Every month, in women of childbearing age, tiny fluid-filled cysts known as follicles develop on the surface of the ovary. Female sex hormones, including estrogen, cause one of the follicles to produce a mature egg. The ovary then releases this egg, and it breaks out of the follicle.
In women who have polycystic ovary syndrome, or PCOS, there is an imbalance in female sex hormones. The imbalance may prevent the development and release of mature eggs. Without a mature egg, neither ovulation or pregnancy can occur.
The hormone imbalance may also include an abnormal increase in testosterone, which is primarily a male sex hormone. Women also produce testosterone, although it is usually in small amounts.
PCOS can lead to changes in facial hair and skin condition. Genetic factors may play a role.
Experts do not know exactly what causes PCOS, but it may involve genetic factors. If a woman's mother or sister has the condition, she has a higher chance than others of developing it.
Along with a genetic link, excess insulin in the body also increases a woman's risk of developing PCOS. Insulin is a hormone that the pancreas produces, and the body uses to convert sugar in food into energy.
Women with PCOS often have insulin resistance. Insulin resistance involves the body's inability to lower blood sugar levels correctly. Blood sugar levels can become too high, which causes yet more insulin production.
Too much insulin also increases testosterone production, which leads to some of the symptoms of PCOS.
Symptoms can occur at any age or time during a person's reproductive years. Symptoms can also change over time.
Some of the most common symptoms of PCOS include the following:
- abnormal hair growth on the face, chest, or back
- acne or a darkening of the skin
- weight gain
- thinning hair on the head
- irregular periods
- ovarian cysts
- increased skin tags
Not everyone with PCOS will have the same signs or symptoms.
Effects on fertility
PCOS can affect a person's fertility in different ways.
Ovulation problems are usually the primary cause of infertility in women with PCOS. Ovulation may not occur due to an increase in testosterone production or because follicles on the ovaries do not mature.
Even if ovulation occurs, an imbalance in hormones may prevent the lining of the uterus from developing properly to allow for implantation of the mature egg.
Due to unbalanced hormones, ovulation and menstruation can be irregular. Unpredictable menstrual cycles can also make it difficult to get pregnant.
Infertility is often one of the main complications of PCSO, but it is not the only one.
People with PCOS also appear to have a greater risk than others of:
- high cholesterol levels
- high blood pressure
- heart disease
- weight gain
- sleep apnea
- depression and anxiety
- poor body self-image
- endometrial cancer
According to the OWH, about half of all women with PCOS develop either prediabetes or diabetes before 40 years of age.
When to see a doctor
Anyone who is having difficulty becoming pregnant should speak to a doctor, who will explain the treatment options.
Anyone who is concerned that they are unable to become pregnant or who has symptoms that may indicate PCOS should see a doctor. Even if a woman does not wish to become pregnant, getting an early diagnosis of PCOS can help to prevent complications.
There are many possible causes of infertility, but assessment for PCOS can help target treatment and improve the chances of conceiving.
If a woman does become pregnant, it is also essential to know if PCOS is present, as studies have found a higher risk of pregnancy complications with PCOS.
These complications can include:
- gestational diabetes
- premature delivery
- high blood pressure during pregnancy
There is no specific test to diagnose PCOS. A doctor makes a diagnosis based on several factors.
Tests may include:
- a physical exam
- medical history
- blood tests for hormone levels
- blood tests for glucose level
- an ultrasound scan
Currently, there is no cure for PCOS. However, treatment can increase the chances of conceiving in those who wish to become pregnant. It can also help people to manage their symptoms.
Symptoms vary between individuals, and so treatment is not always the same. Options also depend on whether or not a person wishes to become pregnant.
Treatment for PCSO symptoms may include:
- Birth control pills to help correct hormonal imbalances.
- Insulin-sensitizing drugs to improve the body's use of insulin and so testosterone production, too.
- In the case of diabetes, medication to control blood sugar levels.
- Exercise and healthful eating to help boost overall wellbeing and control weight.
Maintaining a healthy weight can help reduce insulin and testosterone levels and improve symptoms.
Fertility treatment for PCOS
If a woman wishes to become pregnant, a doctor may prescribe medications to regulate menstrual periods and encourage ovulation. Surgery may be an option if medication does not improve fertility.
Laparoscopic ovarian drilling is a surgical option. In this procedure, the surgeon makes small cuts in the abdomen and inserts a needle with an electrical current.
They use the electric current to destroy a small amount of tissue that produces testosterone on the ovary. Decreasing testosterone levels may allow regular ovulation to occur.
Tips for increasing fertility
Below are some lifestyle tips that can help increase fertility.
For people carrying excess weight, losing weight may help balance hormonal production and increase the chances of ovulation and pregnancy.
According to the OWH, even a 10 percent weight loss may help a person with excess weight and fertility problems restore their normal ovulation.
People with a low weight who have difficulty conceiving may want to see their doctor as well, as this may be another risk factor for infertility.
Reducing stress can help to balance hormones.
Finding healthful ways to manage stress may also boost fertility.
Long-term stress can affect hormones. For example, ongoing stress can increase cortisol in the body, which may trigger a rise in insulin production. High insulin levels can lead to an imbalance in female sex hormones and infertility.
Tips for managing stress include:
- getting regular exercise
- balancing work and home life
- spending time with friends and family
- getting enough sleep
For some people with PCOS, a low glycemic diet may improve symptoms and fertility.
A low glycemic diet involves eating fewer foods that cause a spike in blood sugar levels.
Avoiding spikes means that blood sugar levels become more stable, resulting in lower insulin levels and less testosterone production.
Other factors that affect fertility
PCOS is only one of the many possible causes of female infertility. Some common reasons include:
Endometriosis: A growth of uterine tissue outside of the uterus can also lead to infertility, especially when it develops in the fallopian tubes.
Structural problems: A problem with the structure of the fallopian tubes or other parts of the reproductive system can make it difficult to become pregnant.
Fibroids: These noncancerous tumors in the uterus can cause fertility problems by preventing implantation.
However, many women with fertility problems — including PCOS — can become pregnant with medical help.
The first step to take to increase the chances of pregnancy is for an individual to see a doctor and get an accurate diagnosis. By doing this, they can start treatment as soon as possible.