Why It’s Important to See a Fertility Specialist for PCOS
By Lauren Haring, RN
The views and opinions expressed are those of the authors and should not be considered medical advice. Always consult your doctor, or a mental health professional, for the most appropriate treatment.
Polycystic Ovary Syndrome (PCOS) is a disorder that affects 1 in 10 women of childbearing age. The cause is mostly unknown and not all women with PCOS will have the same underlying symptoms. PCOS is frequently underdiagnosed, despite its prevalence and implications for reproductive, metabolic, and psychological health. There is no cure, but PCOS can be managed and the effects of PCOS can be minimized.
How is PCOS Diagnosed?
Symptoms of PCOS may include:
- Irregular or missed menstrual cycles
- Increased hair growth (hirsutism)
- Acne
- Obesity (extra weight)
- High cholesterol
- High blood pressure
- Insulin resistance/diabetes
- High levels of androgens (male hormones)
- Elevated cholesterol
- High levels of glucose
- Sub-fertility or infertility
Diagnosis of this syndrome is made through a combination of clinical, laboratory, and ultrasound findings. To receive an official diagnosis of PCOS, a woman must have at least two of the three following conditions:
- Chronic lack of ovulation (anovulation)
- Chronic high testosterone levels (hyperandrogenism)
- Ovaries with multiple fluid-filled follicles (polycystic) on ultrasound evaluation or high AMH (anti-müllerian hormone) level
Why See a PCOS Specialist?
Hormones are important regulators of most vital things you do in every day of life, like eating and sleeping. When there are hormonal imbalances present, it can affect your quality of life.
It can be challenging both to diagnose and to treat PCOS, as some gynecologists are not comfortable delving into the details and managing the condition once it is confirmed.
Women with PCOS often face fertility struggles, and are also at higher risk for developing complications during pregnancy including gestational diabetes (diabetes during pregnancy), pregnancy-induced high blood pressure, preterm birth, and increased fetal and neonatal death. There is also a higher risk of developing medical problems unrelated to pregnancy such as type 2 diabetes, heart disease, and high blood pressure. The goal of treating PCOS is to preserve or restore fertility, reduce and manage symptoms, and prevent possible complications that can develop in women from adolescence to the postmenopausal period.
Who Should Be On Your PCOS Care Team?
Depending on your symptoms and goals, a variety of specialists may be on your PCOS care management team. It is important to understand the role each specialist plays when considering how to build your ultimate PCOS support system.
Medical Endocrinologist
The endocrine system regulates hormone production and function. PCOS is the most common endocrine disorder of reproductive-aged women. Patients should see an endocrinologist who is confident in evaluating and managing the multitude of symptoms.
Reproductive Endocrinologist
Many women with PCOS have difficulty conceiving. When ready to conceive, it will benefit you to have a fertility specialist (also known as a reproductive endocrinologist or RE) in your corner early in the process. PCOS is the most common cause of anovulatory infertility, leading women to seek fertility assistance, though many only learn they have PCOS after seeking infertility treatment. Reproductive endocrinologists will create an appropriate treatment plan to help you overcome PCOS and reach your fertility goals.
Registered Dietitian
This invaluable member of your team will provide nutrition education about PCOS, dietary supplements that may improve your condition, and develop a personalized meal plan based on your individual needs. Ongoing work with a registered dietitian may involve additional nutrition education, meal planning, monitoring of supplement use, and support with eating issues.
Mental Health Specialist
Women with PCOS often struggle with many common mental health disorders, ranging from anxiety and depression to body dysmorphia, eating disorders and more. To help manage these issues, a mental health professional is a crucial ally to have in your corner on your journey to better PCOS management and improved health.
It’s important to ensure you are comfortable with any professional you invite to your team. Trust is a vital part of any patient-provider relationship, so you can have open communication about concerns you have relating to your PCOS symptoms, fertility struggles, or any other major life issues you may be facing.
PCOS Treatment Options
Lifestyle changes are typically considered the first-line of treatment for management of infertility and metabolic complications in women with PCOS. Positive lifestyle changes including dietary, exercise, or behavioral interventions with weight reduction have shown to lower circulating insulin and androgen levels and improve lipid and FSH levels. This can improve many physical symptoms of PCOS, normalize menstrual cycles, induce ovulation, and improve general health. The goal is to make and maintain the lifestyle changes needed to help reduce symptoms and prevent complications.
