2023 PCOS Awareness Month: What You Need To Know About IVF With PCOS

PCOS is one of the most underdiagnosed disorders in the world, with less than 25% of women with the disorder not being correctly diagnosed by a physician. Many women who suffer from PCOS may not even realize that anything is wrong, or they may not show significant signs of any issue. Even so, PCOS is a serious issue and an important contributing factor to fertility issues in women. But what is it? And more importantly, how can we manage it, and how can a woman with PCOS increase her chances of having a healthy child safely? This article will explain what PCOS is, its causes and symptoms, how to manage them, and even how to have children when diagnosed with PCOS.

An Overview of PCOS

Polycystic ovary syndrome (PCOS) is a hormonal disorder commonly seen among women of reproductive age. If someone has PCOS, their ovaries produce unusually high levels of hormones called androgens. This causes reproductive hormones to become imbalanced. As a result, people with PCOS often have irregular menstrual cycles, missed periods, and unpredictable ovulation. Multiple small cysts may develop on your ovaries due to a lack of ovulation.

PCOS is one of the most common causes of female infertility. It can also increase the risk of other health conditions. A healthcare provider can treat PCOS based on symptoms and intended plans for having children. With help from IVF (In-vitro fertilization), many women with PCOS can still achieve their goal of having healthy babies.

What Causes PCOS?

In general, PCOS is caused by hormonal imbalance. The changes in hormone levels influence women’s health, well-being, and physical appearance. The exact cause of this condition is unknown; PCOS sometimes runs in families, but it is commonly accepted that PCOS can be caused by a combination of genetic and environmental factors. Unbalanced hormone levels are key factors why PCOS leads to fertility issues. For example, insulin is a hormone that controls sugar levels in the body. Many women with PCOS are resistant to the action of insulin in their bodies, and as a result, they produce higher levels of insulin to overcome this. This extra insulin can cause a myriad of other health issues as well as make it more challenging to get pregnant and have a healthy journey to delivery. Weight is also commonly considered a contributing factor; being overweight or obese can also increase the amount of insulin the body produces.

What Are the Symptoms of PCOS?

One of the symptoms of PCOS is hyperandrogenism, which can cause acne, increased body hair, scalp hair loss, as well as weight gain. PCOS can result in irregular menstrual periods and difficulty in getting pregnant. The symptoms can be variable.

The symptoms and complications of PCOS may include:

• Infertility
• Acne or oily skin
• Excessive body hair
• Multiple cysts in ovaries
• Missed periods or irregular periods
• Male-pattern baldness or thinning hair
• Depression, anxiety, and eating disorders
• Weight gain, especially around the abdomen area
• Gestational diabetes or pregnancy-induced high blood pressure

What You Can Do if You Have PCOS?

You should contact your primary care physician for an evaluation if you have missed or irregular periods, excess hair growth, acne, and weight gain. Your physician will ask about your medical history and your symptoms. A physical exam is usually performed. A pelvic exam is usually added as well. This exam checks the health of your reproductive organs, both inside and outside your body. 

You may also have tests such as:

• A transvaginal ultrasound: This ultrasound is used to check the size of the ovaries and see if there are any cysts. The test can also look at the thickness of the endometrium lining of the uterus.
  
  
• Blood tests: A panel of hormone levels, including high levels of androgens and other hormones, will be evaluated. Your physician may also check your blood glucose levels. And you may have your cholesterol and triglyceride levels checked as well.

What Are the Treatments for Infertility Caused by PCOS?

IVF is one of the most common treatments for women with PCOS who wish to have children. With IVF, there are higher chances of getting pregnant with lower risks.

The medication protocol will be decided based on an IVF specialist’s evaluation. At PFCLA, we monitor the ovarian response by testing estradiol levels and performing transvaginal ultrasound. We specialize in treating women with PCOS and have a few options for IVF stimulation protocols. We commonly use Ganirelix with Lupron trigger protocol or oral contraceptive pills with Lupron protocol. Our IVF specialist will choose the best medication protocol for a patient based on their evaluation results and explain further details during a consultation. Most women need 2-4 visits to monitor the stimulation before getting the HCG trigger shot. The egg retrieval procedure happens 36 hours after the HCG trigger shot.

In IVF treatment, a woman’s eggs will be retrieved when follicles reach around 17–18 mm, then fertilized in our laboratory with sperm from the partner or donor sperm. Traditional IVF or intracytoplasmic sperm injection (ICSI) will be performed as indicated to optimize the fertilization rate. Embryos will be cultured for 5-7 days; our experienced embryologists will evaluate the quality and grading of the embryos based on the blastocyst stage. The blastocyst embryos will be biopsied for PGT-A (preimplantation genetic testing) and then frozen for later use. In a typical scenario, the embryo transfer procedure usually occurs between days 19 and 21 of a woman’s menstrual cycle. This is followed by a pregnancy blood test approximately ten days post-implantation.

The success rate of IVF in PCOS is about 70%, which is excellent for women with PCOS who want to conceive.

If you have difficulty conceiving, think you may show signs or symptoms, or have general questions about PCOS, please get in touch with your OBGYN or PFCLA for more information.