24 March 2022
Written by Claire Bonneau
While every woman’s journey with infertility is different, research connects a particular hormonal condition, polycystic ovary syndrome (PCOS) with a higher risk of infertility. Unfortunately, this disorder is extremely common and may not be diagnosed.
PCOS is a hormonal disorder that causes a wide range of symptoms in women of reproductive age. The Office on Women’s Health indicates that as many as 1 in every 10 women have PCOS. Research suggests that rates of women living with undiagnosed PCOS may be as high as 75%. ¹
Due to the poor rate of diagnosis, many women are unaware they are living with PCOS, and may only seek medical help when they encounter trouble conceiving.
Despite being one of the most common causes of female infertility worldwide, PCOS also causes significant health issues for those living with the condition. From hormonal imbalances to metabolic changes, many symptoms of PCOS can be difficult to pinpoint or diagnose in its earliest stages.
So, why don’t we have a cure for this incredibly common condition?
PCOS is a health condition that primarily impacts the health and function of women’s hormones. In most cases, the hormones that are most affected by PCOS are sex hormones (like estrogen and androgen). As a result of these hormonal imbalances, changes to metabolism, and potential damage to the ovaries a woman’s fertility is often affected.
Additionally, many identifiable symptoms of PCOS are not directly related to fertility (such as weight gain, mood swings, or acne), and therefore it’s common for women to only get diagnosed after seeking help to understand why they’re struggling to conceive.
The hormonal imbalances of polycystic ovary syndrome cause pearl-like cysts to develop on the ovaries, detectable by ultrasound technology.
These cysts can make the development and release of mature ovum (eggs) difficult or impossible, depending on the severity of the disease.
Research estimates that up to 5-10% of women between the ages of 15-45 are currently living with PCOS.² Women of all ethnicities and geographical locations are at risk of developing the disease, especially those with a family history of PCOS.
While the exact causes of PCOS are currently unknown, research has found some common factors that may increase your risk. These include:
High levels of androgen hormones — Often associated with “male” hormones, androgens are a category of hormones that naturally occurs in both men and women. Higher levels of androgen hormones in females can lead to the development of PCOS and disrupt the normal function of the ovaries. Symptoms might include not ovulating releasing an egg) regularly during menstrual cycles, or having acne or extra hair growth on the face.
Elevated body weight and insulin resistance — Insulin is the main hormone responsible for controlling blood sugar levels, and insulin resistance is the second most common cause associated with developing PCOS. Insulin resistance is when your blood sugar levels are higher than normal, but not quite so high they fit a diagnosis for diabetes — this state may also be referred to as “pre-diabetes.” Women with PCOS may also have deposits of fat in their midsection. These fat cells are more likely to be resistant to insulin, causing the body to produce more insulin, causing blood sugar control problems and the possibility of developing type 2 diabetes. Insulin resistance can result in PCOS symptoms such as irregular periods, weight gain, higher levels of testosterone, and fertility problems.
Genetic and metabolic factors — There is a greater risk for PCOS when genetics and family history are a factor. While more research needs to examine the nature of the relationship between genetics and PCOS, women whose mothers, aunts, or grandmothers have had PCOS are more likely to develop the disease themselves.³
As a hormone-based condition, the symptoms of PCOS are not localized to one area of the body. Early diagnosis of the disease can be difficult, especially in younger women who have yet to experience fertility issues, as this is the most commonly identified symptom of PCOS. Every woman will experience PCOS slightly differently, including the number, type, and severity of their symptoms. Some of the most common symptoms of PCOS include
An irregular menstrual cycle
Increased body hair growth on the chest, back, stomach, and chin
Unexplained weight gain
Decreased sex drive
Increased oily and acne-prone skin
Fatigue and disturbed sleep
Thinning of hair or the development of male-patterned baldness
Skin tag growths, most commonly found under the arms
Dark patches of skin on the neck, under the breast, and armpit areas
Infertility and difficulty conceiving
Because of the widespread impact that PCOS hormonal imbalances cause, women diagnosed with PCOS run a greater risk of developing other chronic health conditions as well. This does not mean that having PCOS guarantees you will develop these conditions. The severity of your condition (as well as access to and compliance with treatment) is also a factor. Examples of chronic health conditions commonly associated with PCOS include:
Type II diabetes — Most women diagnosed with PCOS experience some level of insulin resistance. There is a strong connection between this condition and the development of type II diabetes. Type II diabetes, when untreated, can lead to profound damage to blood vessels, nerves, kidneys, eyesight, and more.
Hypertension — Commonly associated with heart disease, hypertension (also known as high blood pressure) is a condition found in women newly diagnosed with PCOS. It is also known as ovarian hypertension. Currently, researchers are unsure if hormonal imbalances or increased body mass index (BMI) are the primary reason why hypertension is common in women with PCOS, and further research is being carried out to better understand the relationship.⁴
Elevated cholesterol levels — Women with PCOS are at a higher risk of dyslipidemia, a condition that impacts the amount of cholesterol present in the body.⁵ Elevated cholesterol levels can increase the risk of developing life-threatening conditions like a heart attack or stroke.
