Polycystic Ovary Syndrome is the most common endocrine disorder diagnosed in approximately 10% of women of reproductive age. The diagnosis is given when at least two of the following three criteria are met:
- Increased levels of androgens in the blood
- Menstrual cycle disorders (irregular menstruation)
- Polycystic morphology of the ovaries in the ultrasound
The syndrome manifests differently from woman to woman, and also in the same woman from birth until after menopause. At a young age, symptoms may include increased bodily hair growth, oily skin and hair, hair thinning and acne; later, resistance to insulin and infertility; and towards menopause, Type II diabetes, high blood pressure, metabolic syndrome, abnormal uterine bleeding, and increased risk for cardiovascular disorders and endometrial cancer.
Finally, a significant aspect of the problem is the psychological burden on women with the syndrome, who experience emotional and social pressure at various stages in their lives from a different cause each time, such as hypertrichosis and increased body weight in puberty or infertility later on.
How is PCOS linked to infertility? The majority of women with this syndrome, due to hyperandrogenism and other disorders in ovarian function, cannot have regular ovulation, resulting in the severe reduction, –of the chances of natural conception. This fact is reflected in irregular periods. However, even in menstrual cycles that may appear normal in duration in women with PCOS, it has been found that ovulation does not always occur.
Consequently, women with PCOS may try to get pregnant for many years without success. However, a diagnosis of PCOS does not preclude the concomitance of other infertility factors, a fact that is often overlooked.
PCOS cannot be cured but it can be treated, differently in each case depending on the desired goal. In puberty, the dermatological symptoms and menstrual irregularities are dealt with.
When a woman with PCOS and her partner decide that they want to get pregnant, she can follow a treatment that will lead to ovulation combined with natural intercourse or sperm injection. Of course, a specialist physician must first investigate, in order to decide on the appropriate induced ovulation protocol. When induced ovulation fails or there is a concomitant infertility cause, such as problems in the man’s sperm analysis test, then IVF is recommended to the couple.
There are also invasive methods to induce ovulation, such as laparoscopic ovarian drilling or diathermy, however this treatment is no longer recommended because it is not particularly effective, has no longer-term effect, and involves the inevitable destruction of ovarian tissue.
Even though this syndrome affects a large number of women and renders getting pregnant difficult, the positive aspect is that women with PCOS have enough eggs to achieve pregnancy with any treatment that is recommended.
They must be mindful to adopt a healthy diet, maintain low body weight, and exercise. This will help them achieve pregnancy and also avoid risks associated with PCOS such as diabetes.
Infertility testing should include an insulin resistance test, which is an indication of predisposition for diabetes.