February 12, 2020

Polycystic Ovary Syndrome: What Is It and How Can It Affect Fertility?

By the time a patient comes to Dr. Laura Cooney, she may have been suffering from ailments like irregular periods or unwanted hair growth for years, without realizing they're actually symptoms of a larger disorder or that there's anything she could do about it.

"These are women who have been to so many different providers, who have been told, 'no, this is normal, everybody has irregular periods. No, there's nothing you can do about it," Dr. Cooney said.

Dr. Cooney is a Reproductive Endocrinology and Infertility Specialist in the UW Department of Obstetrics and Gynecology. She says these common complaints could be symptoms of Polycystic Ovary Syndrome, a chronic condition affecting hormone levels in 10 percent-20 percent of women worldwide.

But despite how common PCOS is, a diagnosis can often take anywhere from two to four years to obtain, leading patients to feel frustrated and discouraged. It's why Dr. Cooney is so passionate about bringing awareness to PCOS.

"There's a lot of decreased quality of life associated with these symptoms," she said. "Being able to put it together for people, and give them hope, is a great place to be."

The diagnostic challenge lies in the condition's broad definition and the variety and severity of symptoms each patient experiences. A woman may have PCOS if she has any two of these three criteria:

  1.  Irregular menstrual cycles

  2. Evidence of elevated testosterone, either in their blood or clinical signs like facial hair growth.

  3. Classic appearance of ovaries on an ultrasound.

"As you can imagine, it's a pretty heterogeneous disorder—you have some people who meet all criteria, and you have some who meet different two of the three criteria, which can make it hard for people to diagnose." Dr. Cooney explained.

When scoring a patient for PCOS, Dr. Cooney looks at nine different body parts for hair growth—from the patient's chest and back to upper arms and thighs. Physical signs can also include cystic acne and thinning hair.

Diagnosis is critical because patients with PCOS have a greater risk of developing conditions such as diabetes, sleep apnea, depression, and some cancers. But it's an irregular period—and the resulting difficulty in becoming pregnant—that most frequently leads her to seek help.

Getting Pregnant When You Have PCOS

For women who have struggled to get pregnant, a PCOS diagnosis may come as somewhat of a relief because it's treatable without more complex and expensive interventions like insemination or IVF.

A typical ovulation regimen, according to Dr. Cooney, may simply consist of an oral medication taken for a few days at the start of the patient's menstrual cycle.

"The good news is that women with PCOS, underlying everything, still have good fertility," Dr. Cooney said. "Once we get them to ovulate, they are able to get pregnant the same way as someone without PCOS."

PCOS and Pregnancy

Once pregnant, a woman with PCOS has a greater risk of complications like preeclampsia, high-blood pressure, or gestational diabetes.

But with early screening and routine monitoring during pregnancy, Dr. Cooney is optimistic that patients with PCOS can look forward to a normal delivery and healthy baby.

Looking Ahead

As awareness of PCOS grows, Dr. Cooney hopes that the long lag time between the presentation of a patient's first symptoms to her PCOS diagnosis will decrease.

"I think there's a lot of education that needs to be done, both for patients and for physicians." She said. "As we bring this to the forefront and everyone starts to realize this is a chronic condition that we need to tackle and focus on, all of that will get better."

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