As women’s health conditions go, PCOS can be one of the most emotionally painful because, in addition to all of the overt symptoms and health risks that women with this condition may experience, they may also face serious challenges in trying to get pregnant. In fact, PCOS is one of the most common causes of female infertility. The good news, though, is that most women with this condition can get pregnant even with their own eggs, if given the right fertility treatment.
While PCOS is a significant health concern affecting so much more than just fertility, the reason it poses such a serious impediment to getting pregnant is the adverse effects of the polycystic ovaries themselves. In addition, women with PCOS also tend to:
- Stop maturing eggs at the earliest stage of development, so they rarely ovulate or have normal cycles. Instead, they develop multiple small cysts on the outer capsule of the ovaries that are technically “preantral follicles” (not to be confused with “prenatal”). They are usually discovered by clinicians during an ultrasound, and are often referred to as a “string of pearls” for the way they appear on the ovary.
- Have long intervals of time between menses, which, technically, are often not even true periods, which is the bleeding that occurs about 12 to 16 days after ovulation.
- Have long cycles of sporadic patches of eggwhite, so they may feel they are constantly on the verge of ovulating (but a lack of thermal shift confirms they actually don’t).
- Have abnormal ovulations if they do indeed ovulate, both in terms of the development of the egg as well as the corpus luteum.
- Have an increased risk of endometriosis, further compounding their chance of infertility.
Finally, you should be aware that women with PCOS rarely benefit from ovulation predictor kits, since they produce numerous spikes of LH during their anovulatory cycles, and this often renders the kit results invalid.
The Good News: PCOS and the Various Options for Getting Pregnant
It’s crucial that a woman’s treatment plan be individualised for her specific genotype, age, and hormone levels, even though for all the treatment options the primary goal is to induce a healthy ovulation. You may have already read about some of the treatments listed below in that chapter, but some will be different in the context of trying to get pregnant.
Natural Hormone Balance
Before trying any of the following treatments, you will probably want to do all you can to take control of your PCOS through the natural methods discussed in Chapter 9, because, in addition to being healthier for you all around, they don’t have any side affects.
This drug is an insulin-sensitising medication that can be very effective in helping women with PCOS to develop more regular ovulatory cycles, but it can have quite a few side effects, including fever and back pain.
An Ovulatory Drug Such as Clomid or Letrozole
If Metformin doesn’t help a woman to ovulate on her own, she will usually be prescribed a drug such as Provera to induce a “period”, after which she can start taking an ovulatory drug such as Clomid or Letrozole, usually beginning on about Day 3 of the new cycle. Letrozole seems to work better for women with PCOS.
However, PCOS patients must be treated extremely carefully, because they have so many immature follicles that they need to avoid ovarian hyperstimulation syndrome, where too many eggs mature simultaneously. They are therefore usually given the least amount of ovulatory drug possible, gradually increasing the dosage until they eventually respond and release an egg. In fact, because of this risk, all women who are prescribed these strong ovulatory drugs should confirm with their doctors that they don’t have PCOS before they take them, to better control for ovarian hyperstimulation.
If women are still unable to ovulate, they are often prescribed a gonadotropin, which is more potent and produces larger numbers of follicles, but poses an even higher risk for ovarian hyperstimulation. For this reason, most clinics will only prescribe these meds in combination with OVF, so that they can be monitored carefully and have only one or two embryos returned to the woman’s uterus.
Ovarian Drilling and Ovarian Wedge Resection
Also mentioned in Chapter 8, these two archaic-sounding treatments can actually be surprisingly effective for women with PCOS. In fact, some physicians believe that either ovarian drilling or ovarian wedge resection should be the first treatment tried if drugs alone don’t work, though naturally, others feel it should be the last (alas, as you’ve seen, such is the nature of modern medicine). The theory behind each is that by removing a portion of the ovary, the androgen-producing follicles are diminished, thereby allowing for more normal cycles and ovulation. In addition, women opposed to IVF on religious grounds may find these procedures more acceptable.
Ovarian wedge resection is rarely performed anymore because it used to have a high adhesion rate, and thus was widely seen as too risky a procedure. However, a growing number of surgeons are now being trained to use this technique with a very low adhesion rate. This can make it a preferable surgery, since it helps women to ovulate on their own while also addressing so many of the debilitating health effects of PCOS. If interested in pursuing this option, I encourage you to contact the Pope Paul IV Institute for the Study of Human Reproduction in Nebraska for a list of the surgeons they have trained in this procedure.
In Vitro Fertilisation (IVF)
IVF, in conjunction with one or more of the ovulatory treatments listed above, tends to be quite successful for most women with PCOS. However, there are those who have a particular genotype who unfortunately tend to have a much lower success rate. These women tend not to be overweight, and may not even demonstrate signs of excessive androgens or other characteristics that are typically associated with PCOS. Yet they still develop polycystic ovaries at a younger age, so they deplete their ovarian reserve earlier, leading to premature ovarian ageing.