Weight Loss
Women with elevated BMI levels will often have difficulty conceiving, most commonly due to ovulation problems. However, for those who are overweight or obese, losing as little as 5-10% of body weight has been associated with significant clinical benefits in improving reproductive, metabolic, and psychological features. Weight loss is associated with lowered androgen effects, less insulin resistance (lowered risk of diabetes), and improved ovulation. Not all women diagnosed with PCOS are overweight so this will not apply to all women with PCOS.
Nutrition
No single food or special diet will be the cure for all women suffering from PCOS. But there are steps that can be taken to optimize the core health foundation and minimize PCOS effects with proper nourishment for the body. Your care team may recommend supplementation to support you, but it’s important to understand you cannot out-supplement a poor diet. It is key for everyone to approach their unique nutritional goals as an individual, but a low glycemic index, Mediterranean, or similar diet based on healthy food choices has shown benefits in overweight and obese women with PCOS.
Physical Activity
Regular activity can help with many of the symptoms from PCOS by assisting with weight management, improving lipid levels, lowering blood pressure, improving insulin sensitivity, and decreasing androgen levels. Regular movement has also been shown to improve body image and mood as well as decrease chronic stress and stress-related eating.
Medications
To control the symptoms of PCOS, multiple therapies are available and may be combined. Your healthcare provider might recommend:
- Oral Contraceptives (Birth Control Pills): When fertility is not the goal, oral contraceptives can be used to regulate your menstrual cycle. There are a variety of pill types that can be used to decrease androgen production and regulate estrogen. Regulating hormone imbalances can promote regular menstruation and lower your risk of endometrial cancer, decrease excess hair growth and acne, and prevent pregnancy.
- Medication to Block the Effects of Androgen on the Skin: This type of medication can be used alone or with other PCOS therapies. It blocks the effects of androgen on the skin, including excessive hair growth and acne. It is important to note this medication is not recommended if you’re pregnant or planning to become pregnant.
- Hair removal: Creams that dissolve unwanted hair, electrolysis, and laser hair removal are some options for removing unwanted hair growth. Multiple rounds will likely be needed, but these are common treatments for aesthetic reasons, especially for facial hair.
- Acne treatments: Multiple oral medications and topical creams or gels may help improve acne. It is important to discuss your goals with your provider before starting any new regimen.
For those with PCOS looking to overcome infertility, a range of treatment options are available to increase the likelihood of ovulation and achieving a pregnancy. Your fertility specialist will recommend the right treatment option for you, but some commonly used fertility medications include:
- Ovulation induction (OI) medication, which is taken at the beginning of the menstrual cycle for five days. It works by causing the pituitary gland to make more FSH, which stimulates the ovaries to grow more follicles (each containing a single egg), which secrete estradiol into the bloodstream. Usually about a week after the last dose of this type of medication, the higher levels of estradiol cause the pituitary gland to release a luteinizing hormone (LH) surge. This surge of the hormone LH causes the egg(s) to be released (ovulation).
- Insulin-sensitizing medicine (used on its own or in combination with an ovulation induction medication), which helps the body use insulin better, control blood glucose levels, and improve ovulation. When taken for several months, this type of medication can lead to regular menstrual cycles and positive ovulation. It can also slow the progression from pre-diabetes to type 2 diabetes.
- When oral medications are not successful to induce ovulation, injectable fertility medications called gonadotropins can be used. These contain FSH or LH, either alone or in combination, and stimulate the growth of multiple follicles (eggs) in the ovaries. Women with PCOS must be monitored very closely when using these medications to ensure they are not responding too vigorously.
It is important with any oral or injectable stimulation medication to determine if the prescribed dose results in ovulation and to monitor for overstimulation. This can be done with menstrual pattern observation, ovulation predictor kits, blood tests, and vaginal ultrasounds to evaluate the uterine lining along with follicle number and size. Some women will need medication doses adjusted to reach their fertility goals.
If needed, talk with your fertility specialist about additional fertility treatments that may help you become pregnant. Some options include intrauterine insemination (IUI), to decrease the distance sperm travels to reach the egg, and assisted reproductive technology like in vitro fertilization (IVF), where fertilization happens outside of the body to create embryos that are then transferred to the uterus, allowing for more control of the process.
Whether you want to become a parent right now, or you’re just looking for symptom relief, forming a PCOS care team that you feel comfortable with is vital. Create your care team sooner rather than later so that they can start working to control your PCOS symptoms, lower your risk of developing chronic disease, help you get pregnant (if and when the time is right), and improve your quality of life. Start your journey to overcome PCOS today!
