It is associated with many health conditions and has an impact on various metabolic processes in the body. A diagnosis of PCOS is made when a woman experiences at least two of the following signs: irregular periods, excessive androgen (elevated levels of this male hormone) and polycystic ovaries, (when ovaries may be enlarged and contain follicles that surround the eggs, which may result in the ovaries not functioning correctly).
About 60%-80% of women with PCOS suffer from insulin resistance and excess body fat, 95% have irregular periods and may not ovulate, 60% suffer from hair loss, acne and unwanted hair growth and 20% have fertility problems. Alarmingly, more than 50% of women with PCOS will develop diabetes or prediabetes before the age of 40.
Polycystic ovary syndrome is the most common cause of irregular menstruation that leads to infertility. According to Dr Johan van Schouwenburg of Medfem Clinic, Johannesburg said, “Insulin resistance occurs in the majority of PCOS patients. Correction of insulin resistance improves fertility dramatically, resulting in better conception rates. This may be through natural conception, by ovulation induction or through assisted reproduction techniques such as in vitro fertilisation (IVF).”
He explained that PCOS-related hyperandrogenism results in low IVF pregnancy rates due to poor quality oocytes and endometrial changes reducing embryo attachment. Reduction of androgen levels can be achieved by:
- Metformin treatment. This drug is effective, even if insulin levels are normal
- Laparoscopically performed ovarian drilling. According to him, ovarian hyper stimulation syndrome (OHSS) can be a life-threatening complication of ART stimulation. PCOS increases this risk.
Preventative measures include:
- Correcting insulin resistance before ovarian stimulation is commences
- Conservative ovarian stimulation
- Using a GnRH antagonist for triggering ovulation before oocyte aspiration
- Aregoline tablets for +-6 days from day of triggering
- Freezing embryos for embryo transfer in a subsequent cycle.
PCOS patients with amenorrhoea, not wishing to conceive, need to have their menstruation cyclically induced by progestogen withdrawal. This will reduce the important danger of developing endometrial carcinoma. Obesity, which is defined as having a body mass index of over 30, can affect fertility by causing hormonal imbalances and problems with ovulation. Insulin resistance, which usually presents with stubborn belly fat, is associated with polycystic ovary syndrome (PCOS), a common hormonal condition especially in infertile women, affecting up to one in five women of reproductive age.
PCOS is a complex hormonal disorder, affecting young women at a reproductive age. While obesity, hypertension and insulin resistance are a few of the symptoms of PCOS, it is also the leading cause of infertility and has now become an epidemic.” A hormonal imbalance is the main difficulty with PCOS. In women with PCOS, the body manufactures more androgens than normal. Androgens are male hormones which females also produce.
High levels of these hormones affect the development and the release of eggs during ovulation. Increased levels of androgens in a woman’s body are responsible for the majority of symptoms, however many symptoms are coming from an underlying insulin resistance. PCOS has a variety of signs and symptoms, which do not necessarily include having identified cysts in the ovaries in order to diagnose this disease. In fact, they are often absent during an ultrasound diagnosis. PCOS symptoms and signs:
- Irregular or absent menstrual cycles
- Infertility or recurrent miscarriage
- Hirsutism (excessive facial hair and body hair)
- Oily skin/acne
- Obesity/abdominal fat
- Male pattern baldness
- Insulin resistance
- Dyslipidaemia (unhealthy levels of one or more kinds of lipid (fat) in the blood)
- Depression and/or anxiety
- Sleep apnoea.
All of the above affect young women who are at a reproductive age. Statistics show that 50% of these women, if left untreated, can develop diabetes type 2 by the age of 40. Meanwhile, their chances of suffering from a cardio-metabolic syndrome, heart attack or cerebrovascular insult is five and seven times higher, while the risk of contracting endometrial cancer is also increased by three-fold.
Rising obesity rates are posing a global public health challenge. While it is increasingly being recognised that this current obesity epidemic has also contributed to fertility problems, obesity is also associated with cardiovascular disease, diabetes, osteoarthritis and malignancies such as colon and endometrial cancer. Studies have shown that overweight and obese women with PCOS may have a greater chance of becoming pregnant if they lose weight before beginning fertility treatment.