THIS SILENT DISEASE IS A LEADING CAUSE OF INFERTILITY IN WOMEN By Dr. Shaun Tregoning MD

Dr. Shaun Tregoning MD received his medical training in reproductive endocrinology and fertility at the University of Cape Town and Stanford University.  He treats fertility patients at Olive Fertility Centre in Surrey, BC and holds a position as an assistant clinical professor in department of Obstetrics and Gynecology at the University of British Columbia. Dr. Tregoning has a special clinical interest in advanced laparoscopic surgery, endometriosis and PCOS.

Polycystic Ovary Syndrome (PCOS), sometimes called the “silent killer,” is one of the most common causes of infertility.  Despite the fact that PCOS affects 8%-12% of women in North America (and that number may be higher for South Asian women), up to 50% of women with PCOS go undiagnosed. This has serious health implications as, in addition to being a leading cause of infertility, PCOS is associated with a number of other health problems, including diabetes, heart disease, and endometrial cancer. Some of the women that I see in my fertility practice have no idea they have PCOS until they discover they can’t get pregnant.

WHAT IS PCOS?

PCOS is a condition in which women have high levels of male hormones (androgens). These hormones play a role in blocking the release of the egg from the follicle and in the overproduction of the female hormone estrogen.

WHAT ARE THE SYMPTOMS OF PCOS?

The hormonal imbalance (especially the excess of male hormones that characterize PCOS) produces symptoms including:

  • Irregular or absent  periods
  • Acne
  • Excessive body and facial hair (hirsutism)
  • High body mass index (BMI)
  • Belly fat
  • Thinning hair on your head
  • Depression and anxiety
  • High insulin levels
  • Infertility

Insulin seems to be a key factor in PCOS. Many women with PCOS have increased insulin resistance. High levels of insulin in the blood lead to the ovaries producing too much androgen. As well, excess insulin leads to excess glucose in the blood and sets the conditions for pre-diabetes, weight gain, and diabesity.

HOW IS PCOS DIAGNOSED?

PCOS can be difficult to diagnose because there is no one single diagnostic test and the signs and symptoms vary from patient to patient.

Clinically, if you have two out of three of the following symptoms, you will most likely be diagnosed with PCOS:

  1. Irregular, few, or absent menstrual periods.
  2. Androgen excess – clinical or biochemical (excessive body hair, acne, loss of head hair, increases testosterone in the blood)
  3. Polycystic ovaries — the ovaries of women with PCOS usually have a distinctive appearance on ultrasound.

TREATMENT OPTIONS

There is no magic bullet for treating PCOS and often a combination of treatment strategies is required. The first approach to treating PCOS should be changes in lifestyle, including following a low glycemic index (GI) diet to help control insulin levels, regular exercise, and additionally weight loss if you have a BMI over 25.

The good news I convey to my overweight patients with PCOS is that they do not need to lose huge amounts of weight to conceive; they do not need to return to a “normal weight” (typically defined by a BMI of 18-25 kg/m2). One study showed that 40% of women with PCOS with a BMI of 34 who lost just 5% of their body weight got pregnant naturally. (1)

MEDICATION

In addition to diet and exercise, you might also be given one of several drugs to stimulate egg production, such as clomiphene, Letrozole, or one of the gonadotropins. Alternatively, you might be given Metformin, a diabetes drug, and/or the supplement myo-inositol to help lower your insulin levels and regularize your cycle.

A final note: if you are overweight and trying to conceive, you should take 5mg of folic acid while trying to get pregnant as well as during pregnancy. Folic acid can reduce the risk of neural tube defects in the fetus.

Olive Fertility Centre (olivefertility.com) is one of Canada’s leading fertility clinics with clinics in Vancouver, Surrey and North Vancouver.