Polycystic ovarian syndrome (PCOS) PCOS is the most common cause of infertility in women, affecting between 70 to 80% of those with the anovulatory phenotype of the condition. Unfortunately, most women only discover that they have PCOS after several attempts to get pregnant naturally fail. In addition to the infertility, Women with PCOS who do become pregnant frequently find that they have developed gestational diabetes mellitus or a cardiovascular disease. These women are also at a higher risk of enduring a first-trimester miscarriage. Interestingly, Androgen production tends to decrease in the years shortly before a woman reaches menopause, thus the menstrual cycles of women with PCOS often become more regular with age, with corresponding improvement in reproductive function.
How PCOS Disrupts Ovulation
The primary reason PCOS contributes to infertility is its disruption of ovulation, the process of releasing an egg from the ovary each month.
In women with PCOS, the ovaries frequently produce an excessive number of follicles, which are small fluid-filled sacs that contain eggs. However, these follicles often fail to mature and release an egg, leading to irregular or absent ovulation. These errant follicles become polycysts.
Hormonal Imbalances and Their Role in PCOS Infertility
The hormonal imbalances associated with PCOS also play a significant role in infertility. Elevated levels of androgens, such as testosterone, can interfere with the development of follicles and prevent ovulation. Additionally, insulin resistance, a common feature of PCOS, disrupts the body’s ability to use insulin effectively, further contributing to hormonal imbalances. Most women with PCOS also present with high levels of luteinizing hormone (LH) and reduced levels of follicle-stimulating hormone (FSH).
Excess weight: Women with PCOS who are overweight or obese are more likely to experience infertility due to the increased production of androgens associated with excess body fat.
Inflammation: Chronic inflammation, often present in women with PCOS, can impair the function of reproductive organs and contribute to infertility.
Metabolic syndrome: PCOS is a major risk factor for metabolic syndrome, a cluster of conditions including high blood pressure, high blood sugar, abdominal obesity, and abnormal cholesterol levels. Metabolic syndrome can further complicate fertility issues in women with PCOS
Cervical Mucus: Cervical mucus is a fluid produced by the cervix that changes in consistency and texture throughout the menstrual cycle. During ovulation, the mucus becomes clear, stretchy, and egg-white-like, creating an ideal environment for sperm to travel through the cervix and reach the fallopian tubes.
In women with PCOS, hormonal imbalances can disrupt the production of cervical mucus, leading to a reduced amount of mucus or mucus that is thick, sticky, and impenetrable by sperm. This can make it difficult for sperm to reach the egg, reducing the chances of conception
Endometrium: The endometrium is the lining of the uterus that prepares for implantation of a fertilized egg. In women with PCOS, hormonal imbalances can also affect the thickness and receptivity of the endometrium. The endometrium may be thinner than usual or have abnormal growth patterns, making it less receptive to implantation.
Impact on Fertility
The combined effects of PCOS on cervical mucus and endometrium can significantly impact a woman’s fertility. If the cervical mucus is too thick or impenetrable, sperm may not be able to reach the egg, and if the endometrium is not properly prepared for implantation, even if fertilization occurs, the embryo may not be able to implant successfully.
Women with PCOS may experience irregular or absent ovulation, making it more difficult to predict their fertile window. They may also experience recurrent miscarriages due to the abnormal endometrial lining.
While PCOS can make it more challenging to get pregnant, it is important to remember that it is not an insurmountable obstacle. Various treatment options can help women with PCOS achieve pregnancy.
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