How PCOS affects fertility

What is Infertility

Medically, infertility is defined as not being able to conceive naturally after 12 months of having regular intercourse. You’re not considered to be infertile if you have been trying for a baby for less than a year.

Infertility is fairly a common condition that affects about 9 to 15% of couples worldwide. Infertility can be caused by many things and the cause of this can affect both men and women. A third of the causes of infertility may be as a result of a male factor and a third as a result of a female factor. The other third can be as a combination of both male and female factors or due to unexplainable reasons.

Females have a fixed number of immature eggs in their ovaries and this number reduces with age. Generally, they start with about 2 million eggs which reduce to about 25,000 by the age of 37. The quality of the eggs also reduces with age and with all other things being equal, the number and the quality of the woman’s eggs help determine how fertile she is.

Source: https://www.britishfertilitysociety.org.uk/fei/at-what-age-does-fertility-begin-to-decrease/

Adapted by permission from BMJ Publishing Group Limited. [Delaying childbearing: e ect of age on fecundity and outcome of pregnancy, van Noord-Zaadstra et al., 302, p. 1363, 1991]

Unlike women, men are not born with their sperm. They produce it daily and just like women, the quality of sperm also declines with age. Typically, this decline sets in around the age of 40 to 45 when the number and the quality of sperm produced reduces.

Causes of Infertility in women

Generally, there are 3 main causes of infertility in women;

• Ovulatory disorders – no ovulation or irregular ovulation
• Tubal disorders – blocked or infected tubes
• Uterine issues – fibroids, polyps or adhesions

Understanding PCOS

PCOS which is also known as Polycystic ovarian syndrome is a common hormonal condition in women of childbearing age which can affect fertility or the woman’s ability to conceive. PCOS causes the ovaries in women to act abnormally and leads to irregular or lack of menstrual periods, abnormal or absent ovulation, and fertility issues.  The American Society for Reproductive Medicine defines PCOS as a condition in which the ovaries contain many cystic follicles that are associated with chronic anovulation and overproduction of androgens (male hormones). The cystic follicles exist presumably because the eggs are not expelled at the time of ovulation. PCOS affects about 5-15% of women of childbearing age and is a common cause of infertility.

Unfortunately, the signs and symptoms of PCOS only start to show up after puberty when menstruation begins. Some of these symptoms are;

• Increased body and facial hair (called hirsutism)
• Oily skin with acne
• Obesity or weight gain especially around the tummy area. It is estimated that about 50% of women with PCOS suffer from obesity and have challenges controlling their weight. If you suffer from PCOS and are overweight, the slightest reduction in your body weight may help improve your menstrual cycle
• Irregular menstrual periods or no periods
• Vaginal yeast infections

You are at a higher risk of developing PCOS if

• You have a relative that has had PCOS
• You have a relative with type 2 diabetes

In addition to the above risk factors, if you have an unhealthy weight with a genetic predisposition, you stand a risk of developing PCOS.

How PCOS affects fertility

The pituitary gland is primarily responsible for PCOS as it triggers the release of hormones for the entire body. PCOS causes the reproductive hormones to get out of balance and also triggers a higher concentration of male hormones (androgens). The result of all this imbalance in the body affects ovulation in the body and ultimately fertility in women.

Under normal circumstances, during ovulation, one follicle matures and an egg is released each month which corresponds to rising progesterone levels. On the other hand, in a polycystic ovary, there are many follicles that do not mature and as such, no egg gets released. As no eggs are released, progesterone levels remain low and out of sync with the other hormone counterparts, androgen, and estrogen. The result of this imbalance is irregular periods and challenges with conception.

Women suffering from PCOS also produce excess insulin or the insulin they produce does not work properly. In the body, insulin which is a hormone helps control blood sugar or glucose and also plays an important role in PCOS. The insulin in the body also interrupts the normal growth of the follicle in the ovaries. The affected ovaries contain such a large number of immature egg follicles; that they become abnormally enlarged and function abnormally.

Also, women suffering from PCOS may have a higher risk of miscarriage and are more susceptible to gestational diabetes during pregnancy. Low-carbohydrate diabetic diet or insulin-lowering medication may help with gestational diabetes during pregnancy but it is also important to speak to a qualified specialist when diagnosed with PCOS.

PCOS treatment

PCOS can affect the chances of conceiving naturally for a woman and any form of treatment concerning fertility should focus on

1. Reducing body weight as a healthy diet with increased physical activity allows more efficient use of insulin and decreases blood glucose levels and may help you to ovulate more regularly
2. Promoting ovulation with ovulation induction medication

In addition to the above, it is also important to consider a low-carbohydrate diabetic diet along with regular workouts to help keep insulin levels low. Women’s fertility supplements can also help women with PCOS increase their chances of getting pregnant.

Because PCOS is a condition you can be born with, it is rare for you to be truly cured, however, with the proper treatment and a lifestyle change, the symptoms can be relieved for you to have a normal healthy life. It is also very possible to conceive naturally when you have PCOS but it requires taking conscious efforts and also seeking advice from qualified persons.

Ways of reducing the risk of PCOS

To reduce the risk of developing PCOS, it is important to watch and monitor your diet and have a good balance of calorie intake, carbohydrate intake, etc. Below are some of the ways in reducing the risk of developing PCOS;

1. Maintain a healthy weight or lose additional weight. The BMI can be used as a standard for monitoring your weight. It is also important to monitor the circumference around the weight.
2. Consume healthy diets that can help reduce insulin resistance and the risk of developing type 2 diabetes
3. Increase physical activity. This helps with maintaining a healthy weight as well as reducing the risk of developing heart disease or diabetes.

Conclusion

Challenges around fertility and PCOS have now come out of the closet and more people are openly discussing and sharing their experiences. Medical technology and modern science have also made it possible for couples to have a fair chance at parenthood. Even though PCOS affects the reproductive hormones, it is very possible to still get pregnant and deliver once you take the necessary steps to help reduces the symptoms associated with PCOS. Your fertility rate can improve if you maintain a healthy weight and consume diets that help reduce the insulin levels in the body. If you feel your diet has been poor in your journey to conceive, taking fertility supplements may be worthwhile in improving your chances of getting pregnant. The multivitamin should contain at least 400mcg of folic acid, vitamin A (from betacarotene), selenium, vitamin C, etc. It is also important to speak to specialists who can help you on your journey to parenthood.

References

Bussell, G., Denby, N. and Brewey, S., 2007. Managing PCOS for dummies. Chichester, England: Wiley.

Perkins, S. and Meyers-Thompson, J., 2007. Infertility for dummies. Hoboken, NJ: Wiley Pub.

Warhus, S., 2011. Fertility demystified. New York: McGraw Hill Professional.

https://www.nhs.uk/