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Understanding the Complex Link Between PCOS and Fertility

  1. Introduction

    1. Definition of PCOS and Fertility:

      PCOS is a hormonal disorder that affects women of reproductive age and is characterized by a range of clinical manifestations, such as irregular menstrual cycles, hirsutism, and acne. The condition arises from excess androgen production and ovarian dysfunction, without any other underlying medical conditions to explain the symptoms. Women with PCOS may experience a variety of symptoms and complications, including infertility, metabolic disorders, and an increased risk of cardiovascular disease

      (Escobar-Morreale, 2018).

      Fertility refers to the ability of an individual to reproduce biologically. In medical terms, it is defined as the natural ability of an individual to produce offspring.

    2. Prevalence of PCOS and Fertility Issues:

      The prevalence and significance of polycystic ovaries (PCO) in ovulatory women with infertility is unclear. To examine this, a study was conducted on 289 couples classified into four diagnostic categories. The study found that polycystic ovaries was prevalent in women with anovulation, sperm dysfunction, tubal disease, and unexplained infertility, with a higher prevalence than in a control group of parous volunteers. Polycystic ovaries women with unexplained infertility had higher midfollicular luteinizing hormone and testosterone. The study suggests that PCO may contribute to the causes of subfertility in women with regular menses, possibly due to hyperandrogenemia.

      (E. Kousta, D.M. White, E. Cela, M.I. McCarthy, & S. Franks, 1999).

    3. The Relationship Between PCOS and Fertility:

      PCOS can cause hormonal imbalances that interfere with ovulation, resulting in irregular or absent menstrual periods, making it challenging to predict when ovulation will occur. Moreover, high levels of androgens can interfere with the development and release of eggs from the ovary, leading to small cysts on the ovaries that can further obstruct ovulation. Although not all women with PCOS experience infertility, some may require treatments such as clomiphene citrate to stimulate ovulation or assisted reproductive technologies like IVF. Pregnancy complications that are commonly associated with maternal polycystic ovary syndrome (PCOS) include early pregnancy loss (EPL), gestational diabetes (GDM), pregnancy-induced hypertensive disorders (PIH/PET), and the birth of small-for-gestational-age (SGA) babies. Metformin can also be used to reduce the prevalence of GDM

      (Homburg, 2006).

    4. Purpose of the Article:

      Purpose of the article is to provide information to readers about the link between PCOS and fertility, as well as the potential risks and complications associated with pregnancy for women with PCOS. The article aims to highlight treatment options available to women with PCOS who are experiencing fertility issues, including lifestyle changes, medications, and assisted reproductive technologies.

  2. Overview of PCOS

    1. Symptoms of PCOS:

      PCOS can cause a variety of symptoms in women, including hirsutism, amenorrhea, dysmenorrhea, and Oligomenorrhoea. These symptoms can be indicative of excess androgen production and ovarian dysfunction and can have significant impacts on a woman’s reproductive and metabolic health. Proper medical management is essential to address the symptoms of PCOS and minimize the risk of long-term health complications

      (Somia Gul, Syeda Adeeba Zahid, & Almas Ansari, 2014).

    2. Causes of PCOS:

      PCOS is a complex condition with both genetic and environmental factors contributing to its development and severity. Unhealthy lifestyle choices, such as poor diet and a sedentary lifestyle, can worsen PCOS symptoms, particularly in susceptible individuals. While some studies have suggested a potential role of environmental factors such as toxins and infectious agents in the development of PCOS, more research is required to establish causality. The genetic studies of PCOS have been challenging due to phenotype confusion, and the proposed PCOS genes such as CYP11A, the insulin gene, the follistatin gene, and a region near the insulin receptor have not been conclusively linked to the condition

      (Evanthia Diamanti-Kandarakis, Helen Kandarakis, & Richard S Legro, 2006).

    3. Diagnosis of PCOS:

      Clinicians diagnose polycystic ovary syndrome (PCOS) primarily through medical history and physical examination. The defining features of PCOS are hirsutism or high androgen levels, and irregular menstrual cycles caused by chronic anovulation. Other common symptoms include insulin resistance, hyperinsulinemia, and obesity. The use of ultrasound imaging has helped to facilitate the diagnosis of PCOS. However, it is essential to rule out other medical conditions that can present with similar symptoms to PCOS, such as hyperthecosis, congenital adrenal hyperplasia, or 21-hydroxylase deficiency

      (Chang, 2004).

    4. Treatment Options for PCOS:

      The management of PCOS is tailored to the individual’s symptoms, which could be related to ovulatory dysfunction, menstrual disorders, or androgen excess. Weight loss is an effective way to improve the endocrine profile, increase the likelihood of ovulation and improve the chances of pregnancy. Modest weight loss of as little as 5% of initial body weight can normalize menstrual cycles and induce ovulation. The treatment of obesity in PCOS includes lifestyle modifications such as dietary changes and exercise, as well as medical and surgical interventions. Anovulation in PCOS is due to low follicle-stimulating hormone levels and the arrest of antral follicle growth during maturation. Medications such as clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins, as well as laparoscopic ovarian drilling, can be used to treat this condition. In vitro fertilization is the last option for achieving pregnancy in cases where other treatments have failed

      (Ahmed Badawy & Abubakar Elnashar, 2011).

