Cracking the PCOS code: Top tips for managing symptoms and boosting fertility

What if a single disorder could disrupt your metabolism, fertility, and hormonal balance all at once? That’s PCOS, or polycystic ovarian syndrome – a complex hormonal disorder affecting 5-10% of women aged 15–44 years.

Approximately 80% of cases where women don’t release an egg during their monthly periods, leading to infertility, are caused by PCOS. That’s not all. 40% to 60% of affected women struggle with obesity, and one-third grapple with metabolic syndrome, which is a cluster of conditions—including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels—that increase the risk of heart disease, stroke, and diabetes.

As we explore the impact of PCOS, it's essential to understand how it specifically affects fertility, which is a significant concern for many women planning to start a family.

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Fertility under siege

One of the main challenges of PCOS is that it can prevent regular egg release from the ovaries, making it difficult for women to conceive because regular ovulation is crucial for pregnancy. Irregular periods also make it hard to predict the best time for conception, complicating attempts to get pregnant naturally.

In PCOS, the balance of hormones that regulate the menstrual cycle is often disrupted. Excess androgens (male hormones that are normally present in small amounts) and problems with insulin (a hormone that controls blood sugar levels) can interfere with the development and release of eggs from the ovaries.

Women with PCOS may develop many small cysts on their ovaries, which disrupt hormone levels and make it harder to get pregnant.

Decoding variability in PCOS symptoms

Both genetics and lifestyle factors, such as diet and exercise, significantly influence the severity and types of PCOS symptoms. A healthier lifestyle can often help manage symptoms, even in those genetically predisposed to more severe forms of the condition. 

It is important to understand that PCOS symptoms vary widely.

Some women may struggle with severe issues like weight gain, acne, and heavy menstrual bleeding, while others might have mild symptoms or none at all, making the condition less noticeable until they find it difficult to conceive. 

Diagnosing PCOS involves several steps: your doctor will ask about your menstrual cycles, weight changes, and symptoms like excess hair growth and acne. They will conduct a physical exam to check for signs of PCOS and order blood tests to measure hormone levels, including testosterone and insulin. An ultrasound can reveal multiple cysts on the ovaries.  

The wide range of symptoms makes treating PCOS complex. There’s no universal solution – so treatments need to be personalised. Each approach is tailored to the woman’s specific symptoms and lifestyle.

Managing PCOS for improved fertility

1. Lifestyle modifications: Managing PCOS starts with lifestyle changes. Losing even 10% of excess weight can help restore normal ovulation and improve fertility in women with PCOS. Weight loss also reduces testosterone and improves metabolic profiles like lipids and total cholesterol. Nearly half of the women who exercise regularly experience increased ovulation and have more regular periods. Moderate-intensity exercise also decreases insulin resistance by 30%. 

To stay active and support weight loss, aim for at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week, plus muscle-strengthening activities twice a week. A low-calorie, high-protein, and low-glycemic-index diet also helps.

2. Medications: Several treatments can help women with PCOS ovulate and conceive. Clomiphene Citrate (CC) helps the ovaries release eggs, leading to ovulation in 75-80% of cases. It has a 22% chance of conception per cycle, and 5% to 7% of pregnancies result in twins. Letrozole lowers estrogen levels, balancing hormones which lead to ovulation. Metformin improves insulin sensitivity, which regulates menstrual cycles in 50% of cases, and induces ovulation.

3. Assisted Reproductive Technology (ART): In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) are considered when other treatments fail. These techniques involve fertilising an egg outside the body and then implanting it in the uterus. While they are successful – with up to 50% pregnancy rates they also come with risks, such as Ovarian Hyperstimulation Syndrome (OHSS).

What is Ovarian Hyperstimulation Syndrome (OHSS)?

Ovarian Hyperstimulation Syndrome is a potential side effect of fertility treatments like IVF. It occurs when the ovaries respond too strongly to fertility medications, leading to swollen and painful ovaries. Symptoms can range from being mild– bloating and nausea to severe– rapid weight gain, shortness of breath, and abdominal pain. Careful monitoring by healthcare providers can help manage and reduce the risk.

In conclusion, facing PCOS can be daunting, especially when you are trying to conceive. But you are not alone! With the right approach and a suitable treatment plan, you can manage your symptoms and improve your chances of conception. By taking these steps, you can navigate your journey with confidence and optimism, knowing that better health and fertility are within reach.

Dr. Rajeev Agarwal is an IVF specialist and medical director at Renew Healthcare headquartered in Kolkata. 

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