July 6, 2020

Infertility due to Polycystic Ovarian Syndrome

Infertility is a condition of a body in which an organism is unable to reproduce naturally and can affect both males and females equally. While men can have hormonal imbalance, low sperm count or immotile sperm; the reason for infertility in women could be varied ranging from hormonal imbalance, fallopian tube blockage to anovulation, problems in the uterine structure or not being able to sustain the pregnancy to a full term. Anovulation, a condition that commonly appears as a symptom of polycystic ovarian syndrome, often results in infertility as the egg never ruptures and thus no conception. Polycystic ovarian syndrome is a very common condition these days and could have an onset at a very young age of 11 years.

What is Polycystic Ovarian Syndrome?

Polycystic Ovarian Syndrome or PCOS is a result of hormonal imbalance condition occurring in females resulting in the presence of excess of androgens and irregular or absence of ovulation. This is one amongst the leading causes of infertility in females. The onset could be from the age of 11 years or could start at any point during the reproductive years of a female. The common symptoms include excess of body and facial hair, loss of hair from the scalp, weight gain, irregular menstruation, scanty or no bleeding, etc.

Infertility due to Polycystic Ovarian Syndrome

Although, all women suffering from PCOS are not infertile, the condition is specific to the females that have a condition of absence of ovulation or anovulation. The pathophysiology associated with this condition is primarily a consequence of inbuilt ovarian dysfunction that is subjective to multiple external factors:

  • Hyperandrogenism: Hyperandrogenism or excessive levels of androgens is the characteristic feature of PCOS, and aggravated by hyperinsulinemia. Hyperandrogenism could lead to follicular arrest wherein the follicle cannot grow and mature resulting in anovulation causing infertility.
  • Neuroendocrine disruption: Excess of gonadotrophin releasing hormone (GnRH) causes an increase in the amounts of luteinizing hormone (LH), which in turn affects the ovarian androgen production as well as the oocyte growth and development. In response to this disruption of the hypothalamic-pituitary-ovarian axis, there is also an increase in gonadotropin abnormalities.
  • Insulin Resistance: It is a condition which results in metabolic abnormalities like poor glucose acceptance and hyperinsulinemia due to the defect in the insulin facilitated glucose transport process.
  • Cyst in the Ovaries: The cysts constituted in the ovaries are not actual cyst instead they are arrested antral follicles. It is due to their arrested growth that they do not develop to the level of reaching maturity and thus does not rupture causing to fertilization and hence infertility.
  • Heredity: If PCOS runs in the family history, then numerous genetic abnormalities may appear to result in features of the syndrome. A woman whose mother, sister or aunt has PCOS has a higher chance of having the disorder.
  • Long-term Illness: PCOS also has multiple long term ailments associated with it viz.,
  • Subfertility
  • Miscarriages
  • Heart diseases
  • Type II Diabetes
  • Hypertension
  • Increased risk for Mental disorders

What causes Infertility in Women having Polycystic Ovarian Syndrome?

The ovaries are minute sacs filled with fluid known as follicles. When the egg develops, the fluid builds up in the follicle. On maturity, the follicle opens and breaks to release the egg. This egg then travels to the fallopian tubes and the process is known as ovulation.

In case of women suffering from PCOS, the hormones needed for the egg to mature completely, are either having a higher level or a lower level. The follicle stimulating hormone is the primary hormone responsible for the initial growth of the follicle. In women with PCOS, this hormone is usually low whereas the Luteinizing hormone has an increased level during the early follicular phase leading to improper growth and development of the egg.  An egg that in underdeveloped never rupture. On the other hand, the follicles start building up the fluid and expect the ovulation to take place. Lack of ovulation makes them to stay in the ovary as cysts. The absence of progesterone also contributes to this condition along with an irregular or absence of the menstrual cycle. In addition to this, the ovaries also secrete androgens or male hormones, which further inhibit ovulation.

Incidence rate of PCOS and its Effect on Fertility

PCOS studies in India reveal the prevalence of the disease in 3.7 to 22.5 percent of females, including 9.13 to 36 percent in teenagers. Its occurrence has been observed in 11 year old females as well.

The rate of infertility due to PCOS is very high and most require medical aid to increase the chances of pregnancy. There are three key reasons owing to which the women become infertile.

