Understanding the Basics of Polycystic Ovary Syndrome (PCOS)

Understanding the Basics of Polycystic Ovary Syndrome (PCOS)

By Hadi Ramadan, MD, Reproductive Endocrinologist at Boston IVF

Polycystic Ovary Syndrome (PCOS) is one of the most common reproductive disorders affecting individuals with ovaries. Not only is it a leading cause of infertility, but it can also disrupt a person's overall metabolic health. However, with the right diagnosis and treatment, many individuals with PCOS are able to manage their symptoms and achieve pregnancy.

What is PCOS?

PCOS is a complex endocrine and reproductive disorder that affects between 6% and 12% of people with ovaries. While its name suggests the presence of ovarian cysts, PCOS is not primarily defined by cysts but by a broader hormonal and metabolic imbalance. This condition disrupts ovulation, and it’s estimated that PCOS is responsible for up to 80% of infertility cases where ovulation is irregular or absent.

PCOS is diagnosed based on a set of symptoms outlined in the Rotterdam Criteria, which state that an individual has PCOS if they exhibit at least two of the following three conditions:

• Hyperandrogenism: Elevated levels of male-type hormones, such as testosterone. This can present as acne, excess facial or body hair (hirsutism), or thinning hair on the scalp.
• Ovulatory Dysfunction: Irregular or absent menstrual periods and ovulation.
• Polycystic Ovaries: Ovaries appearing with multiple small follicles on ultrasound, sometimes described as having a "string of pearls" appearance.

It’s important to note that individuals with PCOS may not have all of these symptoms, making it a somewhat variable and personalized condition.

How Does PCOS Affect Fertility?

At the core of PCOS-related infertility is the disruption of ovulation. Normally, a mature egg is released during ovulation, but in individuals with PCOS, this process is often impaired. The immature follicles that don’t fully develop can accumulate in the ovaries, but it’s the hormonal imbalances—rather than the presence of cysts themselves—that prevent ovulation from occurring regularly.

Because ovulation is unpredictable or absent in PCOS, it makes it harder for individuals to conceive without medical assistance. However, with the right treatment, successful pregnancies are achievable.

What Causes PCOS?

The exact cause of PCOS is still under investigation, but it is believed to involve a combination of genetic and environmental factors. Two major drivers are:

• Hormonal Imbalances: Individuals with PCOS often produce too much luteinizing hormone (LH) and insufficient amounts of follicle-stimulating hormone (FSH). This disrupts normal egg development and ovulation.
• Insulin Resistance: Many people with PCOS have insulin resistance, meaning their bodies require more insulin to regulate blood sugar levels. Excess insulin can lead to the overproduction of androgens (male-type hormones), which further disrupts ovulation and fertility.

What Are the Symptoms of PCOS?

The symptoms of PCOS can vary greatly from one person to another. Common symptoms include:

• Irregular, infrequent, or absent menstrual periods
• Excess facial and body hair (hirsutism)
• Acne
• Infertility
• Thinning hair on the scalp
• Weight gain or obesity
• Insulin resistance or type 2 diabetes

How is PCOS Diagnosed?

PCOS is typically diagnosed through a combination of medical history, clinical symptoms, blood tests to check hormone levels, and an ultrasound to examine the ovaries. There is no single test for PCOS, which is why a thorough evaluation by a healthcare provider is essential.

How Can PCOS Be Treated?

The good news is that PCOS is highly treatable, especially in the context of infertility. Treatments can vary depending on whether an individual is trying to conceive or manage other PCOS-related symptoms. Options include:

• Lifestyle Modifications: Weight loss and exercise are often recommended, particularly for individuals with insulin resistance. Losing even 5% to 10% of body weight can improve ovulatory function and increase the likelihood of conception.
• Medications:
  • Metformin: Often prescribed to improve insulin sensitivity and regulate menstrual cycles.
  • Ovulation Induction: Medications like clomiphene citrate or letrozole can help stimulate ovulation.
• In Vitro Fertilization (IVF): For those who do not respond to other treatments, IVF may be an option to assist with conception.

Conclusion

Polycystic Ovary Syndrome (PCOS) is a common and manageable condition that affects fertility, but with proper diagnosis and treatment, many individuals with PCOS can achieve successful pregnancies. At Boston IVF, we provide a comprehensive approach to managing PCOS, including both medical treatments and lifestyle guidance. If someone suspects that they may have PCOS or are struggling with infertility, Boston IVF’s team of specialists is here to support them on their journey to parenthood.

Dr. Hadi Ramadan and the team at Boston IVF are dedicated to helping individuals with PCOS achieve their family-building goals through personalized, compassionate care.