PCOS (Polycystic Ovarian Syndrome) is a common gynecological diagnosis that causes great alarm in women, especially those who wish to conceive. The condition, being the most common endocrine (hormonal) disorder in women of reproductive age, with its increasing prevalence, has as many misconceptions as the awareness it has gained. One of them is the misconception that ‘a woman with PCOS cannot get pregnant’.
This is not true. Of course, PCOS is a major cause of subfertility as a result of ovulation disorders. But being a victim of this syndrome does not mean that the woman cannot conceive at all.
As I mentioned earlier, the syndrome is a cause of subfertility but not sterility. Subfertility means a diminished ability to conceive and have a child, while sterility is the absolute and irreversible inability to conceive.
PCOS presents with a varied variety of symptoms. If you are diagnosed with this condition, your symptoms do not need to be the same as those of another woman with PCOS. Similarly, her fertility level also depends on whether or not she ovulates, her age, any coexisting medical conditions, the presence of other causes of infertility, etc. Some women with this syndrome may have intermittently regular and fertile cycles, but menstrual irregularity is usually a common symptom of this syndrome. Studies report that of all women diagnosed with PCOS, 2/3 of them do not ovulate regularly. If her doctor finds that she is not ovulating, she will intervene to regularize her cycles and induce ovulation, which means that with proper intervention or treatment she can conceive. The intervention could be a lifestyle change: weight reduction if you are obese, diet modification, or medical treatment.
How is obesity related to PCOS?
Studies consistently show a higher prevalence of PCOS in obese women. Although obesity is not a cause of this syndrome, it has been found to be a major environmental trigger for the onset of symptoms. However, it is observed in many parts of the world that women who fall within the normal range of BMI (body mass index) are also diagnosed with PCOS. However, weight gain is common with this condition and vice versa, and there are studies showing that obesity substantially affects fertility and the response to infertility treatment, regardless of the cause of the infertility.
How does obesity affect your fertility?
Obesity causes insulin resistance in the human body. This means that the body does not respond well to insulin, so the level of glucose in the body rises. To compensate for this increase in glucose level, the pancreas secretes more insulin, which causes hyperinsulinemia (excessive level of insulin in the blood). The ovary is a target organ for insulin; stimulates the ovary to produce an excess of androgens (male sex hormone). Although the ovary normally produces a small amount of androgens (testosterone) along with the female sex hormone (estrogens), excessive androgen production is unfavorable and interferes with ovulation.
How to improve your fertility?
If you are obese, even a small amount of weight loss can bring you back to ovulation because weight loss improves the body’s insulin sensitivity, which decreases insulin secretion and in turn controls the hormonal imbalance. Losing just 5-10% of your body weight can make it easier for you to get pregnant. Studies show that losing body weight through lifestyle changes can restore ovulation and improve pregnancy rates in up to 60% of women with PCOS. Although losing weight for a woman with PCOS is not as easy as it is claimed, the positive effect it has on resuming fertility should itself be a motivator. The hormonal disruption in her body along with the psychological changes will pose the greatest challenge in her mission to lose weight and her success lies in adherence to lifestyle changes. In addition, losing weight also helps prevent complications such as miscarriage and gestational diabetes (diabetes during pregnancy), if she becomes pregnant.
Weight reduction is extremely rewarding when you try to combine physical exercise with diet modification. Physical exercise does not mean vigorous physical activity. A moderate physical exercise with a reduced sedentary lifestyle gives good results.
Diet modification includes a balanced, low-calorie, low-glycemic (low-carbohydrate) diet. Changes in the diet help reduce weight, as well as prevent diabetes mellitus and cardiovascular disease, which are feared long-term complications in women with PCOS.
If you do not ovulate normally or even with lifestyle changes, ovulation induction medications may be needed. These drugs have been found to stimulate ovulation in up to 85% of women with PCOS. Clomiphene citrate is the first-line medical treatment to control infertility in women with PCOS. It causes the eggs to mature and be released. Women who do not respond well to clomiphene or who are obese receive metformin. Metformin can help women ovulate on their own or respond well to clomiphene treatment. Studies report that a good response to metformin is also seen in non-obese women. Gonadotropin analogues form the next line of intervention if treatment with clomiphene and metformin fail. Women who do not respond to medical treatment will need laparoscopic surgery (ovarian drilling to facilitate ovulation) or in vitro fertilization. Most women show positive results with medical treatment but of course with a continuous and effective lifestyle change.
All of the above facts answer the title question: “Does PCOS mean you can’t conceive?” in one dimension – ‘How is pregnancy possible with PCOS?’ There is another dimension to address. There are women with PCOS who wish to delay conception. If you are one of them, do not consider this syndrome as a natural contraceptive. Studies report that some women with PCOS conceive naturally without any intervention. As I mentioned earlier, your fertility level depends on whether or not you ovulate, and if you do, how often. Therefore, you should use adequate contraception if you are not ready for pregnancy.
