What is PCOS, how is it diagnosed, and can it affect your chances of getting pregnant?

Polycystic ovary syndrome (PCOS) is a widespread condition that can affect fertility, but it doesn’t mean that becoming pregnant is beyond reach. With the right lifestyle changes, medical care, and, when needed, fertility treatments, many people with PCOS successfully conceive. This guide will walk you through understanding the condition and how to navigate your journey toward parenthood.

PCOS, or polycystic ovary syndrome, is a hormonal condition that impacts people during their reproductive years. It is marked by an imbalance in hormone levels, which can cause a variety of symptoms and, in some cases, make conception more challenging.

It can often leads to irregular or absent ovulation, which directly impacts fertility. It can also involve the presence of numerous small ovarian cysts and elevated androgen levels (commonly known as male hormones).

PCOS can manifest in many ways, including:

• Irregular menstrual cycles

Long or infrequent cycles can indicate inconsistent ovulation.

• Excess hair growth 

Hair on the face, chest, or back (hirsutism) is linked to higher androgen levels.

• Acne 

Hormonal imbalances often result in persistent acne.

• Weight challenges 

Many with Polycystic ovary syndrome find it hard to manage their weight.

• Thinning hair 

Scalp hair thinning or loss can also be a symptom.

• Insulin resistance 

A condition where the body doesn’t respond well to insulin, leading to hormonal disturbances.

• Emotional shifts 

PCOS may contribute to low mood, self-esteem issues, and even depression.

• Sleep problems and fatigue 

Feeling tired or struggling with focus may indicate issues such as obstructive sleep apnea (OSA).

• Darkened skin patches 

Known as acanthosis nigricans, these patches are often found on the neck, armpits, or groin.

Although the exact cause remains uncertain, several factors are believed to contribute:

• Genetics

There is evidence that polycystic ovary syndrome may run in families.

• Hormonal Imbalances

Elevated androgens disrupt ovulation.

• Insulin Resistance 

Increased insulin levels can exacerbate hormone imbalances, potentially leading to PCOS development.

Diagnosing PCOS can take time, often involving multiple doctor visits due to the complexity of the condition and its varying symptoms. Unfortunately, a lack of awareness among healthcare providers and instances of medical dismissiveness can delay diagnosis.

Advocating for yourself and being well-informed is crucial. The Rotterdam PCOS Diagnostic Criteria outlines that a PCOS diagnosis requires at least two of the following:

1. Elevated androgen levels such as Testosterone on blood testing OR symptoms of this, such as excess facial or bodily hair, hair loss or acne

2. Irregular or absent menstrual cycles.

3. Evidence of polycystic ovaries on an ultrasound or elevated anti-Mullerian hormone (AMH) levels on blood tests.

Checking a number of your hormone levels is key to making the diagnosis. The Ultimate PCOS blood test will help to discover any hormonal imbalances.

Yes, it’s entirely possible! Although PCOS can make conception more complex, many people successfully conceive, either naturally or with medical support. Tracking ovulation is often the first step, and some may require medications or fertility treatments to assist the process.

If you’re trying to conceive with PCOS, these strategies can make a significant difference:

1. Maintain a Healthy Weight

Even a modest weight loss (5-10% of your body weight) can improve ovulation and insulin sensitivity. Focus on sustainable lifestyle changes rather than restrictive diets. A dietitian specializing in PCOS can provide personalized advice.

2. Exercise Regularly

Incorporating both aerobic and strength-training exercises into your routine helps balance hormones and improve insulin sensitivity.

3. Monitor Your Cycle

Tracking your cycle can help you better understand your ovulation patterns. Use apps, basal body temperature charts, or monitor cervical secretions to pinpoint your fertile window. Note that ovulation predictor kits (OPKs) may not work well for those with PCOS.

4. Follow a Balanced Diet

A Mediterranean-style diet with plenty of whole foods, vegetables, lean proteins, and healthy fats is beneficial for regulating hormones and improving fertility. Avoid cutting out food groups unless medically necessary.

5. Seek Emotional Support

Coping with Polycystic ovary syndrome can be emotionally draining. Reach out to friends, support groups, or organizations like Verity, the UK PCOS charity, for understanding and advice. Apps like AskPCOS can also help manage your journey.

For those who need extra help, treatments include:

• Medications: Letrozole and Clomiphene Citrate are commonly prescribed to stimulate ovulation, while Metformin may be used for insulin resistance.

• Fertility treatments: Assisted reproductive technologies (ART), such as IVF, can help achieve pregnancy when other methods don’t work.

• Symptom management: Speak to your doctor about treatments for excessive hair growth, acne, or sleep apnea.

While Polycystic ovary syndrome can make the journey to parenthood more complex, it’s important to remember that countless people with PCOS have gone on to have healthy pregnancies.

By staying proactive, informed, and supported, you can navigate this journey with confidence and hope. Whether through lifestyle changes, medical interventions, or fertility treatments, your path to parenthood is achievable.