polycystic ovarian syndrome: A common cause of female infertility

A couple walked into my office a few years ago, on sighting them, I could almost bet that I knew what the problem was. The young wife was obese, had facial acne and stubs of hair on her upper lip and chin which suggested it was not uncommon for her to shave a beard! They had been married for a little less than a year and had been unable to achieve conception. When I enquired about her menstrual flow pattern, she said it was about twice or thrice in a year she sees her period. She didn’t think it was something to be bothered about till she got married and the waiting for monthly flow “became an issue”. Normally I would have counseled them to keep trying for another few months as the chance of conception per month is about 17-20 per cent. In view of the irregular period, there was no need to wait till one year before the diagnosis of infertility is made. The earlier they were attended to, the better it would be for them.

We requested for some baseline hormone tests, ultrasound scan and sperm test. The ultrasound scan confirmed my suspicions. She had polycystic ovarian syndrome. A very common condition in fertility challenged woman all over the world. We started her on supplements and counseled her on weight loss (her weight was 118kg), so we decided on a target weight. We worked together with the dietitian on this. After having lost 20kg of weight, her periods became regular and one Easter Sunday morning, she called me excitedly on the phone. It was a big fat positive on the urine strip test –a natural conception.

What is polycystic ovarian syndrome?

Polycystic ovarian syndrome (PCOS) is a condition in which the levels of the female hormones estrogen and progesterone are out of balance. This leads to the growth of ovarian cysts (benign masses on the ovaries). PCOS can affect a woman’s menstrual cycle, fertility, cardiac function and appearance. It is widely believed to be the commonest hormonal abnormality in women of reproductive age.

What causes PCOS?

While the exact cause of PCOS is unknown, doctors believe that hormonal imbalances and genetics play a role. Women are more likely to develop PCOS if their mother or sister also has the condition.

Overproduction of the hormone androgen may be another contributing factor. Androgen is a male sex hormone that women’s bodies also produce. Women with PCOS often produce higher-than-normal levels of androgen. This is why women with PCOS have more hair (especially on the face, chest, abdomen and limbs) than the average woman. It can also affect the development and release of eggs during ovulation.

Symptoms of PCOS

Symptoms of PCOS typically start soon after a woman begins to menstruate for the first time. The type and severity of symptoms varies from person to person. The most common characteristic of PCOS is irregular menstrual periods. Difficulty getting pregnant may be another reason that leads to diagnosis.

Because PCOS is marked by a decrease in female sex hormones, this condition may cause women to develop certain masculine characteristics, such as – excess hair on the face, chest and stomach. Other symptoms may include deeper voice, hair loss, acne, weight gain, depression and difficulty in conception.

How is PCOS diagnosed?

There is no definitive test for PCOS. To make a diagnosis, your doctor will review your medical history and symptoms and perform tests to rule out other possible conditions. Your doctor will perform a physical and pelvic examination to look for signs of PCOS, such as enlarged ovaries or a swollen clitoris.

Blood tests to measure sex hormone levels are typically ordered. A vaginal ultrasound allows your gynecologist to view your ovaries as the appearance of the ovaries is one of the fundamental ways to make a diagnosis.

How is PCOS treated?

PCOS can be treated, but there’s no cure. Treatment focuses on controlling symptoms and managing the condition to prevent complications. The treatment will vary from woman to woman, depending on specific symptoms. Tips for controlling symptoms may include:

Eating a healthy diet

A healthy diet and regular exercise are recommended for all women with PCOS, particularly those who are overweight. This can help to regulate your menstrual cycle and lower your blood glucose levels

If a woman with PCOS is having challenges with conception, she and her husband will have to be evaluated. If it is only the irregular ovulation that is the problem, steps can be taken and medications used to regularize ovulation but if there are other problems, they may need in vitro fertilization to achieve conception.

Ask your doctor about medications that may help you. Anti-androgens are drugs that reduce male hormone levels. These can help stop excess hair growth and reduce acne. Diabetes medications may also be prescribed to lower blood glucose and testosterone levels.

Surgery

Surgery may be recommended for some women with PCOS. Ovarian drilling is a procedure in which your doctor punctures your ovary with a small needle that carries an electric current. This is done in order to destroy part of the ovary. It’s a short-term solution that can promote ovulation and reduce male hormone levels.

What are the potential complications of PCOS?

Women with PCOS have a higher risk of developing infertility, hypertension, diabetes, endometrial cancer, mood disorders, and recurrent miscarriages to mention a few.

Pregnancy is possible for some women with PCOS. If you become pregnant, your doctor may refer you to a doctor who specializes in high-risk pregnancies. Women with PCOS have a higher rate of miscarriage, gestational diabetes and premature delivery. They may need extra monitoring during pregnancy.

The earlier your PCOS is diagnosed and treated, the lower your risk of developing these complications. Avoiding tobacco products and participating in regular exercise can also reduce your risk of some of these medical conditions. The hormonal imbalance that leads to problem with metabolism and weight gain is difficult to battle but you can improve hormonal and glucose levels. Talk with your doctor about what PCOS means for your overall health and how you can prevent serious complications.