Polycystic ovary syndrome or PCOS is the most common hormonal disorder in women of reproductive age, affecting 10-15 percent of women and upward of 7 million women in the US alone. Despite its name, ovarian cysts are not required for its diagnosis. Rather than just a condition of the ovaries, PCOS is a condition with genetic links that affects a woman’s entire body throughout her lifespan with symptoms such as weight gain, irregular periods, infertility, acne, hair growth on the face (hirsutism), and hair loss. PCOS also steps-up a woman’s risks for type two diabetes and cardiovascular disease as she gets older—and it doesn’t go away after menopause.
To diagnose PCOS, women need two of the following three criteria:
1. Anovulation (the failure to either produce an egg or discharge it from an ovary) or delayed ovulation (cycles that are typically 35 days or longer).
2. High levels of androgen hormones such as testosterone or clinical signs of high androgens like hirsutism (facial hair growth), acne or hair loss.
3. Polycystic ovaries detected via an ultrasound.
When it comes to conceiving a baby, PCOS ranks as the leading cause of ovulatory infertility. Many women who have trouble conceiving are shocked to learn that they have PCOS, not having known what the cause of their symptoms was previously.
The type of infertility women with PCOS experience is in fact unique–so if you have any of the symptoms these facts are important to know.
- Women with PCOS Have an Abundance of Follicles in their Ovaries
Women with PCOS tend to have a lot of follicles (the structures which house eggs) within their ovaries. In PCOS, the follicles often secrete high amounts of testosterone, causing the follicles to develop more slowly, in some cases blocking ovulation entirely. In some women with PCOS, these stalled follicles create the appearance of multiple small cysts on ultrasound, but in others this may not be present.
- Women with PCOS Ovulate late, or not at all.
Excess androgens can cause many women with PCOS to ovulate 7 days or more later than the average day 14 of the cycle. This causes the menstrual cycle to arrive late as well, often resulting in cycles lasting at least 35 days, or in some cases, much longer. This is one of the hallmark symptoms of PCOS, so if you have long cycles consistently, you may want to request an assessment for PCOS.
- Ovulation test kits often don’t work in women with PCOS.
Ovulation tests that you can buy at the drugstore often don’t work for women with PCOS. That’s because they measure a hormone called luteinizing hormone (LH), which is often already unusually high in PCOS. This hormone typically surges middle of a woman’s cycle, triggering ovulation. In PCOS, many women find that their ovulation tests are positive at unusual times that don’t’ correspond with ovulation, and can even be positive every day! This happens because LH tends to be higher across the whole cycle in PCOS.
- Women with PCOS hit their reproductive peak later and go through menopause later.
Here’s some good news if you’re planning to conceive in the future—women with PCOS tend to hit their peak fertility around two years later than other women. With age, the number of eggs and amount of testosterone that slow ovulation in PCOS naturally decline, and the ovaries can start to become more active. Women with PCOS also have an estimated two years longer before they go through menopause, adding extra years onto their reproductive lifespan.
- PCOS typically causes Subfertility rather than Infertility and Most Women Will Eventually Conceive
Another piece of good news, is that the vast majority of women will be able to conceive in time. In fact, one study found that over a lifetime, women with PCOS had the same chances of having children and bore the same number of children on average as women without the condition. Again, this relates to improved ovulatory function as women with PCOS get older—in most cases of PCOS things just take a little more time.
And the best news of all—numerous studies have found that fertility rates increase significantly in women with PCOS by making nutritional and lifestyle interventions, as insulin resistance is one of its key aggravating factors. This is why it’s important to know the signs and symptoms of this common condition before trying to conceive, as much can be done to reverse it and improve overall hormonal and metabolic health ahead of time.
Photo by Rachael Crowe
References:
Tehrani FR, Solaymani-Dodaran M,Hedayati M, Aziz F. Is polycystic ovary syndrome an exception to reproductive aging? Human Reproduction, Vol.25, No.7 pp. 1775–1781, 2010
Legro, R. S., Dodson, W. C., Kunselman, A. R., Stetter, C. M., Kris-Etherton, P. M., Williams, N. I., … Dokras, A. (2016). Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS. The Journal of Clinical Endocrinology & Metabolism, 101(7), 2658–2666. http://doi.org/10.1210/jc.2016-1659
Marca, A La; Sighinolfi, G.; Radi, D., et al. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update. 2010; 16:113–130.
Mellembakken, J. R., Berga, S. L., Kilen, M., Tanbo, T. G., Abyholm, T., & Fedorcsak, P. (2011). Sustained fertility from 22 to 41 years of age in women with polycystic ovarian syndrome. Human Reproduction, 26(9), 2499–2504. http://doi.org/10.1093/humrep/der214
Hudecova, M., Holte, J., Olovsson, M., & Sundstrom Poromaa, I. (2009). Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve. Human Reproduction, 24(5), 1176–1183. http://doi.org/10.1093/humrep/den482
Fiona McCulloch, N.D.
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