Approximately one in six couples in the UK may have problems conceiving and after 12 months trying approximately 84% will have been successful. There are many factors that affect fertility for both partners and some are unexplained.
A common endocrine condition that affects and disturbs the hormones and therefore causing irregular or absent menstrual cycles is PCOS. Some women may have problems with weight gain and difficulty losing/maintaining a healthy weight and some have problems with acne and excess facial /body hair. Not all women will have PCOS. In fact approximately 20% of women will have all the symptoms.
Ovaries (women usually have two, unless removed for a specific reason) produce eggs and hormones. With PCO, the ovaries have many small follicles containing eggs (as in women without PCO), but rather than the follicles maturing to 20mm and releasing an egg each cycle (ovulation), the follicles do not mature and remain between 2-9mm and are often unable to release an egg. An ultrasound scan can assess the ovaries but is not used on its own to diagnose PCO/PCOS. The ovaries may appear enlarged and contain many small follicles peripherally .Blood tests on the hormones produced by the ovaries – testosterone, oestrogen sex hormone binding globulin (SHBG) – sometimes Anti-Mullerian hormone (AMH) and oral glucose tolerance test are also used in making an assessment.
Development of the symptoms of PCO may happen over a period of time. We know that insulin levels are higher and in turn the ovaries have higher levels of hormones, e.g. testosterone, and therefore affects ovulation. Whilst it is still not known the exact cause of PCOS, it may run in families. Symptoms of PCOS can be treated with weight loss and healthy balanced diets but there is no cure. Reducing sugar, salt and caffeine intake is recommended and eating regular meals and taking regular exercise will reduce the long term health risks associated with having higher insulin levels. Due to the symptoms, that vary from mild to severe, women may have low self esteem with difficulties managing the symptoms. Assessment for anxiety and depression related to low self esteem and body image issues may be required with referral to support groups/counselling. Referral for treatments of specific symptoms for example excess hair growth may be required. Some treatments may be available through the NHS .
Following assessment and diagnosis, treatment options for fertility will be discussed by the fertility consultant and many women can be successfully treated to enable pregnancy.
If you would like to read more about PCO/PCOS further information and support is available through many links such as:
Verity – The UK PCOS Charity – Verity PCOS UK (verity-pcos.org.uk)