Sleep apnea — This common sleep condition that affects breathing usually impacts more men than women. However, increased levels of male androgen hormones in women with PCOS are believed to play a role in cases of sleep apnea among women. ⁶
Endometrial cancer — Research shows that adequate estrogen levels are needed to reduce a woman’s risk of developing endometrial cancer. For women with PCOS, high levels of androgen hormones can cause lower estrogen levels.⁷
Depression and Anxiety —Depression and anxiety are common among women with PCOS.
In women with PCOS, the reason for infertility may be due to blockages from the fluid-filled cysts in the ovaries as well as imbalances in sex hormones. Consequently, it’s common that a healthy, mature egg won’t form or be released from the ovaries.
Even if a woman is still getting her period regularly,the egg may not be viable, which is why many women with this condition seek modern fertility treatments for help.
While ovulatory issues (the process of maturing and releasing an egg) are involved in 40% of all infertility cases (with 85% of ovulatory problems being caused by PCOS). Other problems like fallopian tube trauma or uterine factors (such as fibroids or polyps) can also make conceiving difficult for any woman.,⁸ ⁹
In one cross-sectional study, researchers found that 72% of women with PCOS reported infertility. 16% of women from the study without PCOS reported infertility. It was also found that women with PCOS were 4.5 times more likely to report infertility.¹⁰
For many women diagnosed with PCOS, one of their primary concerns is knowing if they will still be able to have children. Thankfully, with modern advances in fertility technology, many women living with PCOS can get pregnant, either naturally or with the help of fertility specialists. Treatment options that can help a woman with PCOS become pregnant include:
Making healthy lifestyle changes — Dietary changes, increasing daily exercise, maintaining a healthy body weight, and practicing good sleep hygiene are all great ways to reduce the severity of PCOS symptoms that a woman may experience. If a woman has mild PCOS and is able to stick to these lifestyle changes, they may be able to conceive a child naturally without the need for medical intervention, despite their diagnosis.
Taking prescription medications — Fertility medications like clomiphene (also called Clomid) can be given to women with PCOS to induce ovulation. This is often done as part of a more involved fertility procedure like in vitro fertilization (IVF). This should only be carried out under the supervision of a trained gynecology professional. Additionally, hormone-based contraceptives like oral birth control pills, intrauterine devices (IUDs), patches, and injections can help to make a woman’s menstrual cycle more regular and predictable.
Surgical interventions — When other treatments haven’t succeeded, surgery may be required to induce ovulation in ovaries affected by PCOS. The outer layer of the ovary (cortex) may be thickened and damaged by the development of cysts. In this case, a surgeon may be able to restore ovulation with laser surgery (multi perforation or laparoscopic ovarian diathermy). This procedure is usually effective for approximately 6-8 months.¹¹
In vitro fertilization (IVF) — One of the most common treatment options for fertility around the world, IVF therapy can be performed on women with PCOS after they have undergone hormonal injections to assist in creating mature eggs ready for fertilization. Because this process involves harvesting mature eggs from the ovaries, issues with releasing the egg can be avoided, allowing for a woman with PCOS to become pregnant after the egg has been fertilized and implanted into her uterus.
Anyone who is concerned about being 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 health complications. There are many possible causes of infertility, but an assessment for PCOS can help target treatment and improve the chances of conceiving.
If you do become pregnant, your healthcare team knowing that you have PCOS can help ensure a healthy outcome. Otherwise, complications may include high blood pressure, gestational diabetes, or premature birth.
There is no specific test to diagnose PCOS. A doctor makes a diagnosis based on several factors.
Testing will likely include:
A physical exam
A full medical history
A pelvic ultrasound
Bloodwork to determine hormone and glucose levels
Polycystic ovary syndrome (PCOS) is one of the most common reasons for female infertility in the world. It is not curable, but it can be treated. PCOS is a complex hormonal disorder, but there are many ways to reduce symptom severity and support fertility.
Speaking with a qualified healthcare provider and following healthy lifestyle recommendations are crucial components of managing PCOS.
In recent years, more women are opening up publicly about their struggles with PCOS and infertility, which has brought increased awareness to the need for improved treatments, and eventually, a cure.
Despite the prevalence of PCOS, experts have described its research as underfunded. The same researchers suggest there is a need for heightened public awareness, not only for the general public but amongst the scientific community and elected officials.¹²
With the demand for answers continually on the rise, it is hopeful that PCOS will be better understood in the coming years and possibly cured in the coming years.
The author, Claire Bonneau, is a medical writer and certified trauma operating room nurse.