Polycystic Ovarian Syndrome (PCOS) is a medical condition characterized by excess androgens, ovulation dysfunction, and polycystic ovaries. 5-10% of women are affected by PCOS, many of whom experience issues with getting pregnant.
Diagnosing the condition early on, as well as identifying treatment to address its symptoms, is key in preventing issues in the long-run. Daniela from Dreaming of Baby speaks with Dr. Lakeisha W. Richardson on your OB-GYN appointment when PCOS is involved, its treatment, and its effects on fertility.
Daniela: Good morning Dr. Lakeisha, and welcome to Dreaming of Baby. Today we will be discussing PCOS, and more specifically its effect on fertility. We have quite a few pertinent questions to ask, but it would be great if you could introduce yourself to our readers first.
Dr. Lakeisha W. Richardson, F.A.C.O.G.: Thank you, Daniela, for this opportunity. I am so excited to be here with Dreaming of Baby to discuss PCOS and Infertility. I am Dr. Lakeisha Richardson, a Board Certified Obstetrician and Gynecologist and have been in private practice for more than 10 years.
What is PCOS?
Daniela: To start with, what is PCOS exactly?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: PCOS, also known as Polycystic Ovarian Syndrome is a medical condition that affects 5-10% of women and is characterized by excess androgens, ovulation dysfunction, and polycystic ovaries.
Daniela: That’s quite a high percentage. Based on your own experience, is it an easy condition to diagnose?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: Based on my experience, PCOS is very easy to diagnose. PCOS has some very classic symptoms such as hirsutism, obesity, and irregular menses. However, it is always very important that the patient has a thorough work-up to exclude other diagnoses.
Daniela: So if I understand well, during her appointment, the woman is asked whether or not she’s experiencing these symptoms? Also, grateful if you could explain what hirsutism is to our readers.
Dr. Lakeisha W. Richardson, F.A.C.O.G.: Hirsutism is a condition where women have excessive facial hair, most commonly a beard. During the history and physical, the physician would ask a series of questions and do a physical exam looking for clinical findings that would be consistent with PCOS.
Preparing for your Ob-Gyn appointment
Daniela: Are any specific medical tests done, such as bloodwork etc?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: Before we diagnose any patient with PCOS, we always want to rule out any other possible medical conditions. Therefore, lab work such as thyroid panel, cholesterol panel, fasting glucose, and androgen levels are always tested. In addition, a pelvic ultrasound is also ordered looking for ovaries with more than 12 cysts measuring 2-9mm.
Daniela: So how can a woman prepare for her Ob/Gyn appointment? What are the questions she should be asking, specifically if she wants to conceive?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: Any woman who is looking to conceive, should start by being completely honest with her physician and provide a very detailed history. A detailed history would include a menstrual cycle calendar and how often she is sexually active. Also, how long she has been on birth control and the types of birth control are very important. In addition, if she has already been trying to conceive prior to her appointment, how long she has been trying, and if she has been using any ovulation kits to test for ovulation.
Daniela: How imperative is menstrual cycle tracking in diagnosing PCOS?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: Menstrual cycle tracking is not that important for the actual diagnosis of PCOS; however, it is very important for conceiving because it gives the physician an idea of how often she may be ovulating or if she is not ovulating at all.
‘Any woman who is looking to conceive, should start by being completely honest with her physician and provide a very detailed history.’
Daniela: So how does PCOS affect the menstrual cycle?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: PCOS, secondary to the obesity and the excess androgens, makes women have very irregular cycles and leads to irregular ovulation. Women with PCOS usually skip several cycles per year and some women don’t have cycles at all.
Daniela: Thank you for clarifying that. For the woman wishing to conceive, but who has also been diagnosed with PCOS, what would be the first step in her journey to pregnancy, (after she has consulted with her Ob/Gyn and provided all the necessary information as you shared with us above)?
PCOS and Fertility
Dr. Lakeisha W. Richardson, F.A.C.O.G.: The first step for women with PCOS who are trying to conceive would be to regulate their cycles. Most women with PCOS require ovulation induction in order to conceive. Physicians typically use two medications in order to achieve ovulation. One pill will regulate the cycle and the other pill will induce ovulation.
Daniela: To help achieve a successful outcome, are there any specific lifestyle changes which can also help with fertility when experiencing PCOS?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: Most women with PCOS are considered overweight or obese. Diet and exercise can really help with infertility. If these women lose approximately 10% of their body weight, they can have spontaneous ovulation and not require ovulation induction.
Daniela: That’s very positive to hear! Based on your experience, what would be the average time between starting medication and improving lifestyle choices, and achieving pregnancy?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: The average amount of time to achieve pregnancy is about 6 months; however, it really depends on the patient. For example, if a patient starts medication and is very diligent about her diet and exercise regimen, she will have success sooner than the patient that just does medication. Also with ovulation induction, it does take a small amount of time to find the right dose that actually produces ovulation.
‘The average amount of time to achieve pregnancy is about 6 months; however, it really depends on the patient.’
Daniela: So if I understand well, treatment is very specific to the case in question. What is the success rate of pregnancies through ovulation induction? If this treatment does not work, are there any other options for achieving pregnancy?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: Yes, treatment is very specific to each individual patient. If there are no other factors affecting fertility, the success rate is 60-80%. However, if other factors are involved, such as endometriosis or tubal blockage, then the success rate is much lower. For women who do not respond to ovulation induction, other options would include Ovarian Drilling, a laparoscopic procedure where multiple holes are drilled into each ovary. Other options include IVF.
Daniela: Thank you for this information; the insight you are providing will be most helpful to our readers. If I may, I would like to ask another question: In terms of IVF, would donor eggs have to be utilized in such cases?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: In most cases for healthy women, donor eggs do not have to be utilized. Most women with PCOS usually have very healthy ovaries with a normal ovarian reserve, they just have difficulty releasing the eggs or ovulating.
Daniela: Thank you for clarifying that. As a final question, what would be that one piece of advice you would give a woman dealing with PCOS and who dreams of becoming a parent?
Dr. Lakeisha W. Richardson, F.A.C.O.G.: The best advice I would give a woman with PCOS is to see her doctor early and develop a plan a for pregnancy even if she is not ready to conceive at this time. Another reason women should see their doctor early and start discussing infertility is because IVF is a very expensive procedure. Women need to know early on if they will have to have IVF in order to conceive so that they can start saving and planning financially. Having a plan and knowing what she will have to do later decreases the anxiety associated with infertility.
Daniela: I’m sure many women will find this advice helpful. Being prepared remains key. I would like to thank you for your time today Dr. Lakeisha, and for the valuable insight provided on PCOS and fertility!
Dr. Lakeisha W. Richardson, F.A.C.O.G.: Thank you so much, Daniela, for this opportunity.