Treatment for PCOS: A PCOS Diagnosis Does not Mean Infertility

 

Believing that PCOS causes guaranteed infertility is the biggest misconception relating to the syndrome, says the Polycystic Ovary Syndrome Association of Australia (reference: http://main.posaa.asn.au/index.php/what-is-pcos/pcos-a-fertility).


A PCOS Diagnosis Does Not Equal Infertility

Although Polycystic Ovary Syndrome starts, in many cases, just after the female experiences her first period, she will probably be in her 20s or 30s before an official diagnosis is made.

Fertility may not always be a cause for concern among young sufferers, after all starting a family is rarely a priority in a woman’s late teens or even early twenties.

While PCOS generally does have a significant impact on a woman’s fertility – it is by no means a guaranteed indication of infertility.

In fact, many women have the appearance of polycystic ovaries, yet are naturally fertile. If a woman suffers from ovulation issues as part of her PCOS or if she hasn’t been ovulating at all, this could be an indication of a more serious issue.


My Own Early PCOS Diagnosis at 16

I was 16 when I was diagnosed with Polycystic Ovary Syndrome and I can safely say the potential fertility issues linked to the condition were the last thing on my mind.

Instead, I was more concerned about some of the more “cosmetic” PCOS symptoms, such as potential acne, excess body hair and weight gain.

I was also concerned about the possible risk of diabetes, as the condition ran in my extended family.

I was referred to the hospital to see a gynaecological specialist, who would be able to investigate the full extent of the condition and whether it had affected my ovaries.

I can remember being thankful that some of my symptoms now had a diagnosis but I can also remember being worried – the condition sounded so serious, I was worried for my health even at such a young age.

Polycystic Ovary Syndrome is the most common cause of ovulation-related infertility, says a National Institute on Health pamphlet. (reference: http://www.nichd.nih.gov/publications/pubs/documents/pcos_booklet.pdf).


Tracking Your Cycle: Initial Steps Before Potential Treatment for PCOS

According to the University of Chicago Medicine, absence of periods does not automatically mean that a woman is not ovulating.

Before considering more formal treatment for potential fertility issues, it is recommended you track your menstrual cycle.

This will give you an idea of any pattern, as well as helping your doctor see exactly how many periods you are having over a specific time period.

As well as writing down when your period arrives, your doctor will also arrange:

  • Regular ultrasounds
  • Take your basal temperature
  • Note changes in the position of your cervix and whether there has been any mucus passed.
  • Blood tests to determine whether the woman has ovulated or not.

The doctor or PCOS specialist will then compile this evidence, taken over a lengthy time period, so they can get a better idea of the condition and how it is affecting you.

It is after this type of analysis that a firmer decision may be made regarding the woman’s fertility and/or chances of conceiving naturally.

The information collected can also help a woman become pregnant, as it will show when she is most likely due to ovulate.

According to the Polycystic Ovary Syndrome Association of Australia, women are twice as likely to fall pregnant during cycle tracking than at any other point – this is because the doctor will be able to recommend when the best time is for conception.


The Different Options for Treatment for PCOS

Receiving an official diagnosis of infertility because of Polycystic Ovary Syndrome is actually quite rare.

Unless the ovaries are severely damaged or the woman has not ovulated for a certain amount of time, there is always hope.

However, women who suffer from ovulation problems relating to PCOS will find it difficult to get pregnant because their ovulation schedule is not as predictable as the average woman.

There is hope of course, even if it is a small amount and some women with fertility issues may be offered one or several of the following different kinds of treatment for PCOS:


Clomiphene

A common treatment for PCOS, Clomiphene stimulates the ovaries to produce eggs.

According to figures supplied to the National Institutes on Health, women with PCOS who take Clomiphene are six-times more likely to conceive than those who don’t.

Some thought definitely needs to go into whether taking Clomiphene is an option, especially given that the chances of the woman conceiving a multiple pregnancy are significantly increased with the drug.


Metford

This drug specialises in insulin-sensitivity and is designed for use by people with diabetes.

However, according to the Polycystic Ovary Association of Australia, it has successfully restated regular ovulation in women with PCOS.

Unfortunately, while the drug is approved by the US Food and Drug Administration for use in people with diabetes, it is not yet officially cleared for use in women with PCOS-related infertility.


Gonadotrophins

This drug is a collection of hormones and is usually given to women with PCOS infertility issues when the drugs, Metformin and Clomiphene, have had no effect on the PCOS symptoms.

This drug is something of a last resort in the treatment for PCOS, as specialists would expect the other two drugs or a combination of the two to be more effective.

Gonadotrophins can only be prescribed in low doses, which can make the whole process take longer than with other drugs.

Women who do not benefit from the above treatments will need to consider other forms of assistive reproductive technology.

According to the Polycystic Ovary Syndrome Association of Australia, women who do not respond to the above infertility treatments are likely to have more serious fertility issues.

This is not a reason to give up hope though, women with PCOS who wish to conceive can also consider:


Egg Donation

Because producing their own eggs is an issue, women with PCOS-related infertility could consider egg donation.

