Infertility, PCOS and How to Get Pregnant

Infertility is defined as the failure to get pregnant after a year of unprotected intercourse. Women with polycystic ovarian syndrome often are infertile because they don't ovulate. 40% to 80% of them have a problem with fertility. The reason for this wide variation is that polycystic ovary syndrome is a complex metabolic syndrome, with multiple factors that can interfere with fertility.

What Causes You to Be Infertile?

Lack of fertility is a very distressing disorder. It is also very complex to deal with.

In general, infertility falls into one of five categories:

  • Ovarian disorders (20-25%) - disturbances in the production and release of eggs.
  • Male factor (40-50%) - inadequate sperm quality, function or motility. (This category also includes couples who are unable to have intercourse due to injuries or for other reasons.)
  • Pelvic factor (20-25%) - including uterine abnormalities, fibroid tumors, blocked fallopian tubes, endometriosis and/or pelvic adhesions.
  • Cervical factor (5%) - abnormalities with the cervix that hamper sperm movement.
  • Unexplained infertility (10-15%) - remains undefined in spite of an extensive medical evaluation.

It's not uncommon for couples to have a combination of two or more of the above causes. Even though your primary concern is about ovarian problems (the first category), you should remain aware of the additional causes.

PCOS-Related Infertility

The inability of some women with polycystic ovary syndrome to produce and release an egg is due to a complex web of multiple hormone imbalances. The hormones involved include insulin, androgens, estrogens, progesterone, luteinizing hormone, follicle stimulating hormone, adrenal hormones, thyroid hormones, prolactin, and others.

All of these hormones influence each other in some way. Therefore, if you can optimize any one of them, you are taking a step towards optimizing the others and increasing your chances of becoming fertile.

In addition, some women have other factors that contribute to inability to become pregnant (like a husband with a low sperm count or a uterus scarred by a previous infection), which have nothing to do with PCOS. If you have polycystic ovarian syndrome, it's difficult to estimate your chances of having a baby. Nevertheless, there's plenty you can do to improve your odds.

Polycystic Ovaries May Not Affect Fertility

Infertility is a primary concern for many women with PCOS. However, a recent study has shown that even if you have polycystic ovaries as shown by ultrasound, you may be as fertile as other women.

Researchers at Tufts University identified 210 women as having polycystic ovaries, based on an ultrasound exam. One-third of these women were free of the typical symptoms of PCOS. The non-symptomatic women had a mean time-to-pregnancy similar to that of women with normal ovaries who were included in the study for comparison purposes. In other words, the symptomatic polycystic women were no less fertile than women with normal ovaries.

The women who did have symptoms of PCOS were less fertile than the asymptomatic and normal groups.

If you have an ultrasound exam and ovarian cysts are discovered, it does not necessarily mean that you are less fertile, IF you don't have the typical symptoms of polycystic ovary syndrome. This study suggests that if you can reduce your symptoms, you may become more fertile in spite of having polycystic ovaries.

Is Your Male Partner Infertile?

It's advisable for your partner to have the quality and quantity of his sperm assessed before you decide to undergo expensive IVF or ICSI procedures, and before you expose yourself to powerful drugs. If your partner is sub-fertile or infertile, your chances of success with IVF or ICSI are diminished.

It's not uncommon for men to have a low sperm count, low sperm motility (ability to move), or abnormally shaped sperm. These and other factors will reduce your partner's ability to help you achieve a pregnancy. In addition, you could have a higher risk of miscarriage if your partner's sperm is abnormal.

Related Articles


Sources:
Hassan, M et al, Ultrasound diagnosis of polycystic ovaries in women who have no symptoms of polycystic ovary syndrome is not associated with subfecundity or subfertility, Fertility and Sterility, 2003, 80(4):966-975.
Thatcher, SS, "PCOS: The Hidden Epidemic", Perspective Press, 2000, p.378
Thatcher, SS, "PCOS: The Hidden Epidemic", 2000, Perspective Press, p.210
Furuhjelm, et al, The quality of human semen in spontaneous abortion, International J of Fertility, 1962, 7:17-21
Ward, N, Foresight 1990-1993 study of preconceptual care and pregnancy outcome, J Nutr Environ Med, 1995, 5:205-8
Paulus, et al., Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy, Fertility and Sterility, 2002, 77(4)
Domar, A, et al, "Healing Mind, Healthy Woman", Henry Holt and Co., 1996, pp. 255-257 - See more at: http://www.ovarian-cysts-pcos.com/footnotes.html#infertility

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