PCOS to parenthood: A guide to reclaiming fertility

Preeti, like most young women today, wanted it all: a dream job and the patter of little feet to come home to. That dream, however, seemed to be fading owing to health problems. Even though she had battled with lethargy, acne and unwanted body hair since her teens, she also experienced stubborn weight gain that wouldn’t budge despite her active lifestyle. 

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

“It was incredibly frustrating,” says Preeti who became my patient. “I exercised regularly and ate healthy, yet the weight gain continued. On top of that, my periods became unpredictable, which worried me because my husband and I were actively trying to conceive.” Preeti was eventually diagnosed with Polycystic Ovary Syndrome (PCOS), a hormonal imbalance affecting up to 20% of Indian women, usually between the ages of 15 and 45 years. Unfortunately, it manifests in various ways, often leaving patients confused and frustrated. As a gynaecologist and infertility specialist, let me explain the connection between PCOS and health concerns like infertility and weight gain. 

PCOS disrupts the hormonal balance in a woman’s body. This can lead to excess production of androgens, or male hormones which contribute to irregular periods, unwanted hair growth, acne, and less commonly known symptoms such as severe mood swings, fatigue, sleep apnea and chronic inflammation. 

An effective way to diagnose PCOS is to get a thorough evaluation by an expert. This includes undergoing tests for hormones like progesterone, estrogen, luteinising hormone, follicle-stimulating hormone, prolactin, testosterone, Dehydroepiandrosterone sulfate (DHEA-S) and Thyroid-stimulating hormone (TSH). Preeti got an ultrasound scan, which showed the characteristic presence of small cysts in both ovaries, leading to a diagnosis of PCOS.  

Complications accompanying PCOS

PCOS can lead to several other conditions beyond infertility, including:

1. Metabolic syndrome: A cluster of conditions that increase the risk of heart disease, stroke and diabetes. These include high blood pressure, blood sugar, and abnormal cholesterol or triglyceride levels. 
2. Type 2 diabetes: Women with PCOS are at a higher risk of developing diabetes due to insulin resistance. Here, body cells, particularly in muscle, fat and liver become less responsive to the insulin hormone's signal to take up glucose from the bloodstream. 
3. Mood disorders: Including depression and anxiety, which are more prevalent among women with PCOS. 
4. Sleep apnea: More common in women who are overweight and have PCOS, this condition can lead to fatigue and increase cardiovascular risks. 

Connection to endometrial cancer 

Women with PCOS have a three times higher risk of developing endometrial cancer compared to women without PCOS.  This is due to long periods without ovulation – or the release of the egg from one of the ovarian follicles during a monthly period. As a result, there is an imbalance of estrogen and progesterone (hormones that regulate menstruation). Hormonal fluctuations lead to endometrial hyperplasia, where the lining of the uterus thickens abnormally and could turn cancerous if not treated.

Endometrial cancer is diagnosed by checking the thickness of the uterus lining with an ultrasound, and possibly, taking a small tissue sample (biopsy) if anything unusual is found. Treatment depends on the cancer’s progression, ranging from hormone therapy to more extensive surgeries like removing the uterus (hysterectomy). Monitoring this condition closely and starting treatment early is essential.

A multifaceted approach to the treatment of PCOS

Weight management is crucial to treat PCOS. Studies show that losing even 5-10% of body weight can improve insulin sensitivity and regulate menstrual cycles in women with PCOS. In Preeti's case, she adopted a personalised diet, exercise plan, and metformin to help control her weight.

The path to parenthood with PCOS

PCOS can cause ovulation to become irregular and this can make it difficult for a woman with PCOS to get pregnant. Research shows that 70 -80 % of women with PCOS have difficulty conceiving. For Preeti, ovulation-inducing medications like clomiphene citrate were given, and ultimately, an artificial reproductive technique (ART) procedure called Intracytoplasmic Sperm Injection (ICSI) was necessary. After several months, she was thrilled to discover she was pregnant. 

One can conclude that PCOS, while challenging, doesn’t have to define a woman’s life. With proper diagnosis, a personalised treatment plan, and ongoing support, women like Preeti can manage their symptoms, improve their overall health, and achieve their dreams of parenthood. 

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

Also read: Adult hormonal acne: A guide to understand and treat the problem