This is relying on a donor to provide the egg, which would then be fertilized with the woman’s partner’s sperm before being transplanted into the woman’s womb.

This is seen as something as a last resort by women, who ideally want to carry their own biological baby.


In Vitro Fertilization

Commonly referred to as IVF, this procedure is long and expensive and while it may result in the woman having her own biological child the success rates are not attractive.

Of course, for women who definitely cannot have their own baby naturally, IVF is a viable option.


Never Give Up Hope; Most Women with PCOS Do Actually Ovulate

According to the National Institutes of Health, women who have PCOS generally suffer from ovulation problems rather than failing to ovulate at all.

These problems could vary from only ovulating once a year, to being unable to follow ovulation because of an irregular menstrual pattern.

According to the Women’s Web MD website, women who ovulate have every chance of conceiving, it just may take longer than the average woman.


My Own Fertility Worries

Although potential infertility had not been my official concern when I was first diagnosed, it soon became one.

After marrying young, I was just 18 years old, my husband and I decided to try for a baby. After five months of trying and still nothing, I went to see my doctor. Ordinarily, he would have sent me away and told me to keep trying. (According to the National Institutes of Health, the average couple takes around 12 months to conceive naturally.)

I, however, was referred to my PCOS specialist, who told me to come back in eight weeks for a few fertility tests.

I hadn’t had a period for three months, so I knew there were issues but all I could do was hope that I would have a chance.

When I returned for my tests, we had been trying for nearly eight months with no joy. Before going for a battery of blood tests, I was given a urine test to check for protein, a sign of diabetes in my urine.

The nurse returned and told me the blood tests were not necessary – the obligatory pregnancy test she had carried out had been positive – I was finally pregnant.

I now have four healthy children, and while I have also suffered two miscarriages – I have never really had any trouble conceiving.

Proof may be that my lack of menstrual periods did not automatically mean I wasn’t ovulating. My own story, and that of other women I know with PCOS who have successfully conceived more than once, is the reason I tell people that – until you receive an absolute set-in-stone infertile diagnosis – there is always hope of natural conception.


PCOS and Potential Pregnancy Complications

Unfortunately, women with PCOS who fall pregnant are also at a higher risk of suffering from certain pregnancy complications because of their condition, says the National Institutes of Health.


Miscarriage

It is not known exactly why women with PCOS who fall pregnant are at a greater risk of miscarriage.

However, risk of diabetes and obesity, both common in PCOS women, are both thought to play a part.

Medical research has indicated that women with PCOS who fall pregnant may benefit from taking Metformin – as it is an insulin-sensitizing drug.


Pre-eclampsia

Marked by a sudden spike in blood pressure after the 20th week of pregnancy, pre-eclampsia can be a life-threatening condition for both mother and child.

The only cure for pre-eclampsia is to deliver the baby, which often means complete bed rest for the mother until she reaches a stage where delivery will not be risky for the baby.

Again, why PCOS women are more likely to get pre-eclampsia is unclear, although it is almost certainly linked to being overweight and obesity.


High Blood Pressure due to Pregnancy

Women with PCOS are more likely to suffer from high blood pressure, even when they are not pregnant, says the Women’s Web MD website.

This means, women with PCOS can suffer from significantly higher blood pressure when pregnant – which can lead to other serious complications.

Left untreated, high blood pressure can lead to pre-eclampsia and it can also have serious implications during labor.


Talking to a PCOS Trained Counsellor Can Be Very Helpful

The Polycystic Ovary Syndrome Association of Australia recommends women with PCOS should consider counselling – regardless of their possible fertility problems or pregnancy plans.

Because PCOS is such an intimate condition, which centers on a woman’s reproductive system it can be easy for some woman to feel like a failure.

I can relate to this feeling, as after suffering my first miscarriage, I felt that my condition made me less of a female.

Talking to a counsellor, or even just someone close to you who you can trust, can be immensely helpful.

Not only can it help you understand the condition, it can assist you in coming to terms with some of the more serious symptoms.

Talking about how you feel is particularly important if you are trying to conceive. This is because stress is one of the biggest obstacles to conception, so it is worth bearing in mind that it is just as important to look after your mental health, as it is your physical.

Women suffering from PCOS-related infertility may find talking to a PCOS trained counsellor especially helpful. While many counsellors are well meaning and sympathetic, many do not understand the deeper issues revolving around PCOS.


Living With PCOS Infertility

A small number of women may find they cannot conceive naturally, with the help of fertility drugs or assisted technologies.

In these cases, the only remaining option is adoption. This may be ideal for some and others may choose to accept that having a child was not meant to be and enjoy other areas of their life.

If you have been diagnosed as infertile because of PCOS, don’t discount the various treatments available straight out.

News such as that will take a long time to come to terms with, but it is possible to learn to accept your PCOS condition.

Once you have accepted that, you may be in the right frame of mind to consider trying one or more of the PCOS treatment options.

As always, for advice and further information to find the right treatment for PCOS tailor suited you, you should consult your doctor, who, if he or she can’t help you, will ensure you are referred to people who can.


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