PCOS & Infertility
What is Polycystic Ovarian Syndrome (PCOS)?
Let’s first break down the word. Poly means many, cystic meaning a fluid-filled sac and ovary meaning our ovary gland. Any time you see the word syndrome that means a basket of symptoms. One female could have certain symptoms while others have different symptoms.
To diagnosis this condition doctors look for 2 of 3 criteria: multiple cysts, high androgens/testosterone and cycle issues. Too many androgens/testosterone causes many of the signs and symptoms.
What are the signs and symptoms?
· Missed periods, irregular periods, or very light periods
· Ovaries that are large or have many cysts
· Excess body hair, including the chest, stomach, and back (hirsutism)
· Weight gain, especially around the belly (abdomen)
· Acne or oily skin
· Male-pattern baldness or thinning hair
· Infertility
· Small pieces of excess skin on the neck or armpits (skin tags)
· Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts
