PCOS Effects on Fertility & Long-Term Health
What is PCOS?
Polycystic ovary syndrome (PCOS) is a very common reproductive endocrine disorder affecting about 5-10% of reproductive age women. Research is still ongoing to delineate the causes of PCOS, however most experts believe that it may have a multifactorial etiology that involves genetics, environmental factors as well as fetal and childhood exposures.
Some of the symptoms commonly experienced by women with PCOS:
- Menstrual irregularity
- Increased male hormone actions in the woman (such as increased coarse facial hair)
- Resistance to the actions of insulin in the body and a characteristic appearance of the ovaries on pelvic ultrasound.
Although many women with PCOS are overweight or obese, thin women can have PCOS as well.
How does PCOS affect fertility?
Women with PCOS often have irregular periods because of lack of regular ovulation caused by abnormal hormonal secretory patterns. This leads to infertility caused by ovulatory dysfunction. However, it is extremely important to exclude other causes of ovulatory dysfunction such as thyroid or pituitary abnormalities before pinpointing PCOS as the cause of the irregular periods.
Due to chronic anovulation in women with PCOS, intercourse can be difficult to time and pregnancy hard to achieve. Treatment for infertility due to ovulatory dysfunction involves the use of medications such as clomiphene citrate (“Clomid”) which help induce ovulation.Most pregnancies achieved with Clomid occur within 3-4 ovulatory cycles. If you are not successful by that time then it would be prudent to seek care from a reproductive endocrinologist. If you are already seeing one, then it makes sense to move on to more aggressive treatment modalities. Not all women will respond to clomid, even at the higher doses, such as 200-250 mg. For these women, treatment options involve injections of the hormone FSH which helps induce ovulation.
The biggest “side effect” of treatment is multiple gestations. The risk of twins is estimated to be about 5-8% with clomid and 15-20% with injectable medication. Another medication to consider before moving on to the injectable medications is an aromatase inhibitor such as letrozole which is an oral medication like clomid, but with a different mechanism of action. Some clomid resistant women may respond to letrozole.
What are the long term impacts of PCOS?
Since PCOS is an endocrine disorder associated with resistance to the action of insulin in the body, there can be long term metabolic impacts on the development of disorders such as diabetes and coronary artery disease. It is important for women with PCOS to have testing for glucose and lipid levels at least once every two years. This is done by checking a two hour glucose tolerance test and a fasting lipid panel.
Often women with glucose intolerance can benefit from medications such as metformin which help improve the action of insulin in the body. The development of the “metabolic syndrome”, which involves high triglyceride levels, abnormal glucose levels, hypertension, and an increased waist to hip ratio, can have a profound impact on the development of cardiovascular disease. Maintaining a healthy diet and weight is of great importance to slow or prevent the onset of type 2 diabetes, lipid disorders, metabolic syndrome and ultimately coronary artery disease.
Another important aspect of chronic anovulation is its effect on the endometrium, which is the lining of the uterus. If a woman goes for long periods of time without having menses, then she can be prone to developing hyperplasia (precancerous abnormal growth) of the endometrium. Atypical hyperplasia can ultimately lead to endometrial cancer if untreated. It is important to protect the endometrium either by using a progesterone containing contraceptive or by inducing a period every couple of months by taking a course of Provera or other such progesterone.
PCOS is a complex disorder with no easy fix, but many of its manifestations can be controlled with the right lifestyle modifications, medications and of course fertility treatments in those desiring pregnancy.