Video: How much does PCOS affect fertility?

Playlist: PCOS Q&A

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How much does PCOS affect fertility?

Dr Sarah Jarvis MBE, FRCGP

00:31

How much does PCOS affect fertility?

Dr. שרה ג'רוויס MBE, FRCGP

01:07

Does PCOS affect weight?

Dr. שרה ג'רוויס MBE, FRCGP

00:41

How many cysts do you have to have to be diagnosed with PCOS?

Dr. שרה ג'רוויס MBE, FRCGP

00:56

How often is PCOS misdiagnosed?

Dr. שרה ג'רוויס MBE, FRCGP

00:31

Can PCOS cysts rupture?

Dr. שרה ג'רוויס MBE, FRCGP

00:34

Can PCOS be cured?

Dr. שרה ג'רוויס MBE, FRCGP

00:33

How do sufferers of PCOS ovulate?

Dr. שרה ג'רוויס MBE, FRCGP

00:45

How often should PCOS be checked?

Dr. שרה ג'רוויס MBE, FRCGP

How much does PCOS affect fertility?

PCOS or polycystic ovary syndrome is one of the most common reasons for women having problems getting pregnant. Although you have lots of follicles, which are the tiny little cysts that eggs usually develop in, the abnormal balance of hormones in your ovaries means those eggs don't develop properly and you don't ovulate regularly. However, treatment to cause you to ovulate is often effective and can restore fertility in PCOS.

The answer in many cases is yes. But the relationship between weight and PCOS is really complicated. PCOS is largely down to an imbalance of hormones, particularly, in excess of the male hormone testosterone that can make you more prone to putting on weight - and in particular to putting on weight around your tummy. But we know that women who are of בעל עודף משקל produce more of a hormone called אינסולין and if their bodies are resistant to insulin or does not respond properly to it, that can make the symptoms of PCOS as worse.

It also increases the risk of סוכרת סוג 2. So there is a complex relationship going on between PCOS and weight. Some women who are normal weight do have PCOS, but you are much more likely to have PCOS if you are overweight. On the plus side, if you could lose just five to seven percent of your weight and ideally get down towards the ideal range of BMI - that is, the ratio of your weight to your height - you can significantly improve your symptoms.

You can have polycystic ovaries without having polycystic ovary syndrome. To have polycystic ovaries you have to have at least twelve tiny follicles or cysts on your ovaries. To have polycystic ovary syndrome you also have to have:

• An abnormally high level of the male hormones called androgens, particularly, testosterone and an abnormal balance of female hormones in your system

• Not ovulating regularly, so you may have irregular or absent periods.

The early symptoms of PCOS can be fairly vague, so they might be missed. But, the criteria we use to diagnose PCOS are pretty straightforward. You have to have two out of three things. Those three things are:

1. multiple cysts, at least twelve on your ovaries on אולטרסאונד;

2. either evidence of high levels of testosterone in your blood and an abnormal balance of the female hormones or the symptoms that come out of that. So excess body hair, אקנה, sometimes thinning of the hair on your scalp

3. not ovulating regularly, which may mean you have irregular or absent periods.

PCOS is more common in women who are overweight, so it may well be more likely that you will be misdiagnosed or not diagnosed with PCOS if you are of normal weight.

We do hear about ציסטות שחלתיות rupturing, twisting, getting blocked and causing severe pain. However, the cysts in polycystic ovary syndrome tend to be very small - smaller or about the size of the normal follicle that you would produce every month if you were ovulating regularly.

Therefore, if those cysts do rupture, it could be because they are producing an egg, but if it's not, they are unlikely to cause severe problems.

Although PCOS can't be cured, there is lots that you can do to improve your symptoms. PCOS is largely down to an imbalance of hormones and stopping smoking can improve that balance.

A lot of women with PCOS are overweight. That's partly a consequence of PCOS. But it can also make symptoms worse. So, although it can be difficult to lose weight if you have PCOS, getting even five percent of your excess weight down can make a real difference to your symptoms.

Normally, ovulation - producing an egg - involves an egg follicle in your ovary growing and, when its ripe, rupturing releasing that egg. In PCOS, you have lots of those follicles. But the abnormal balance of hormones that are needed for the egg to develop often means that the egg does not develop normally.

Fortunately, for most women with PCOS, treatment to bring on ovulation is successful, which is great news, if you are trying to get pregnant.

Women with PCOS often produce too much of the hormone insulin or their bodies are resistant to it. In other words, they can't process it. That increases their risk of type 2 diabetes and of heart disease.

It's important to get checked once a year to make sure that you are not moving towards a diagnosis of type 2 diabetes. It is also important to have iat least three periods a year, because the high levels of oestrogen that circulate when you got PCOS can increase your risk of cancer of the womb lining. Hormone treatments can often help to give you regular periods which will reduce this risk.