Can PCOS Create Problems in Conception? Here’s What You Need to Know

Polycystic ovary syndrome (PCOS) is a common condition that affects women of reproductive age. Reports state that its incidence among Indian women is approximately 10%, making it a significant health concern for the females. Due to its symptoms and its effects on the reproductive hormones, it can cause problems in conception. 

What Is PCOS and How Does It Affect the Body?

PCOS is a chronic endocrine and reproductive disorder. The signs and symptoms include:

• heavy, long, intermittent, unpredictable or absent periods
• weight gain
• excessive hair
• infertility

Hormonal Imbalance and Irregular Periods

Hormones, such as insulin, growth hormones (GH), ghrelin, LEAP-2, gonadotropin-releasing hormone (GnRH), insulin, the luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio, androgens, and estrogens, are all abnormal in PCOS women. 

These hormones are related to metabolic disorders, such as diabetes and insulin resistance, overweight and obesity, infertility, and disturbed menstrual cycle

The hormonal imbalances include-

• Increased insulin, ghrelin, androgens, basal LH, LH/FSH ratio, LEAP-2
• Decreased estrogens, GH

Due to the hormonal abnormalities, the menstrual cycles phases are affected, leading to problems with the release of egg (ovum). This leads to infertility problems and period irregularity.

Impact on Ovulation

For women with PCOS, ovulation issues are typically the main cause of infertility. The ovaries’ follicles may not mature (due to several hormonal abnormalities) or testosterone production may rise, which would prevent ovulation.

The uterine lining may not develop appropriately to allow for the implantation of the mature egg, even in cases where ovulation takes place, due to a hormonal imbalance.

Ovulation and menstruation may be irregular as a result of hormone imbalances. This unpredictability further makes conception difficult.

How PCOS Affects Fertility

The prevalence of infertility in women with PCOS varies between 70 and 80%.

Challenges in Conception

When the female egg combines with the male sperm for fertilization, pregnancy results. You have to release an egg to become pregnant. Female infertility is frequently caused by ovulation issues, such as those associated with PCOS. It is more difficult for women with PCOS to conceive because they do not ovulate regularly.

These are the potential challenges in conception due to PCOS.

Risk of Miscarriage

PCOS increases the risk of stillbirth and neonatal death by putting the woman at risk for a number of unfavorable pregnancy outcomes, such as a high risk of pregnancy-induced hypertension, spontaneous abortion, gestational diabetes, preeclampsia, and preterm birth. Additionally, fetal growth abnormalities might be more prevalent. 

Therefore, PCOS predisposes the woman to miscarriage and negative preganancy outcomes.

Diagnosis and Testing of PCOS

The diagnosis of PCOS and its effects on infertility is made based on the signs and symptomatic history (unwanted facial or bodily hair, loss of hair from the head, acne or an elevated blood level of testosterone), presence of period irregularities and on testing (blood tests and ultrasound). 

Blood Tests and Ultrasound

Blood tests done for diagnosing PCOS include:

• testosterone (an ovarian androgen hormone that influences hair growth)
• oestrogen (an ovarian hormone that stimulates growth of the womb lining 
• luteinising hormone (LH, a pituitary hormone which influences hormone production by the ovaries and is important for normal ovulation)
• anti-müllerian hormone (which is measures the fertility level of the ovaries)

Ultrasound scan is also performed to look for Polycystic ovaries (presence of cysts in the ovaries).

What to Expect at a Gynecologist Appointment

To help rule out other potential explanations, the gynecologist will inquire about your symptoms.

To determine whether PCOS or another hormone-related disorder is the cause of your excessive hormone production, they will also set you up with a series of hormone testing.

An ultrasound exam may also be necessary to determine whether you have polycystic ovaries, which are characterized by an excessive number of follicles in the ovaries. 

A blood test can also be necessary to check for diabetes or excessive cholesterol and monitor your hormone levels.

