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PCOS - what is it? How does it impact fertility? Why was I diagnosed so late in life? What would a PCOS diagnosis mean for fertility treatment?

PCOS was first described in the 1930’s, which is why this name is so confusing for us today. The physicians who were describing PCOS were looking under the microscope at ovaries from women with a clustering of symptoms of obesity, very few menstrual cycles, and hair growing where they did not want it. These physicians had no understanding about the hormones that were causing these changes in the ovaries and they mistakenly thought it was the ovaries that were abnormal.

PCOS is an abbreviation for poly-cystic ovarian syndrome. There are, however, no true “cysts” in the ovaries at all. The many small areas in the ovaries that we see on ultrasound are not cysts but “follicles”. Follicles are the areas in the ovaries where there are eggs. Women with PCOS recruit many small follicles containing eggs to start growing and then they get stuck before they mature and can release an egg. This is called anovulation. In most women, the reason that these follicles stop growing is due to the presence in the ovary of too much androgen hormone. In most women, the abnormal production of androgens is caused by increased amounts of insulin, a condition known as insulin resistance. Insulin resistance leads to many things women commonly experience in addition to the anovulation and missed periods. Insulin resistance can lead to obesity. When you have insulin resistance, your body’s metabolism is always in storage mode, making it easy to gain weight but very hard to lose weight! Insulin resistance is the most commonly inherited hormonal abnormality. Many women with insulin resistance have family members with weight problems and some with diabetes. The insulin resistance gene is turned on or off depending on many factors some of which are our determined by our lifestyle. Many women are diagnosed with PCOS later in life when they are less physically active and may have gained weight. More sustained physical activity will turn the gene off. The amount of processed sugar in our diet can turn the insulin resistance gene on or off. As we eat more processed sugar, our insulin levels increase.

Women with PCOS do not ovulate monthly making it much harder to get pregnant. Fertility treatments for PCOS will focus on getting the women to ovulate each month. The best way to bring about ovulation will vary from woman to woman and may change throughout the course of a women’s treatment.

For all women with PCOS it is very important to have a healthy lifestyle. This lifestyle should include 30 to 45 minutes of sustained exercise that elevates your heart rate daily. It should also include a well balanced diet full of unprocessed foods like lean meats, dairy, nuts, fruits and vegetables.

Lynda Wolf, M.D.

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