  3. Overview of Fertility

    1. Factors Affecting Fertility:

      Various factors such as physical, psychosocial, and chemical environments can affect reproductive function. Occupational exposure to hazardous chemicals has been extensively documented to negatively affect reproductive function. However, the effects of chemical contaminants on the general population, at levels typically encountered, are not well understood.

      Although evidence of adverse reproductive effects from environmental contaminants is stronger in animals than in humans, the hazards of exposure to these contaminants are a potential cause for concern. Apart from chemical contaminants, the physical and psychosocial environments can also have unfavorable reproductive effects

      (Edward V. Younglai, Alison C. Holloway, & Warren G. Foster, 2005).

    2. Signs of Infertility:

      • Irregular periods or absence of periods
      • Painful periods
      • Abnormal uterine bleeding
      • Pain or discomfort during intercourse
      • Changes in libido
      • Abnormal discharge or bleeding from the vagina
      • Changes in male reproductive function, including difficulty maintaining an erection or decreased sexual desire
      • Testicular swelling or lump
      • Ejaculation issues, including premature or delayed ejaculation
      • Reduced facial or body hair in men.
    3. Causes of Infertility:

      Infertility can be caused by various factors, such as delayed childbearing, lifestyle habits like smoking and alcohol consumption, changes in sexual behavior, and the breakdown of traditional taboos. There are several factors that have been studied in the context of infertility, including ovulatory, utero-tubal peritoneal, semen migration, and male factors. In around 40% of cases, there are multiple factors contributing to infertility, while 15% of couples may not exhibit any clear indicators of infertility

      (Santiago Brugo-Olmedo, Claudio Chillik, & Susana Kopelman, 2001).

    4. Diagnosis and Treatment Options For Infertility:

      The case history is an essential initial step in diagnosing infertility in couples. It involves asking reproductive age couples about their sexual activity and how long they have been trying to conceive. The tests or procedures that are necessary for diagnosing infertility in females include antral follicle count, clomiphene citrate challenge test, measuring the concentrations of various hormones such as antimüllerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), thyroid-stimulating hormone (TSH), and steroids like estradiol and progesterone levels. The following tests or procedures are essential for diagnosing infertility in male patients: genetic screening tests, hormone level testing, semen analysis, scrotal, testicular or transrectal ultrasound, testicular biopsy, and vasography.

      Treatment options depend on the underlying cause and may include fertility medications, intrauterine insemination, in vitro fertilization, intracytoplasmic sperm injection, surgery, and the use of donor eggs or sperm

      (Marian Szamatowicz & Jacek Szmatowicz, 2020).

  4. Understanding the Complex Link Between PCOS and Fertility

    1. Impact of PCOS on Ovulation and Menstrual Cycles:

      Arrested follicular development is a key factor in an ovulatory infertility associated with polycystic ovary syndrome, and can be influenced by various endocrine factors. Excessive secretion of luteinizing hormone and insulin, along with high levels of androgens within the follicles, can lead to increased cyclic AMP levels within the granulosa cells. This can cause the premature activation of terminal differentiation and ultimately result in the cessation of follicle growth

      (Stephen Franks, Helen Mason, Davinia White, & Debbie Willis, 1998).

      According to a study, the prevalence of polycystic ovaries (PCO) is positively correlated with the irregularity of menstrual cycles. PCO was found in 9% of girls with regular cycles, 28% of those with irregular cycles, and 45% of those with Oligomenorrhoea. The study also found that girls with PCO had higher levels of luteinizing hormone and androgens, but their insulin levels and glucose-insulin ratio were not significantly different from those of girls with normal ovaries

      (Marcel H.A van Hooff, Feja J Voorhorst, & Margriest B.H Kaptein, 2000).

    2. The Role Of Hormonal Imbalances In The Development Of Infertility In Women with PCOS:

      Polycystic ovary syndrome (PCOS) is a multifactorial condition that affects 5-10% of women of reproductive age. It is characterized by oligo/amenorrhea, anovulatory cycles, clinical or biochemical hirsutism, and the presence of polycystic ovaries. Insulin resistance is also common in many cases of PCOS. PCOS is caused by a combination of genetic, endocrine, and environmental factors, resulting in hormonal imbalances that contribute to the development of infertility. High levels of androgens and insulin resistance are significant hormonal imbalances in PCOS that lead to anovulation, irregular menstrual cycles, and changes in cervical mucus and the endometrial lining, which can result in infertility. Addressing hormonal imbalances is crucial in the management and treatment of infertility associated with PCOS

      (G Morgante , MG Massaro, A Di Sabatino, V Cappelli, & V De Leo, 2018).