Your gynaecologist will then discuss with you about the best strategy to manage your symptoms if you have been diagnosed with PCOS and will start you on any essential medications and suggest lifestyle modifications.

Additionally, if required, your doctor will ask you to return for follow-up appointments.

Treatment Options for PCOS

There is no cure for PCOS, but symptomatic treatment can reduce the symptoms and its problematic effects on conception. Management of PCOS include lifestyle changes and diet as well as medications and fertility treatments.

Lifestyle Changes and Diet

Lifestyle change is considered the first-line treatment for infertility in obese women with PCOS. Preconception counseling, administering folic acid to reduce the risk of fetal neural tube defects, encouragement of physical activity and identification of risk factors, such as obesity, tobacco use and alcohol consumption, should be performed.

Eating a healthy diet and getting proper exercise can help reduce weight and incidence of comorbidities (such as hypertension and diabetes) that can hamper the chances of conception.

Medications and Fertility Treatments

There are also medications available for the treatment of PCOS, particularly for those with absent or irregular periods

Clomiphene citrate – This is used for women with absent periods. It is used to induce ovulation. It is given for a maximum of 6-12 cycles.

Gonadotropins – This is also used for women with absent periods and infertility. It includes recombinant follicle-stimulating hormone (FSHr) or human menopausal gonadotropin (HMG). This is used for timed intercourse and even for artificial insemination.

Surgical treatments may be performed if the underlying cause is an abnormal structure in the reproductive organs. It also includes procedures that help with the artificial fertilisation of the egg (ovum) to facilitate conception.

• Laparoscopic ovarian surgery – This is an invasive treatment which is particularly used for women having absent periods along with other symptoms such as abdominal pain and masses.
• In vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI)- This is done when the previously mentioned treatments fail or if the woman has tubal occlusion (blockage in the fallopian tube which affects the transport of the egg) or semen alterations that impair the occurrence of natural pregnancy. 

It is a procedure that involves fertilising a sperm and egg in a lab and then implanting that fertilised egg in the uterus. 

Insights from Fertility Experts at SGVP Hospitals

• Treatment initially includes preconception guidelines, such as lifestyle changes (weight loss), folic acid therapy to prevent the risk of fetal neural tube defects and halting the consumption of tobacco and alcohol. 
• The principle infertility treatment includes lifestyle changes. 
• The first-line drug treatment to induce ovulation consists of Clomiphene citrate along with timed intercourse. 
• The second-line treatment consists of the exogenous administration of gonadotropins or laparoscopic ovarian surgery in cases where laparoscopy is indicated. 
• The third-line treatment consists of IVF/ICSI, which is indicated when the previous treatments fail.

Backed by Research: Reliable Medical Sources 

Studies by Hoeger et al (2021) on lifestyle interventions demonstrated improvement in weight, androgen levels, and BMI with weight reduction from lifestyle interventions. It has also been shown to improve menstrual irregularity.

Papadakis et al (2021) in their research have also stated that Individualized treatment remains the main approach for PCOS. 

• The therapeutic approach to the reproductive phenotype of PCOS includes oral contraceptives, weight loss, clomiphene citrate, gonadotropins, and laparoscopic ovarian surgery.
• The therapeutic approach to the metabolic phenotype of PCOS includes diet, exercise, weight loss, bariatric surgery, insulin sensitizers, and statins. 
• The therapeutic approach to the hyperandrogenic phenotype of PCOS includes oral contraceptives, antiandrogens, cosmetic procedures and GnRH-agonists.

Disclaimer and Red Flags to Consult a Doctor

Here are a few Red flags need to stay aware of, which may prompt a doctor’s consultation:

• Irregular periods
• Painful periods
• Heavy bleeding during periods
• Skipped periods
• Excessive weight gain
• Abnormal bleeding through the vagina (outside of periods)
• Painful sex (vaginal spasms)

Frequently Asked Questions