Although it is rarely talked about, Polycystic Ovary Syndrome (PCOS) is very common, affecting around 5-10% of women in the UK.
If you’ve been diagnosed, you may be worried about your fertility. In addition to dealing with the other possible symptoms of PCOS, you may be asking: will I be able to conceive?
Here Dr Gorgy, Director of The Fertility and Gynaecology Academy and one of the UK’s foremost fertility experts, helps explain.
What is Polycystic Ovary Syndrome (PCOS)?
There are three main indicators of PCOS, which are:
Irregular menstruation – when your ovaries are releasing eggs (ovulation) irregularly, or not at all (known as anovulation).
High androgen levels – where you have excess ‘male hormones’ in your body, which may be shown in increased body or facial hair. (Note: other visible symptoms of PCOS may include weight gain and acne).
Polycystic ovaries – This can be identified by means of transvaginal ultrasound. Ovaries become swollen and contain numerous ‘cysts’ – which are not really cysts but actually egg-containing follicles that, because of hormonal imbalances, have not developed normally. A woman with PCOS will have about double the number of follicles found in normal ovaries. They are up to 8mm each in size and situated right below the ovary surface.
Women with at least two of these indicators may be diagnosed with Polycystic Ovary Syndrome. However, it is estimated that more than 50% of women that have PCOS have no symptoms. In such cases, you might not realise anything is wrong until you find you’re struggling to get pregnant.
How can Polycystic Ovary Syndrome affect fertility?
The ovaries of women with PCOS are populated with ovarian follicles, each one of which is home to an egg. All women’s ovaries host these follicles and every month a group of follicles begins to develop, with one follicle becoming the ‘dominant follicle’ that ovulates an egg. In women with PCOS, due to the hormonal imbalances inherent in the condition, their ovary follicles do not develop normally and therefore don’t ovulate an egg every month. Because of this, many women with PCOS will experience fertility problems. Unfortunately also, women with PCOS who do conceive are more likely to suffer miscarriage.
Fertility treatment for Polycystic Ovary Syndrome
“The good news is,” says Dr Gorgy, “that with the right treatment, most women who have PCOS are able to conceive.”
In fact, most women with Polycystic Ovary Syndrome can be treated successfully through a course of tablets taken at the beginning of each cycle for a few cycles.
Oral Medication
Usually, the medication you will be offered first will be clomifene, which is a drug that works to stimulate ovulation. Sometimes tamoxifen or letrozole are used instead. You may be offered metformin instead. Metformin can help women with PCOS by lowering their insulin resistance (which tend to be elevated in women with PCOS). It can help to trigger ovulation and encourage regular periods, as well as reduce miscarriage risk.
Hormone Injections
If this doesn’t work, then gonadotrophin hormone injections to stimulate ovulation may be an option. There’s a higher chance they could create ovarian overstimulation and lead to multiple pregnancies, close monitoring with ultrasound scans is essential.
Ovarian Drilling
One alternative to gonadotrophins is ovarian drilling; a surgical procedure under anaesthetic to destroy part of the ovary, which may lead to ovulation. Because of its invasiveness it is not used a lot, but some women opt for it after other methods have been unsuccessful. It is roughly as effective as gonadotrophins, but without the risk of multiple pregnancies.
If this is ineffective, then you may wish to consider IVF intervention.
Dr Gorgy told us: “The thing to remember is, most women with PCOS can indeed become pregnant – the main question is which intervention will work for you, because every woman is different. That’s why initial checks matter so much – for example your doctor should check that your fallopian tubes aren’t blocked in any way. But with the right doctor holding your hand through the process, the odds are certainly in your favour.”
Based in central London, The Fertility and Gynaecology Academy is home to the most state of the art technology in the industry and some of Britain’s best fertility doctors. If you are trying to get pregnant or have fertility concerns, call us for a consultation on 020 7224 1880.
