Polycystic ovary syndrome (PCOS) is a hormonal disorder characterized by an ovulatory dysfunction caused by hyperandrogenemia, ie, an excess of male hormones, and affects approximately 10% of women. It is closely related to female infertility, so it is difficult to get pregnant if the patient suffers from polycystic ovaries, which does not mean that it is not possible.
Difference between polycystic ovarian syndrome (PCOS) and polycystic ovaries (OP)
It is important to point out that polycystic ovary syndrome (PCOS) is not the same as polycystic ovary syndrome (OP). Although both can cause fertility problems, their characteristics and treatments are different.
In order for a case to be considered polycystic ovarian syndrome, at least two of these symptoms must be present:
1. Anovulation / Oligoanovulation
2. Clinical or biochemical signs of hyperandrogenism
3. Detection of more than twelve follicles in at least one ovary.
In contrast, women with polycystic ovaries have follicles in the ovaries but suffer from hormonal disorders associated with the first two points. This is why OPs can be treated by the gynecologist while, in the case of PCOS, endocrine support will also be necessary. It should be noted that, although they are different, both may involve fertility problems.
Why Polycystic Ovary Syndrome Occurs
Ovarian function depends on many hormones, and when one or more is not produced at the right time and concentration, it interferes with the development of the ovules and, consequently, the functioning of the ovaries.
In the case of micropymbiotic or polycystic ovary syndrome, an excess of luteinizing hormone and a high level of insulin cause women to produce more testosterone than usual. As a consequence, the eggs do not mature enough and do not expel during ovulation, so they remain installed in the ovary in the form of small cysts.
As a rule, cysts caused by anovulation are benign and do not require excision. However, non-ovulation causes the woman to not produce progesterone, one of the essential hormones in the menstrual cycle, so that it disappears or becomes irregular, resulting also in irregular ovulations. This is the main cause to make it more complicated to get pregnant.
How to know if you have polycystic ovarian syndrome
Symptoms of polycystic ovarian syndrome usually manifest between 20 and 30 years. However, in some women they appear at puberty and even before the first menstruation. The most common symptom is an irregular menstrual cycle. Some consequences, which can be interpreted as symptoms, would be:
1. Oligomenorrhea: very long menstrual cycles (more than 35 days). Occurs in 80% of cases.
2. Polymenorrhea: menstrual cycles of less than 24 days.
3. Hypermenorrhea: abundant rules.
4. Amenorrhea: absence of menstruation, related to infertility.
On the other hand, women with polycystic ovarian syndrome are more likely to develop high blood pressure, obesity, dyslipidemia (altered blood cholesterol levels), and diabetes. In addition, as a result of excessive secretion of testosterone, acne, alopecia, oily skin, dandruff and hirsutism (increased body hair and appearance in typically male areas such as the face or chest) may also develop.
How to Treat Polycystic Ovary Syndrome
Treatment for polycystic ovarian syndrome is usually pharmacological and includes contraceptives, anti-androgens, and insulin-controlling medications. Surgical options, such as ovarian perforation to eliminate cysts with laparoscopy or wedge resection, can also be given to stimulate ovulation.
Treatments for polycystic ovarian syndrome depend on the symptoms, the intensity of the symptoms, and whether they are intended to treat hyperandrogenism, infertility or menstrual irregularity. When deciding on a treatment or another, it will be essential to know the age of the patient and their desire to become pregnant in the short or medium term.
Can a patient with polycystic ovary syndrome become pregnant?
Although the probability of pregnancy with polycystic ovary syndrome is lower, it is possible. In fact, many women with this syndrome have no problem getting it. In other cases, menstrual irregularity or absence of ovulation make it more difficult to plan a pregnancy.
There are also natural treatments related to the regulation of ovarian function. Taking care of your health before, during and after pregnancy, as well as losing weight, controlling your diet, analyzing insulin resistance, and having medical, gynecological and endocrine checkups can help stabilize hormone levels, reduce symptoms, regulate ovulation And thus increase fertility.
In any case, if the patient notices any symptoms associated with polycystic ovarian syndrome, she should go to the doctor or gynecologist to rule it out or, if the diagnosis is confirmed, be treated as soon as possible.
Polycystic ovarian syndrome and fertility: techniques of ovarian stimulation and in vitro fertilization
As mentioned above, the symptoms of polycystic ovary syndrome directly affect fertility. The first step is to regulate the reproductive cycle, which is usually done with contraceptives, so this option is discarded for women who want to become pregnant.
In such a case, the usual treatment is the induction of ovulation with a hormonal treatment. In most patients, clomiphene citrate is the first choice in the treatment of ovarian stimulation. If it fails, try metaformin, taken with clomiphene.
Another common treatment to stimulate ovarian function and to reach pregnancy with polycystic ovarian syndrome is the administration by gonadotropins (FSH and HMG), the hormones directly involved in reproduction. They are given to the patient with subcutaneous injections and increase the chances of multiple pregnancy.
The fact that the pregnancy can be multiple is because the gonadotrophins work on the ovary so that it produces several ovules, instead of only one, as it happens in a regular menstrual cycle. In this way it is easier for more than one egg to be fertilized.
Likewise, ovarian stimulation is also important for those women with polycystic ovarian syndrome who want to become pregnant and, because they have not been successful by natural means, resort to in vitro fertilization. Thanks to this the doctors will obtain more number of oocytes during the cycle and the probability of pregnancy will increase. In fact, in vitro fertilization is one of the methods most likely to lead to pregnancy and makes it easier for specialists in assisted reproduction to control multiple pregnancies.
Pregnancy and Polycystic Ovary Syndrome
Although pregnancy can be reached with polycystic ovarian syndrome, the risk of miscarriage is higher (up to 45%), especially during the first trimester.
The fertility problems of women with polycystic ovarian syndrome include: hormonal imbalance or elevated insulin and glucose levels, which may interfere with the implantation of the fertilized egg and the development of the embryo in the first few weeks. On the other hand, the abnormal levels of insulin influence that the eggs are of lower quality, making conception even more difficult.