    3. The Impact Of Insulin Resistance On Fertility In Women With PCOS:

      The study examined the levels of different biomarkers in patients with Polycystic Ovary Syndrome (PCOS) and found that those with insulin resistance (IR) had higher levels of malondialdehyde and lower levels of catalase and serum zinc, indicating increased oxidative stress. Furthermore, infertile PCOS patients showed a similar pattern of increased oxidative stress and decreased antioxidant response. The study concluded that oxidative stress and insulin resistance may contribute to the development of infertility in PCOS patients. These findings suggest that the relationship between insulin resistance and oxidative stress may be a critical factor in the development of fertility issues in PCOS patients

      (Alev Ozer, et al., 2016)

  5. Conclusion

  1. Summary of Key Points:

    Polycystic ovary syndrome (PCOS) is a medical condition that impacts approximately 5-10% of women of reproductive age. It is identified by various symptoms like oligo/amenorrhea, anovulatory cycles, clinical or biochemical hirsutism, and the presence of polycystic ovaries. Insulin resistance is common in many cases of PCOS, and patients may experience oxidative stress, particularly those with infertility or insulin resistance. Hormonal imbalances, including hyper secretion of LDH and/or insulin and high intrafollicular concentrations of androgens, contribute to the infertility associated with PCOS.

  2. The Importance Of Early Recognition And Treatment of PCOS for Fertility:

    Early recognition and treatment of PCOS is crucial for fertility. Patients with PCOS should be screened for potential fertility issues and treated accordingly. Treatment may include lifestyle changes, such as weight loss, as well as medications to regulate ovulation and hormonal imbalances. Early recognition and treatment can improve the chances of successful conception and pregnancy.

  3. The Need For A Holistic Approach To Treatment, Addressing Both PCOS and Fertility Issues:

    A holistic approach to treatment is necessary to address both PCOS and fertility issues. Treatment should not only focus on regulating ovulation and hormonal imbalances, but should also address factors that may contribute to infertility, such as obesity and insulin resistance. Patients should receive comprehensive care that considers their overall health and well-being, including mental health, stress management, and healthy lifestyle habits.

  4. Final Thoughts and Recommendations For Future Research:

    Future research should focus on improving early detection and treatment of PCOS to improve fertility outcomes. Research should also explore new treatment options that take a more holistic approach, addressing both PCOS and fertility issues, as well as underlying conditions such as insulin resistance. It is important to continue to educate patients and healthcare providers about PCOS and its impact on fertility, and to advocate for increased access to comprehensive care and resources for patients with PCOS.

References:

  • Ahmed Badawy, & Abubakar Elnashar. (2011). Treatment options for polycystic ovary syndrome. International Journals of Women’s Health, 25 – 35.
  • Alev Ozer, Murat Bakacak, Hakan Kiran, Onder Ercan, Bulent Kostu, Mine Kanat-Pektas, . . . Ferhat Aslan. (2016). Increased oxidative stress is associated with insulin resistance and infertility in polycystic ovary syndrome. Ginekologia Polska, 733 – 738.
  • Chang, R. J. (2004). A practical approach to the diagnosis of Polycystic ovary Syndrome. American Journal of obsterics and gynecology, 713 – 717.
  • E. Kousta, D.M. White, E. Cela, M.I. McCarthy, & S. Franks. (1999). The prevalence of polycystic ovaries in women with infertility. Human Reproduction, 2720 – 2723.
  • Edward V. Younglai, Alison C. Holloway, & Warren G. Foster. (2005). Environmental and occupational factors affecting fertility and IVF success. human reproduction update, 43 – 57.
  • Escobar-Morreale, H. F. (2018). Polycystic ovarian syndrome, definition, aetiology, diagnosis, and treatment. Nature Reviews Endocrinology, 270 – 284.
  • Evanthia Diamanti-Kandarakis, Helen Kandarakis, & Richard S Legro. (2006). The role of genes and environment in the eiology of PCOS. Endocrine, 19 – 26.
  • G Morgante , MG Massaro, A Di Sabatino, V Cappelli, & V De Leo. (2018). Therapeutic approach for metabolic disorders and infertility in women with PCOS. Gynecological Endocrinology, 4 – 9.
  • Homburg, R. (2006). Pregnancy complications in PCOS. Best Practice & Research Clinical Endocrinology & Metabolism, 281 – 292.
  • Marcel H.A van Hooff, Feja J Voorhorst, & Margriest B.H Kaptein. (2000). Polycystic ovaries in adolescents and the relationship with menstrual cycle patterns, luteinizing hormone, androgens, and insulin. Fetility and Sterility , 49 – 58.
  • Marian Szamatowicz, & Jacek Szmatowicz. (2020). Proven and unproven methods for diagnosis and treatment of infertility. Advances in Medical Sciences, 93 – 96.
  • Santiago Brugo-Olmedo, Claudio Chillik, & Susana Kopelman. (2001). Definition and causes of infertility. Reproductive Biomedicine Online, 173 – 185.
  • Somia Gul, Syeda Adeeba Zahid, & Almas Ansari. (2014). PCOS: symptoms and awarness in urban Pakistani women. Int J Pharma Res Health Sci 2, 356 – 60.
  • Stephen Franks, Helen Mason, Davinia White, & Debbie Willis. (1998). Etiology of anovulation in polycystic ovary syndrome. Steroids, 306 – 307.
Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 17, 2023

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