PCOS and Infertility – The Connection Between Them

Polycystic Ovarian Syndrome, commonly referred to as PCOS, is a caused by a hormone imbalance that produces a thick coating around the ovaries. In this article we will explore the connection between PCOS and infertility.

What is the connection between PCOS and infertility?

A woman who has PCOS does not have a ‘normal’ menstrual cycle and doesn’t ovulate the way that a women with a ‘normal’ cycle does. The word ‘normal’ is in quotation marks because ‘normal’ is more of a medical definition than what the majority of women actually experience.

The medical definition of a menstrual cycle, that is considered normal, goes like this:

  • Ovulation, 2 weeks before the endometrial lining of the uterus is shed, if there is no pregnancy. This is the start of the monthly “period” or bleeding.
  • The eggs are held in follicles, until the pituitary gland sends follicle stimulating hormones to the ovaries. In response to the FSH, the follicles grow and the body selects a dominant follicle from an ovary about day 5 of the cycle.
  • This dominant follicle produces estrogen which causes the endometrium to thicken, in preparation for receiving a fertilized egg.
  • At the mid-cycle stage, the pituitary gland again organizes hormone production, this time luteinizing hormones, LH, to trigger the release of the egg. This is ovulation.
  • When the egg is released from the ovary, the follicle produces progesterone to change the endometrium.
  • The fallopian tube catches the egg where it is held until a sperm travels up the tube to fertilize it.
  • The fertilized egg then takes 5 days to travel down the fallopian tube into the uterus, guided by the follicle, and attempts to attach to the endometrium.
  • If the egg doesn’t attach to the endometrium, or if it isn’t fertilized, the hormone levels of both estrogen and progesterone will drop 2 weeks after ovulation. This causes the endometrium to shed and the menstrual flow to start.
  • Menstruation ‘normally’ lasts from 3 to 5 days.

What are the symptoms of PCOS and infertility?

A clinical diagnosis of polycystic ovary syndrome usually requires two out of the following three criteria to be present:

  • Abnormal menstrual cycle
  • Many small follicles, apparent when the ovaries are examined by ultrasound
  • An excess of male hormones, determined by blood tests.

There are other symptoms that could indicate PCOS like skin tags, obesity or acanthosis nigricans, which are dark patches on the skin of the neck or inner thigh area. Some patients respond to simple method of increasing daily exercise accompanied by a reduced carbohydrate diet to balance blood glucose levels and lose weight.

Blood sugar levels are significant with PCOS because of the association with insulin. As well as helping the body store sugars, insulin is also implicated with the pituitary gland and its release of reproduction hormones. If your body doesn’t produce enough insulin, you would need insulin therapy to rectify the situation.

The implication of all this is that your reproductive system doesn’t recognize the signals that the insulin is sending to the pituitary gland and so the necessary hormones are not produced, meaning ovulation doesn’t occur regularly.

Some PCOS patients respond to insulin-sensitizing medication, which restores a normal cycle. The success rate for this treatment is about 20%. Patients are started on a low dosage of the medication, which is gradually increased. Other treatments include drugs that artificially stimulate ovulation or stimulate the emergence of a dominant follicle.

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