Ask an RE: How can PCOS affect my fertility?
ASK AN RE: HOW CAN PCOS AFFECT MY FERTILITY?
Dr. Michael Homer of the Reproductive Science Center in the San Francisco Bay Area gives advice for women with PCOS who are trying to conceive.
Polycystic ovary syndrome (PCOS) is a common but hard-to-diagnose reproductive condition that is estimated to affect 8–20% of women of a reproductive age worldwide, and about 5 million women in the United States.
September is PCOS Awareness Month. In honor of this national initiative to educate women about the condition, Celmatix asked Dr. Michael Homer, a reproductive endocrinologist at the Reproductive Science Center in the San Francisco Bay Area, to answer a few questions about PCOS and what women diagnosed with the condition should know about their fertility.
Celmatix: Given that PCOS affects millions of women worldwide, why do we often hear that it’s such a difficult condition to diagnose?
Dr. Homer: PCOS is a syndrome, not a disease. A syndrome is defined as, “a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms.” This means that even in our own clinic, we can see variants of PCOS symptoms.
Part of the difficulty of diagnosing PCOS lies in the fact that there are four national and international organizations that define PCOS differently. They agree that the hallmark symptoms of PCOS are periods further than 35 days apart, unwanted hair growth (or elevated testosterone in the blood), and the presence of many follicles in the ovaries. They disagree over which symptoms must be present in order to diagnose the syndrome, and these “hallmark” symptoms don’t include weight gain and acne, which are common in PCOS patients.
If the NIH, the Androgen Excess Society, and the European and American societies of reproductive medicine (ESHRE/ASRM) can’t agree on the symptoms that diagnose PCOS, what are the chances of the patient figuring this all out?
Celmatix: If a woman suspects that she has symptoms of PCOS, what tests will her physician run to determine a diagnosis?
Dr. Homer: The important thing to remember is that PCOS is a diagnosis of exclusion.
For an accurate diagnosis, your doctor will need to take your full medical history, including medications you’ve taken, your family history, and a review of your symptoms, as well as perform a physical exam. They will most likely order a transvaginal pelvic ultrasound to examine your ovaries. To make sure your irregular periods are not caused by other conditions, they’ll run other tests on your thyroid, prolactin, and male hormone production from your ovaries and adrenal glands. They may also check hormonal signals from the brain like Follicle Stimulating Hormone (FSH) along with estradiol to ensure that the brain and ovaries are signaling each other properly. Lastly, the doctor may do a diabetes and cholesterol screen.
That may seem like a lot of tests, but for most patients it just means having a doctor’s visit, an ultrasound, and one blood draw at a specific time early in a menstrual cycle (or on a random day, if the patient doesn’t experience menstrual cycles).
Celmatix: A lot of the PCOS information online has to do with non-invasive ways for women to manage PCOS symptoms. Do you recommend any of these diet or lifestyle changes to your PCOS patients?
Dr. Homer: This question is so important, and a lot of the information online today — which often doesn’t come from experts — can be very confusing and conflicting.
The bottom line is that a woman with PCOS should follow the exact same guidelines regarding lifestyle and diet as any other woman. If you have PCOS and are overweight or obese, losing weight may help you regain regular periods, and helps to ward off future complications like diabetes (which women with PCOS are prone to developing). Unfortunately, women with PCOS have slower metabolisms and may find it very difficult to lose weight.
Almost all research and testimonials will tell you that exercising can strengthen your mental game as well, which I believe is crucial for women with PCOS. Exercise can put you back in control at a time when it might seem like your body is doing things you don’t expect, without asking you first.
Seeing your doctor, determining the cause of your symptoms, and possibly getting a referral to a nutritionist or dietician if needed can be very helpful as well.
And don’t ever forget about PCOS support groups! There are so many that you can find online, and some that meet locally. Be aware, however, that some people target these groups in order to sell a product, system, or service.
Celmatix: What challenges will a woman with PCOS face when she’s trying to conceive?
Dr. Homer: Because PCOS affects the frequency or regularity of ovulation, it can be hard for a woman with PCOS to get pregnant. The main focus of treating women with PCOS who are trying to conceive is to induce regular ovulation.
For most women, taking five days of medication in order to stimulate ovulation and having regular ultrasounds to monitor the effectiveness of the medication will help. If that’s ineffective, medications which boost the effectiveness of stimulation medication might be considered. Focusing on diet and exercise may also help the body respond.
Aside from these oral medications, your doctor might suggest injectable medicines, though these can lead to twins or multiples. Instead, women are usually directed to IVF, as the risk of twins can be minimized. Plus, with major advancements in treatment and embryo freezing, we can keep women with PCOS safe while offering a very high chance of successfully freezing embryos so patients can conceive again in the future.
Fertility treatment in women with PCOS is a marathon, not a sprint. Not everyone responds to the medication, and even those who do may respond differently to the same medication from one month to another. Going to your doctor’s office can be nerve wracking and, sometimes, disappointing.
The emotional impact makes it really important for you and your partner to mentally prepare for the journey. Start by focusing on each other, and make sure you are communicating. Look into speaking with a counselor who can help you sort out all of the normal — yet powerful — emotions that go along with PCOS and fertility treatment.
Celmatix: What advice would you give to a woman who is trying to conceive with PCOS?
Dr. Homer: Always remember: PCOS does not define you.
It may be an extremely annoying hurdle that you will need to jump over from time to time, but PCOS is simply one chapter of your story. If you’re thinking about starting a family, trying to keep yourself healthy, or simply feeling overwhelmed, I urge you to make an appointment with your doctor!
Realizing you may need to see a fertility specialist isn’t easy. No one wants to take medicines — and deal with their side effects — just to have what seems to come easily to a lot of other women. But it’s important for you to understand what’s actually going on inside your body, rather than ignoring your symptoms or dealing with them in silence.
There are many aspects of PCOS that are still a mystery, but over 60 years of shared and published medical experience has shown us a pretty good path for how to deal with it. Your doctor can help you stay healthy, get you ovulating regularly, and help you reach your family building goals whenever you’re ready to start your journey.
Dr. Michael Homer is a Reproductive Endocrinologist at the Reproductive Science Center (RSC) in the San Francisco Bay area, where he specializes in polycystic ovary syndrome and oncofertility, as well as serving the LGBQT community.
According to Dr. Homer, the best part of his job as a fertility specialist is seeing a positive pregnancy test and making that phone call to his patient. He says he takes great pride in being able to listen to, connect with, and guide his patients through their journey.
You can learn more about Dr. Homer and RSC here.