What is the Connection Between PCOS and Infertility?

Infertility is a symptomatic, reproductive condition associated with the presence of polycystic ovary syndrome (PCOS). Women with PCOS and infertility experience irregular menstrual cycles due to the presence of multiple ovarian cysts that compromise their ability to conceive. Treatment for PCOS and infertility generally involves the administration of an anti-estrogen medication or synthetic hormones to promote ovulation. In the event that medication and hormone therapy proves unsuccessful, surgery may be performed to improve one’s chances for conceiving. Since traditional treatment for PCOS often involves the administration of birth control pills to normalize menstruation, treatment options may be limited when conceiving a child is one’s ultimate goal.

A woman’s reproductive cycle is naturally governed by the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which work together to promote proper ovulation. Accompanying the LH and FSH hormones produced by the pituitary gland, the ovaries also produce androgens, or male hormones, during ovulation. In the presence of PCOS and infertility, high amounts of LH are produced, which combine with increased amounts of androgens produced in the ovaries. The combined overproduction of reproductive hormones induces an imbalance that disrupts the menstrual cycle and jeopardizes one’s fertility. There is no known, single cause for the disruption in hormone regulation associated with PCOS and infertility, though there are several factors that may contribute to its development.

Women with a familial history of PCOS and infertility are considered to be at an increased risk for becoming symptomatic. It has been asserted that the presence of unnecessary amounts of androgens while a fetus is in utero may also contribute to hormonal imbalance later in life that may manifest as PCOS and infertility. Additional factors that may contribute to PCOS development include insulin resistance, which can adversely affect the functionality of one’s ovaries, and the presence of certain medical conditions characterized by chronic inflammation.

It has been suggested that PCOS-induced infertility may be due to the compromised development of FSH releasing follicles in the presence of an overabundance of LH and androgens. Considering the follicles serve to house one’s eggs as they mature, if the follicles are inadequate to foster proper egg development the eggs themselves may not mature nor may they be released. It has been asserted that the remaining eggs accumulate to form cysts within the ovarian walls.

There is no single test designed or utilized to diagnose PCOS. A diagnosis of this condition is generally made from the exclusion of other conditions that may be suspected of inducing one’s symptoms. In most cases, imaging tests, including ultrasound and magnetic resonance imaging (MRI), are used to evaluate the abdominal and reproductive regions. Blood tests may be administered to evaluate hormone levels and thyroid functionality. Additional diagnostic tests may include the use of a urinalysis and ovarian biopsy, which may be performed in the presence of distention or inflammation.

Polycystic ovary syndrome generally manifests at the initial onset of menstruation. Most young women who are diagnosed experience abnormal menstruation that may present as infrequent cycling, unusually frequent cycles that are either very light or excessively heavy, or a lack of menstruation for several months in the absence of pregnancy. The presence of excessive male hormones combined with high LH production often induces the onset of severe acne and an overgrowth of body hair. Additionally, women with this condition often develop issues with obesity and, as a result, the onset of secondary medical conditions, such as diabetes and insulin resistance.

Often diagnosed in women 30 years of age and younger, treatment for PCOS-induced infertility is generally multi-faceted in its approach. Issues of infertility usually require the administration of an anti-estrogen medication to promote ovulation, such as a combination of clomiphene and metformin. If the use of anti-estrogen medications does not work, synthetic LH and FSH hormones may be administered or a procedure known as laparoscopic ovarian drilling may be performed to induce the release of eggs and promote ovulation. Additional treatment approaches for PCOS-induced symptoms that manifest in the presence of infertility include lifestyle and dietary changes and proactive medical care, such as regular doctor visits to monitor the individual's condition.