Ever heard of Polycystic Ovarian Syndrome? In this month’s Fertility Logia, learn 10 important things you need to know about this common disorder.
Fertility Logia: Polycystic Ovarian Syndrome – what you need to know
Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. This syndrome is manifested by hormonal changes as well as and metabolic dysfunctions. Incidentally, some Greek women may be more at risk than others for this condition, so do speak to your doctor. Let’s take a brief look at the common questions that come up, revealing the top 10 critically important things to know about PCOS.
10 critically important Q&A about PCOS and fertility
What does a woman feel with PCOS?
Common symptoms may include:
- Hair growth in places that are undesirable including face, chin, chest and pubic hair extending onto legs
- Skipping periods so that they are less predictable due to lack of ovulation
- Difficulty getting pregnant
What are tests that can be done to check for PCOS?
- AMH (anti-Müllerian hormone) test checks how many eggs remain from birth. The usual number is between 1-3 but with PCOS the AMH is typically higher than 3 indicating that this woman has many eggs left since she may not always ovulate.
- An ultrasound can be done to see the egg cysts called follicle cysts. These typically look like a small black circle on the ultrasound. With PCOS there are a very high number visible instead of the normal 6-12.
Are there other important checks to be done for PCOS?
At Vios Fertility Institute, we also check male hormone levels which may be higher than usual due to the hormone imbalance of PCOS. These include DHEAS, Testosterone and 17OH Progesterone.
Does PCOS put a patient at risk for Diabetes?
Another important check is for diabetes and includes fasting glucose, insulin, chemistry panel and Hemoglobin A1c. Some women have abnormal metabolism because of PCOS and it is important to check for these things as well.
Is the uterus okay when someone has PCOS?
Some women that skip periods can have an extra thick lining since they did not menstruate. It is very important for women to have regular periods to shed this lining. Without periods, the lining can build up, which can result in pre-cancer, called hyperplasia or cancer of the uterine lining.
How common is obesity in the US?
PCOS is often seen with weight gain, and obesity can be an added problem. Body mass index (BMI) is height compared to weight and a BMI over 40 is considered morbid obesity. With the holidays around the corner, careful choices with regard to the extra delicious Greek treats remain important.
Info from JAMA 2005
Do PCOS embryos grow more slowly than normal embryos?
The hormones may result in eggs that are not as healthy and strong. This may be why the baby embryo in its first few days of existence may be slower in its growth.
Does the embryo have less implantation potential?
Embryos from PCOS patients may not be as likely to attach to the uterus and implant, and also have higher rates of miscarriage.
What is the best treatment for PCOS?
- Healthy diet and exercise is #1. Avoid white foods like bread and pasta. I know — here come the holidays and family special recipes. Be thoughtful about taking second helpings!
- Metformin, a diabetes medicine, is a consideration for patients who need it.
- When not trying to get pregnant, a birth control pill is very helpful to regulate cycles and hormones.
- When trying to get pregnant, ovulation medicine like clomiphene citrate or letrazole can assist in getting eggs to grow.
- Finally IVF may also be a great idea for this patient population as it can lessen the chance of multiples and with PGS (preimplantation genetic screening) may decrease miscarriage. Note: practical management of PCOS is not always straightforward.
- Multiple pregnancies like twins can occur with fertility treatment and this has higher risks to Mom and babies. IVF twin pregnancies are at an increased risk of: Preeclampsia (2-fold risk increase) Extreme prematurity (7.4-fold increase delivery <32 wks)2 . NICU admission (3.8-fold increased risk)2. Perinatal Death (2-fold increase)2. Two IVF singleton deliveries have better obstetrical outcomes than one IVF twin delivery3. For this reason many patients want to decrease the chance of a multiple pregnancy as well as miscarriage and so move more quickly to IVF with PGS.
Once pregnant what are special considerations?
PCOS patients are at higher risk of developing issues like gestational diabetes so should be screened early. There are tests done like first trimester screening which is a simple blood test to check for a healthy baby. These levels of biochemical components of first trimester combined aneuploidy screening test (PAPP-A and fβ-hCG) are altered in pregnant women with PCOS. Future trials are needed to assess any need for readjustment of the risk in the patient population with PCOS.
New treatment is in the works
A new fertility treatment paradigm for PCOS is evolving. This entails placing into the uterus a single, genetically tested PGS normal Frozen Embryo Transfer (FET) embryo. Applying this technology to the PCOS patient may provide an ideal outcome for many patients. In this, trying to optimize chance of healthy Mom and healthy Baby is the goal.
See you next time, with more Fertility Logia from Vios Fertility Institute.
- ASRM Practice Committee, Fertil Steril, 2012. PMID: 22192352
- Pinborg A, et al., Acta Obstet Gynecol Scand, 2004. PMID: 15488125
- Sazonova A ,et al., Fertil Steril, 2013. PMID: 23219009
- Prenat Diagn. 2014 Nov;34(11):1073-6. doi: 10.1002/pd.4430. Epub 2014 Jun 29
- Do we need readjustment of the biochemical parameters in first trimester combined aneuploidy screening test in women with polycystic ovary syndrome? Karsli MF1, Gultekin IB, Cakmak B, Yeral MI, Seckin KD, Alt Nboga O, Kucukozkan T.
- JAMA 2005- Obesity
Angeline N. Beltsos, MD is CEO and Medical Director of Vios Fertility Institute. She is board certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility (REI), practicing medicine since 1991. Dr. Beltsos is also the Clinical Research Division Director of Vios and participates in a number of research projects and scientific publications. She has received numerous awards in teaching and has been honored as “Top Doctor” from Castle Connelly for several years. She is a popular speaker, both nationally and internationally, and a frequent media resource on the topic of infertility. She is the executive chairperson for the Midwest Reproductive Symposium International, an international conference of fertility experts. Dr. Beltsos is also a contributor to Thrive Global.
As the REI Division Education Director for the Obstetrics and Gynecology residency programs of Illinois Masonic Medical Center, Lutheran General Hospital, and St. Joseph’s Hospital Chicago, Dr. Beltsos helps educate future OB/GYN doctors. She is a Clinical Assistant Professor for the Department of Obstetrics and Gynecology at University of Illinois at Chicago.
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