Improved understanding of Polycystic Ovary Syndrome (PCOS), a condition that affects 5–10% of women and a common cause of infertility, suggests that early diagnosis and treatment could increase natural fertility for PCOS patients and improve long-term health prospects.
Dr Arpita Ray, Regional Lead Clinician for Bourn Hall Clinic in Essex, comments: “PCOS is a complex syndrome that produces a wide variety of symptoms, which makes it difficult to both diagnose and treat.
“Patients often report seeing different specialists over a number of years for treatment for various symptoms – acne, excessive facial hair, weight gain, heavy periods – without the realisation that the problems all have the same cause.
“For example, acne is treated with antibiotics, hirsutism with laser treatment, and menstrual disturbances with the contraceptive pill. It is only when they have tried to conceive that the PCOS has been correctly diagnosed.
“However, if it is only diagnosed at this stage, many women will have an increased BMI (body mass index) as PCOS can cause weight gain. This makes fertility treatment less effective and pregnancy more of a problem.”
Women with PCOS who are obese also have additional risk while pregnant of pre-eclampsia, gestational diabetes, high blood pressure and miscarriage.
It has only recently been determined that a large proportion of women with PCOS are suffering from insulin intolerance. In some women, raised insulin levels have a knock-on effect on the ovaries, preventing them from releasing mature eggs, and so leading to infertility.
Women who go to their GP when they are unable to conceive are often given Clomid or injections of Gonadotrophin to stimulate the ovaries and treat the infertility. However, PCOS can affect the woman’s hormones and her reaction to fertility drugs. Therefore the condition needs careful management to prevent gestational diabetes, multiple birth or early miscarriage.
Greater understanding of PCOS has made accurate diagnosis and early treatment more important as the condition has long-term health implications such as an increased risk of developing diabetes and heart disease, so improved early detection with lifestyle management could greatly improve a patient’s overall health, boost her natural fertility and delay onset of other conditions.
Diagnosis of PCOS
The diagnosis of PCOS is made principally on clinical grounds, supported by ultrasound and by a small number of biochemical tests, which may include an estimation of serum testosterone, LH and FSH. Before diagnosis of PCOS is confirmed other possible endocrine disorders will be eliminated.
Improving fertility for PCOS patients
There is no cure for PCOS but it can be managed effectively. Although weight management is important for health, fertility and general well-being, it can be difficult for a patient with PCOS to lose weight, as the body is very efficient at storing fat. Bourn Hall is sympathetic to this and can provide advice.
For example, help to develop an exercise regime can be very effective. Studies have found that a 5-10% weight loss restores ovulation and fertility in 55-100% of women within 6 months.
Nicola was just 16 she was told by her GP that she had a condition called Polycystic Ovary Syndrome (PCOS) and that she would never become a mother.
She recalls: “PCOS affects how a woman’s ovaries work and I was told I wouldn’t be able to have a baby. It was almost as if a switch went off in my head and I showed no real interest in children.”
That was until she met her husband-to-be Terry who had always wanted children.
Terry takes up the story: “I wanted children but only with the right person and at the right time. I remember telling my Mum that Nicola was the one!”
The couple were amazed when Nicola fell pregnant naturally. Unfortunately she miscarried but it gave the couple hope that they could have a family.
After tests, the couple were referred for NHS funded IVF and chose the Bourn Hall Wickford Clinic for treatment. This was successful and the couple now have a little girl.
Nicola adds: “My Mum never thought she’d have grandchildren and yet amazingly now has a granddaughter. My Dad makes Sydney lots of lovely things and Terry’s parents are also over the moon as their first grandchild too.”
Terry concludes: “Bourn Hall did what they said they’d do, help us have a family, and the clinic’s staff, at Wickford and Colchester, were there all the way being supportive and helpful.”
Dr Ray would like to see a multi-disciplinary holistic approach towards the condition.
“I would like to see greater communication between the people involved with the various disciplines – the cosmetologist, the endocrinologist, the gynaecologist, and a dietician – together with the GP and the patient at the centre. This should help the condition to be spotted earlier, which can then make it easier to manage.
“One example would be a new exercise regime; this can boost metabolism and help weight loss and provide long term health benefits.”