Polycystic ovary syndrome is a condition that puts a woman’s hormones out of balance. It is often characterized by excessive production of the male hormone, androgen.
In the human ovaries, the follicles grow, mature, and release eggs during ovulation in a normal menstrual cycle. When the ovaries produce excess androgen, the follicular may be arrested along the line, resulting in ovulation failure and the development of several cysts(fluid-filled sacs) in the ovary.
What Are The Symptoms Of PCOS?
The following signs are indicative of polycystic ovary syndrome:
- Irregular menstrual cycle
- Anovulation (absent of ovulation)
- Hirsutism (excessive hair growth)
- Acne
- Change in cercal mucus consistency
- Alopecia (hair loss)
PCOS Co-morbidity Diseases
These are health conditions that can simultaneously exist in women with PCOS. Such conditions include:
- Infertility
- Obesity
- Insulin Resistance
- Type II Diabetes Mellitus
- Psychological Disorder
- Cardiovascular Disease(CVD)
- Cancer
Types Of PCOS
Polycystic Ovary Syndrome is of four types based on their different causes.
- Insulin-resistant PCOS: This is the most common type of PCOS which occurs due to the body’s failure to use insulin properly.
2. Pill-induced PCOS: Women who take contraceptive pills have their ovulation suppressed in a bid to prevent pregnancy. The effect usually reverses when the pills are stopped. However, many women do not resume ovulation for several months and years after stopping the pills.
3. Inflammatory PCOS: Environmental toxins, stress, and gluten foods can lead to inflammation in the body. Inflammation causes hormonal imbalance and the consequent production of excess androgen. such symptoms like headache, skin reactions and infections are often suggestive of inflammatory polycystic ovary syndrome.
4. Hidden PCOS: When PCOS is a result of an existing problem such as thyroid disease and lack of essential nutrients for the ovaries.
How Does PCOS Affect Fertility
For a woman to conceive naturally, there is a need to develop and release at least one egg (ovum) from one or both ovaries in a process called ovulation. This happens monthly in a normal cycle for every woman of child-bearing age.
In PCOS, there is usually a challenge in the growth and release of eggs from the ovaries due to hormonal imbalance. About 70%-80% of women with PCOS could go several months without ovulation and monthly flow. A good percentage may be getting their monthly flow without actual ovulation, a condition referred to as anovulatory bleeding.
The cervical mucus is another fertility factor that is significantly affected by PCOS. For your cervical mucus to be fertile enough, it has to be in an optimal PH (a measure of how acidic/basic something is) and fluidity for the sperm cells to be able to penetrate and swim up to your egg.
Women with PCOS have been found to have cervical mucus that is dense and thicker than normal. This makes it difficult for the sperm to penetrate, thereby causing a major delay in conception.
Getting Pregnant With PCOS
Non-Pharmacological Approach
Several lifestyle modifications help treat infertility in women with PCOS. Such changes include:
- Weight loss
- Exercise and
- Diet
Weight Loss
Obesity affects about 40%-60% 0f women with PCOS, causing increased abdominal fat deposits and insulin resistance in the body. Insulin, a sugar-regulating hormone, plays a vital role in androgen secretion by the ovaries. Insensitivity to this hormone results in excessive secretion of androgen which is a major culprit in PCOS development.
When you lose weight, especially around the abdominal tissues, the insulin sensitivity will improve and ovulation can take place.
Excercise
In a review by Harison et al, it was observed that active exercise can help improve the body’s insulin sensitivity and can bring back your ovulation.
Diet
If you have inflammatory PCOS, you will need to avoid certain foods that cause inflammation such as dairy products, wheat, and sugar. Replace them with non-inflammatory foods that are rich in magnesium such as;
- Leafy green vegetables
- Whole grains
- Black-eyed beans
- Almond nuts
- Cashew nuts
- Brazil nuts
- Avocado etc.
Cinnamon has also shown a marked antiinflammatory action in several studies. You can find cinnamon capsules in pharmacies as a dietary supplement. There are also cinnamon teas and powder you can get from the stores.
For insulin resistance PCOS, you will need to avoid sugar and foods with a high glycemic index, they cause a spike in your blood glucose level. Also take inositol-rich foods and supplements such as pears, oranges, bananas, and whole grain, etc.
Iodine and zinc are other important nutrients needed for optimal ovarian function. Eating foods like fish, seafood and the use of iodized salt can be very helpful. Zinc can be gotten from red meat, poultry, beans, nuts, cereals, etc.
Take at least 3 liters of water every day. it can also help to thin your cervical mucus making it more sperm-friendly.
Pharmacological Approach
As reported by the World Health Organisation (WHO), PCOS contributes over 80% of anovulatory type II infertility affecting women. Due to this fact, the treatment of PCOS for infertility is largely tailored towards inducing ovulation.
Drugs used in PCOS treatment includes;
- Clomiphene Citrate(CC)
- Letrozole
- Metformin
While Clomiphene citrate and Letrozole are ovulation-inducing agents, Metformin acts as an insulin sensitizer, ensuring the body makes proper use of the hormone.
They are the first-line treatment options for women with PCOS who want to increase their chances of getting pregnant. Nevertheless, these drugs are to be used on prescription and supervision by your health care providers.
From research, about 75%-80% of women will ovulate after taking Clomiphene Citrate. There is, however, a high risk of multiple births and ovarian hyperstimulation syndrome with CC, more reasons why it should be taken under proper supervision.
Letrozole, which was originally given when CC fails is presently the first-line agent in anovulation treatment due to its demonstrated higher rate of ovulation and successful pregnancy.
Assisted Reproduction
Women with PCOS who are unable to conceive naturally may need some help to boost their chances.
It could be in the form of sperm insemination where sperm is introduced directly into a woman’s womb to bypass the cervix and its mucus. This procedure is performed in a fertility Centre around the same time you’d be ovulating.
It could also be in the form of in vitro fertilization (IVF) where your eggs are retrieved and fertilized with your partner’s sperm outside your body. The fertilized egg is then transferred into the woman’s womb with the hope for successful implantation and pregnancy.