  • Irregular Ovulation or Anovulation
  • Irregular Menstrual Cycles
  • Endometrial lining in the uterus may be insufficient in the implantation of the fertilized egg causing increased risk of miscarriage

Treatment of Polycystic Ovarian Syndrome for restoring Fertility

There is no documented cure for PCOS, thus, the way to restore fertility depends on a number of factors. Some of the ways are:

  • Lifestyle Modification:PCOS women should keep a check on their weight which can cause health problems in the long run. The weight can be managed by healthy eating habits and regular exercising. It has been observed in studies that reduction in body weight to 10 percent or more has helped women in getting their normal menstrual cycles restored.
  • Oral Contraceptives:PCOS women can administer birth control pills in the case they do not want to get pregnant anytime soon, as these pills help in controlling the menstrual cycles, lowering of androgen levels and prevent acne. However, one should keep in mind that these benefits stay only as long as the medicine is continued.
  • Medication for Diabetes:The diabetes medicine Metformin helps in controlling the blood sugar levels and also reduces androgen production. To add on, it also decreases cholesterol and helps in maintaining the body weight.
  • Fertility medications:Fertility medication utilizes ovulation-stimulating medications to help PCOS females in getting pregnant. However, the other causes for infertility must also be ruled out before proceeding with the treatment. The various treatment options include:
    • Clomiphene: It is usually the first choice for therapy; it is used to stimulate ovulation in PCOS patients.
    • Gonadotropins: These are much more expensive and also involve the risk of multiple births in comparison to clomiphene.
    • Intrauterine Insemination: In case of mild PCOS where ovulation could be induced with the help of medicines, this method could be utilized. The method involves injecting healthy motile sperms obtained after processing the husband’s semen sample in the laboratory into the vagina to enhance fertility.
    • IVF (In-vitro Fertilization): Though expensive, this treatment offers the maximum possibility of getting the female pregnant during any given cycle.
  • Surgery:Surgical measures are opted when women with PCOS do not respond to fertility medication. One such surgical measure is “Ovarian drilling” which involves puncturing the ovary using a small needle with electric current. This procedure helps in lowering of androgen levels and benefit ovulation. The downside of the treatment is that its effects are not permanent; also it does not help in reducing hair growth on the body and loss of hair from the scalp.
  • Medication for increased levels of Male Hormones:Anti-androgen drugs help in reduction of hair growth from body and clearing of acne. These drugs are also given with birth control pills for better results. Some drugs are:

         – Aldactone
– Finasteride

How does Polycystic Ovarian Syndrome affect Pregnancy?

Pregnant women suffering from PCOS frequently encounter problems like Miscarriage, Gestational diabetes, Pregnancy-induced high blood pressure or Preeclamsia and Premature delivery. Women with PCOS also witness multiple births and their new born are prone to get admitted to neonatal ICU.

Prevention of Infertility due to PCOS

Since prevention is the only cure for PCOS thus, the sooner the measures are taken up for its prevention, the better results can be seen. Some measures to follow are:

  • Maintaining an optimum hormonal level
  • Maintaining a good body weight
  • Reducing stress and practicing stress release techniques like deep breathing exercise or meditation.
  • Maintaining a healthy food habit and lifestyle by doing regular exercise.
  • Consuming essential vitamin like Vitamin B, C, D and E, Folic acid, and minerals like vanadium, chromium, manganese and magnesium along with Omega-3 supplements. These helps in lowering the risk of insulin resistance and folic acid help in enhancing the fertility.
  • Avoid smoking, drinking and abusing drugs in any form.
  • Patients should undergo routine checkup for complication like diabetes, heart diseases, to ensure that their severity could be lowered in time.

Polycystic Ovarian Syndrome is a very common problem in today’s world and is seen in very young girls. The major factor responsible is leading an unhealthy sedentary lifestyle, poor food habits i.e., consumption of more fast foods, junk, oily, spicy and fried foods, and lack of exercise. However, one can easily manage the condition once the unhealthy habits are changed and healthy habits are incorporated. In contrary, it can lead to complications like infertility in women belonging to the reproductive age group if left untreated. It can further lead to serious health problems like diabetes, hypertension and cardiovascular diseases if not attended on time.

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Note: This information is only for reference and is not a substitute of a medical care in any form. Kindly consult with a Healthcare Professional for detailed diagnosis, treatment and follow up.

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