Trying to get pregnant with no success month after month can be frustrating, discouraging and very confusing. But most especially frustrating is when you are experiencing irregular periods. While it may seem initially that there is no answer to your question, when it comes to infertility and irregular periods, polycystic ovary syndrome (PCOS) is often the answer. The good news is that you can have a successful pregnancy even if you have PCOS.
What is it & getting a diagnosis
PCOS is a hormonal disorder common among women of reproductive age. It may cause infrequent or prolonged menstrual periods, which is often one of the first signs of PCOS. Many women with PCOS have higher than normal levels of the male hormone, testosterone. This hormonal imbalance interferes with the development of your eggs and the regular release of your eggs (ovulation). The ovaries are commonly characterized by numerous small collections of fluid (follicles) or ‘cysts’ which is why it is referred to a ‘polycystic ovaries’.
Some women with PCOS do ovulate occasionally, while others do not ovulate at all. If a healthy egg isn’t released, it can’t be fertilized by sperm. This is why you don’t get pregnant each month.
Additionally, women with PCOS are at risk for insulin resistance, diabetes, and metabolic syndrome. Aggressively treating insulin resistance (often with Metformin, a pill that can help control sugar levels), and obesity, can help improve some of the symptoms of PCOS. This can also prevent the progression to diabetes and help improve outcomes for mother and baby in pregnancy.
To receive a diagnosis, you will likely start with your OB/GYN. There’s no test to definitively diagnose PCOS, but your doctor will start with a discussion of your medical history, including your menstrual periods and any weight changes. You will likely have a physical exam to check for signs of excess hair growth, insulin resistance and acne.
Other tests for diagnosis may include:
- Pelvic exam — The doctor may inspect your reproductive organs for masses, growths or other abnormalities.
- Blood tests — These will measure hormone levels, and may also check glucose tolerance, fasting cholesterol and triglyceride levels.
- Ultrasound — This involves checking the appearance of your ovaries and the thickness of the lining of your uterus.
If your doctor determines that you may indeed have PCOS, you will be referred to a specialist in reproductive medicine (also called a fertility specialist). That’s us!
Occasionally though, patients will come to us with a misdiagnosis of PCOS. Just because you’re not getting your period doesn’t mean you have PCOS! Because it’s important to rule other factors out, our first step with you is to ensure your diagnosis is appropriate before proceeding.
Weight loss can help
Gaining a lot of weight can affect your hormones, which can lead to PCOS and make symptoms more severe. If you are overweight, losing weight may help get your hormones back to normal levels. Sometimes losing just 5- 10% of your body weight can sometimes restore your ovulation and make our fertility medications work more efficiently, which could help you get pregnant.
Remember that living a healthy lifestyle involving a nutritious diet, regular exercise, no smoking and less stress will help your overall well being and improve your fertility. That said, calorie restriction in women is proven to be the most effective step leading to weight loss.
If lifestyle and weight loss do not help improve your fertility after three to six months, then your doctor may recommend medication to encourage ovulation.
Called ovulation induction, this treatment is designed to stimulate the ovary to increase egg production. Ovulation induction uses tablets (pills) or injections over a period of time. The medications we use are quite effective and lead to ovulation roughly 80% of the time.
Letrozole is the medication that we usually utilize for ovulation induction. It is often recommended as the first option for improving fertility in women with PCOS who are infertile and do not ovulate. In a landmark study conducted by the Reproductive Medicine Network, investigators compared Clomiphene Citrate to Letrozole, and noted higher live birth rates after women took Letrozole. However, some women are more responsive to Clomiphene Citrate, so your doctor will help recommend the best medication for you.
Even though infertility and irregular periods can be frustrating, the good news is that there are simple, effective treatment options for women with PCOS.
To take some of the mystery out of what you can expect when you visit us at Alabama Fertility, get an idea of the different types of fertility testing we do and meet the team you will be working with.