Five Ways PCOS May Impact Your Fertility
by Dr. Fiona McCulloch
Polycystic ovary syndrome or PCOS is the most common hormonal disorder in women of reproductive age, affecting 10-15% of women and upward of 7 million women in the US alone. Although the name PCOS implies that the syndrome centers around ovarian cysts, cysts are not even required for its diagnosis. PCOS is a syndrome that affects a woman’s entire body - in particular her hormonal and metabolic systems. It is lifelong, begins in childhood and lasts past menopause causing a constellation of symptoms such as weight gain, irregular periods, infertility, acne, hair growth on the face (hirsutism), and hair loss. PCOS also steps-up a woman’s risks for type-two diabetes and cardiovascular disease as she gets older.
When it comes to the reproductive years, PCOS ranks as the leading cause of ovulatory infertility. Many women who have trouble conceiving are shocked to learn that they have PCOS, never having known as up to 50% of women with PCOS don’t know they have it.
The type of infertility women with PCOS experience is, in fact, quite different from other types of infertility – so, if you have this common condition there are a few facts you might like to know.
- Women with PCOS Have an Abundance of Follicles in their Ovaries
Women with PCOS tend to have an abundance of follicles in their ovaries. Follicles are structures in the ovaries that house the eggs which secrete hormones like estrogen, and testosterone. After ovulation, they transform into the corpus luteum which secretes the important female hormone, progesterone. In PCOS, the follicles often secrete much more testosterone than they typically do, causing the follicles to develop more slowly, in some cases blocking ovulation entirely. In some women with PCOS, multiple stalled follicles create a cystic appearance within the ovaries on ultrasound.
- Women with PCOS Ovulate late, or not at all.
Many women with PCOS ovulate 7 days or more later than the typical day 14 of the cycle due to excessive androgens. This causes the menstrual cycle to arrive late as well, often resulting in cycles lasting at least 35 days, or in some cases, much longer.Some women with PCOS don’t ovulate at all, or if they do it occurs rarely. The best way to determine ovulation in PCOS is to track cervical mucous or to use fertility awareness method (FAM), a time-tested method to understand ovulatory patterns.
- Ovulation test kits often don’t work in women with PCOS.
Ovulation tests that you can buy at the drugstore often don’t work for women with PCOS. That’s because they measure a hormone called luteinizing hormone (LH), which is often already unusually high in PCOS. This hormone typically surges middle of a woman’s cycle, triggering ovulation. In PCOS, many women find that their ovulation tests are positive at unusual times that don’t’ correspond with ovulation, and can even be positive every day! This happens because LH tends to be higher across the whole cycle in PCOS.
- Women with PCOS hit their reproductive peak later and go through menopause later.
Here’s some good news – women with PCOS tend to hit their peak fertility around 2 years later than other women. The abundance of follicles and androgens that stall ovulation in PCOS naturally decline with age, and therefore women’s ovaries start to become more active as they become older. Women with PCOS also have an estimated two years longer before they go through menopause, adding extra years onto their reproductive lifespan. One study found that across the age range of 22–41 years, egg count and live birth rates remained stable in women with PCOS. Whereas in the non-PCOS comparison group, these parameters decreased significantly with age.
- PCOS typically causes Subfertility rather than Infertility and Most Women Will Eventually Conceive
The word “infertility” doesn’t quite fit in PCOS, as the vast majority of women will be able to conceive in time. In fact, one study found that over a lifetime, women with PCOS had the same chances of having children and bore the same number of children on average as women without the condition. Again, this relates to improved ovulatory function as women with PCOS get older. Numerous studies have also found that fertility rates increase significantly in women with PCOS by making nutritional and lifestyle interventions, as insulin resistance is one of its key aggravating factors.
Overall, the news is very good when it comes to fertility in this common condition. Chances of conception tend to improve with age and with enough time. As PCOS is one of the conditions that responds the best to nutritional and lifestyle changes, there is a great deal of hope for women to achieve reproductive success.
Tehrani FR, Solaymani-Dodaran M,Hedayati M, Aziz F. Is polycystic ovary syndrome an exception to reproductive aging? Human Reproduction, Vol.25, No.7 pp. 1775–1781, 2010
Legro, R. S., Dodson, W. C., Kunselman, A. R., Stetter, C. M., Kris-Etherton, P. M., Williams, N. I., … Dokras, A. (2016). Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS. The Journal of Clinical Endocrinology & Metabolism, 101(7), 2658–2666. http://doi.org/10.1210/jc.2016-1659
Marca, A La; Sighinolfi, G.; Radi, D., et al. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update. 2010; 16:113–130.
Mellembakken, J. R., Berga, S. L., Kilen, M., Tanbo, T. G., Abyholm, T., & Fedorcsak, P. (2011). Sustained fertility from 22 to 41 years of age in women with polycystic ovarian syndrome. Human Reproduction, 26(9), 2499–2504. http://doi.org/10.1093/humrep/der214
Hudecova, M., Holte, J., Olovsson, M., & Sundstrom Poromaa, I. (2009). Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve. Human Reproduction, 24(5), 1176–1183. http://doi.org/10.1093/humrep/den482
Fiona McCulloch, N.D., founder and owner of White Lotus Integrated Medicine, is a naturopath practitioner having worked with thousands of people seeking better health over the past fifteen years. She is a data-junkie who specializes in evidence-based therapies for PCOS, thyroid health, autoimmunity, weight management and infertility among other unique conditions that can all benefit from a system reboot.
Dr. McCulloch is also a medical advisor for IVF.ca: Canada’s premier fertility community and is on the medical advisory committee for the PCOS Awareness Association. As a woman with PCOS herself, she is dedicated to increasing both awareness and research of this important condition that has far reaching effects on the lives of so many women. When she was a young girl, Dr. McCulloch would spend hours “compounding” mixtures made from plants and trees in the woods near her house. Today, Dr. McCulloch is a graduate of the Canadian College of Naturopathic Medicine (2001) and the University of Guelph (biological science). She is married and the mother of three boys. She can be reached on Facebook, LinkedIn, and Twitter.
Dr. McCulloch’s new book, 8 Steps to Reverse Your PCOS, is available on Amazon and all fine booksellers.