Background
One of the primary sources of infertility problems in women is Polycystic Ovarian Syndrome or PCOS. Although perhaps not completely understood, it appears to be closely related to excessive production of insulin by the body. In some cases the response is for the woman to produce unusually high levels of male hormones, or androgens. A woman with PCOS is typically insensitive to insulin and that can actually lead to diabetes. This emphasizes the importance of a correct balance of hormones.
PCOS has been linked to causing infertility problems in women.
Let’s look a bit closer at what happens when Polycystic Ovarian Syndrome jams up the works. In the course of the monthly cycle a number of follicles develop inside the ovaries. There is an egg that grows inside each follicle. As the menstrual cycle proceeds, a single follicle will stay, to release its egg during the ovulation process. Basically, after the egg is sufficiently developed levels of LH increase significantly. That causes the egg to break loose; and voila, there is ovulation!
Women dealing with PCOS normally don’t create a sufficient amount of the female hormones needed to jump start the ovulation process. That means that the follicles do not create the expected eggs which can cause infertility in women. Consequently some of the stunted follicles turn into cysts. An ultrasound may show a group of cysts like pearls or little islands; they are underachieving follicles. There will be numerous cysts on the outside of the ovaries.
One of the prime symptoms that a woman has PCOS is when the period is irregular or absent altogether. When ovulation does not take place during the monthly cycle, there is little or no progesterone created and that is what causes the lining of the uterus to thicken in anticipation of a fertilized egg. No progesterone and no symptoms of a period.
Polycystic Ovarian Syndrome can become more pronounced as a woman ages; this is one of the reasons that it becomes harder to get pregnant with age. It does not have to be the case that there is no period; an irregular period can also be involved.
Experts have estimated that Polycystic Ovarian Syndrome affects somewhere around 5% to 10% of women in the likely child-bearing years. There is a good chance that they don’t even know they suffer from this condition; actually only around 20% or so of those with the affliction have been diagnosed. It is possible for certain fortunate women to conceive even if the periods are irregular.
Another clue that PCOS may be present is if you see changes in hair growth. Specifically, increased hair growth on the face, chest or on the back. Also, if your hair starts to thin unexpectedly, you gain weight for no particular reason or develop acne. Excessive insulin levels or pelvic pain could be other signs. But for some the irregular period is the only clue. Obviously if these signs are evident, a visit to the doctor is called for right away.
Solutions
So it is the lack of ovulation that disrupts the ability of the woman to conceive. Fortunately there are steps that are often effective against PCOS. Since it is related to hormones, any adjustment to diet and exercise that helps the body balance hormones can be significant. Losing weight is one way to allow the body to naturally balance its hormone chemistry.
As we noted above, insulin is an important player in this situation. A doctor may prescribe Metformin, which is a drug that enhances the ability of the body to process insulin. This treatment is typically used with women who do not have diabetes; it affects the level of insulin in the body but does not do anything to reduce the blood sugar level, a big deal to diabetics.
Another common drug is Clomid, which helps to get pregnant back in 1985 (December 1, I believe). This drug affects the estrogen receptors in the brain, blocking their sensitivity to that hormone. The brain is tricked into assuming that estrogen levels are too low. This results in an increase of FSH and LH in the system and they tend to trigger ovulation. Clomid reportedly works quite well to induce ovulation. Around 35% to 40% of users who do ovulate from this approach are actually successful in getting pregnant.
Another more substantial treatment is the use of In-Vitro Maturation (IVM), where the eggs are harvested before becoming mature, early in the cycle. The eggs are allowed to grow in the lab and then used for fertilization when the time is right. In-Vitro Fertilization is slightly different in that they remove the eggs after they mature inside the woman. In either approach, the eggs are fertilized and implanted back in the uterus. Medications are used with IVF to help the eggs develop.
A Final Word of Encouragement: Although it has been over 20 years and the terms have changed, my wife most likely had some form of PCOS when we were trying to get pregnant. A prescription for Clomid and the use of the “secret” techniques mentioned above and we were successful in a reasonable amount of time—a few months at most. So PCOS can be beaten!