A Gynecologist Explains How PCOS Affects Fertility
Polycystic ovary syndrome, sometimes referred to as PCOS for short, is estimated to affect as many as 6 million women of childbearing age, according to the Endocrine Society.
"PCOS is a complex endocrine condition that primarily affects one's reproductive and metabolic health," says Dr. Ilana Ressler, a reproductive endocrinologist, board-certified in both Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility, at Illume Fertility, a leading fertility clinic. Health Digest spoke with Dr. Ressler, who explained the ways in which fertility may be impacted by a PCOS diagnosis.
"It commonly involves having irregular menstrual cycles, elevated 'male' hormones (such as testosterone), and enlarged ovaries that contain many follicles (structures that contain the eggs)," she states. "It is also commonly associated with metabolic abnormalities, such as insulin resistance, which may lead to type 2 diabetes."
"Due to hormonal imbalances, menstrual cycles are commonly irregular, meaning that ovulation is also irregular as a result," she goes on to explain. "If ovulation is not occurring, or it is difficult to detect when it is happening, conception can be more challenging," Dr. Ressler states. "Research shows that the prevalence of fertility issues in those with PCOS is between 70% to 80%," she says, referencing a 2015 article published in the scientific journal Clinics.
Treating PCOS when trying to conceive
"Unfortunately, there is no cure for PCOS, which means there is no one-time treatment for the condition," Dr. Ressler tells Health Digest. "However, there are many ways to successfully manage PCOS," she offers.
"Pregnancy can be attempted while actively managing PCOS[.] [H]owever, certain commonly used treatments, such as birth control pills, will need to be stopped once you are ready to conceive." Dr. Ressler states that in addition to symptom management, conception takes precedence in a patient's treatment plan for those looking to become pregnant. "When treating PCOS, if someone is trying to conceive, that becomes our priority and focus with the treatment," she says.
Dr. Ressler explains that treatment plans for people with PCOS generally involve medication. "The first-line treatment for PCOS is a combination birth control pill, which contains estrogen and progesterone. This will prevent pregnancy while [the patient is] taking it, but it does not impact future fertility," she states. "Once you are ready to conceive, the birth control pill will be stopped, and ovulation may resume."
Dr. Ressler points out that in some cases, more medication may be required. "Additional medication may be needed to assist with inducing ovulation in some people with PCOS," she says. "Treatments that improve metabolic health will increase the success of fertility treatment, as well as decrease the risk of gestational diabetes."