PCOS or polycystic ovarian syndrome or polycystic ovarian disease is a name given to a hormonal imbalance which may present as following:
Menstrual irregularities: No menses, irregular menses, less bleeding during menses.
Abnormal (androgenic pattern) hair growth over chin, upper lip, cheeks etc or excessive hair growth on arms and legs.
Increase in weight.
There is enlargement of one or both the ovaries which leads the ovaries and a gland (pituitary) in the brain to secrete hormones in an irregular manner. This hormonal irregularity further leads to failure of ovulation (egg) from the ovaries and thereby difficulty in conceiving, increased and abnormal hair growth and weight gain.
What is the cause of PCOS?
Various causes have been cited in literature to explain the cause of PCOS, but to pinpoint a single cause is impossible.
It may run in family and the woman may inherit it from either of her parents. Even males can carry the PCOS gene though the manifestations are different. The underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are primarily male hormones that are produced by females too. High levels of these hormones affect the development and release of eggs during ovulation.
Some researchers also believe that insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body use or for stores. Many women with PCOS have too much insulin which is believed to increase production of androgens. This high androgen levels can lead to acne, excessive androgenic hair growth, weight gain and problems with ovulation.
Literature also suggests that PCOS treatment can be precipitated by stress, irregular lifestyle (not having timely meals or sleep) and faulty diet (eating more junk and / fried food and eating less fruits and vegetables). Obesity or overweight per say can also precipitate development of hormonal imbalance.
How does PCOS cause Infertility?
As already discussed the hormonal imbalance in PCOS women leads to anovulation. This means that the egg does not mature properly and is also not released from the ovaries, hence not able to fertilise with the sperm and form an embryo. In some cases the quality of the egg is also poor. This diminished release of egg leads to infertility and decreases chances of having a baby. In addition increased body fat can also have harmful effect on the lining of the uterus and thereby failure of implantation. Weight gain, which goes hand in hand with PCOS can also affect fertility, though indirectly.
What is the treatment for PCOS and infertility?
Simultaneous weight loss significantly helps in achieving results earlier with lesser dosage of drugs and injections. These women are also benefitted by antidiabetic drug called metformin. It affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It also slows the growth of abnormal hair and, after a few months of use, may help return of ovulation. Use of metformin along with ovulation inducing drugs have shown better results and higher pregnancy rates.
If the above treatment modality fails to achieve ovulation than laparoscopic surgery called ovarian drilling can be done. This involves puncturing the ovary with a small needle carrying electric current to destroy small portion of the bulky polycystic ovary. This procedure carries a small risk of adhesion formation, which can however be avoided by washing the ovary with saline after the drilling. This surgery helps lower male hormone levels and ovulation. But, these effects may only last a few months.