A silent struggle
Abayomi Ajayi
Polycystic Ovarian Syndrome is a common cause of failure to ovulate (anovulation) and female infertility.
It is a complex metabolic syndrome, with multiple factors that interfere with fertility. Women with polycystic ovaries and fertility problems do not release eggs (ovulate) regularly and they often have ovaries that contain many small cystic structures.
PCOS is the most common cause of lack of ovulation and certainly a leading cause of female infertility because 40-80 per cent of women with PCOS have problems with fertility. The condition is common and the infertility rate with it is high.
In a normal menstrual cycle with ovulation, a mature follicle develops. About 14 days after ovulation, the woman would be expected to get a period if she is not pregnant.
The basic difference between polycystic and normal ovaries is that although polycystic ovaries contain many small follicles with eggs in them, the follicles do not develop and mature properly – so there is no ovulation. Without regular ovulation, there is no regular menstrual period and pregnancy cannot occur.
Characterised by irregular or absent menstrual periods, women with PCOS often complain of abnormal bleeding, infertility, obesity, excess hair growth, hair loss, and acne.
Some women with PCOS will ovulate occasionally or not at all, have difficulty getting pregnant, and usually require treatment to improve their chances for pregnancy.
If you have polycystic ovaries, you are likely to often have an excess amount of the male hormones testosterone and androstenedione.
You may have increased facial and body hair growth – called hirsutism. You may also suffer some physical or psychological manifestations of depression.
If you are showing signs of depression you should consult your doctor as well as consider seeking emotional support. Be sure to find a doctor who is willing to listen to your concerns and not dismiss this potential side effect of PCOS.
Despite the many symptoms associated with PCOS, not all women will display the obvious signs. Some women may not be aware that they have PCOS until they undergo a fertility workup.
Other women, though, may already be aware that they have PCOS and see no reason to undergo fertility testing because they already know why they can’t get pregnant.
Treatment for PCOS and infertility often begins with ultrasound diagnosis. In a polycystic ovary, the numerous small cystic structures give the ovaries a characteristic and quot; polycystic and quot; (many cysts) appearance on ultrasound.
fter reviewing your medical history, the physician will determine the necessary tests. If you have irregular or absent menstrual periods, clues from the physical examination will be considered next.
Your height and weight will be noted along with any increased facial or body hair or loss of scalp hair, acne, and discolouration of the skin under the arms, breasts, and groin.
About half of women with PCOS are overweight, which means that the other half is not. So does PCOS cause obesity, or does obesity cause PCOS? It appears more likely that PCOS comes first.
Symptoms of PCOS may be lessened by weight loss, or increased by weight gain, but the syndrome is not caused by weight or body mass. You could be of normal weight and have PCOS.
Worse still, insulin resistance, which is common to PCOS may play a role in weight gain and the difficulty in losing any extra weight.
As a PCOS patient, losing weight, not only for yourself but also for your partner is a great idea. Undergoing an assessment for fertility issues in both partners can bring to light any other factors that may cause problems, such as male infertility, which may also require treatment.
A pertinent question is whether you can conceive with PCOS. The chance of getting pregnant with PCOS using fertility treatments is very good, so most women with the condition will be able to have a baby with fertility treatment.
If you are a woman under age 35 with PCOS, the real question is more about which treatment will be effective for you – and not so much whether any treatment can ever work.
Another question is if pregnancy can cure PCOS. There is no cure for PCOS presently, but some women do have a normalisation of cycles after a pregnancy.
Those who have fertility problems may find it easier to get pregnant again.
Many medications can be used to control PCOS symptoms, and some may be used in combination with each other. The best course of action depends on individual needs.
PCOS may worsen during the prime reproductive years, ages 20-40, especially with weight gain.
A healthy lifestyle is probably the best defence. It seems as women approach menopause that the severity of PCOS improves, as judged by hormonal parameters.
A good option if you are a couple dealing with PCOS is to undergo IVF. How successful IVF will be, though, can depend very much upon individual characteristics such as age, length of infertility, and weight.
Additionally, neither IVF nor ovarian stimulation is likely to be successful if you are severely overweight (body mass index greater than 35).
The bottom line is that despite the problems that present with PCOS, you can still look forward to getting pregnant. A successful pregnancy is entirely possible and has been experienced by numerous women with PCOS. In fact, for many women, getting pregnant the second time around is much easier.
Furthermore, it is not unusual for women with PCOS to notice that their menstrual cycles begin to regulate themselves after a pregnancy.
