetes, hypertension and heart disease. These symptoms are high blood pressure, insulin resistance, low levels of good cholesterol (HDL) and obesity.
Syndrome O is a term used by reproductive endocrinologist Dr Ronald Feinberg to describe a condition of insulin overproduction and ovarian disruption, which can lead to abnormal bleeding, missed periods, and fertility problems. Feinberg suggests that Syndrome O should replace the term PCOS, as many womenwith PCOSdon’t have any significant cysts when checked by ultrasound, although there is still evidence that they may be at risk of developing insulin resistance. He also believes that Syndrome O is easier to teach; most women with PCOS who were polled by the PCOSA desired a name change for the syndrome, recognizing that it is a whole body female problem, not just an ovarian disorder.
Feinberg has a point but on the face of it there really isn’t much to distinguish his definition of Syndrome O and the standard definition of PCO and PCOS. It’s really just a new name for the cluster of symptoms we recognize as PCOS.
HOW WILL IT AFFECT MY FERTILITY?
However, these symptoms do not mean you’re infertile. Infertility means being unable to have a baby when you want one, and as we have seen, 70 percent of women with PCOS conceive naturally. If you’ve got PCOS and have absent, or irregular periods, or problems with ovulation, you’re not infertile– you have a condition known as subfertility. This means that getting pregnant may not be as simple for you as it is for some women but that it’s by no means an impossible feat. And it’s amazing how much you can do yourself to boost your chances of success.
This is where self-help comes in. A sperm can be a champion swimmer but if ovulation doesn’t happen and there is no egg to fertilize, there will be no pregnancy. But in PCOS there are often lots of potential eggs there, just waiting to mature. As the hormonal imbalance of PCOS is the cause of problems with fertility, if you can bring your hormones back into a more regular pattern, you can increase your chances of triggering ovulation.
HOW WILL IT AFFECT PREGNANCY?
The right hormonal conditions are also essential for a healthy full-term pregnancy. Many of the factors that can upset hormonal balance and hinder fertility or potentially contribute towards miscarriage are within your power to control or change. Simple changes in your diet, lifestyle and attitude can make all the difference. For instance, research suggests that what you eat is very significant for your fertility. Understanding nutrition and correctly supplementing your diet is the first essential step to balancing hormones naturally. Countless studies also show that stress can affect fertility and upset hormonal balance, so managing your stress levels will also help. Weight management problems can also hinder pregnancy and potentially increase the risk of pre-term birth. ‘What I try to show my patients with PCOS,’ says Dr Robert Franklin, Clinical Professor of Obstetrics and Gynecology at Baylor College of Medicine in Houston, Texas, ‘is how her excess or under weight affects her hormones and her ability to get pregnant.’ So tackling any weight issues will also boost your chances.
That isn’t to say you’ll necessarily get pregnant overnight if you eat well, destress and deal with weight problems. After all, even ‘normal’ couples are expected to try for a year before undergoing any medical investigation, and there are other factors you need to bear in mind that may be causing problems with fertility. For example, researchers believe that sperm counts have been reduced by over 40 percent in the last 50 years, with environmental pollutants from plastics and toxins, such as pesticides, thought to inhibit fertility due to their ability to act like oestrogen and disturb hormonal balance. Factors like these show that, far from being something you have little control over, there is a lot you can do to boost your fertility.
WHY DOES IT HAPPEN?
No one is really sure why women with PCOS can’t produce the correct balance of hormones so that an ovary can develop and release an egg. There are several theories, including those that suggest that inappropriate levels of the hormones testosterone, insulin, cortisol and LH are the culprits, but the general consensus is that PCOS is most likely a disorder that runs in the family. So if your mum has PCOS and irregular periods, the chances are you will too. Factors such as diet, lifestyle, weight and pollution also contribute to the development of and severity of your symptoms, and although you can’t change your genetic heritage, you can change your diet and your lifestyle. You can start to be the driver of your hormonal life to maximize your chances of health and fertility.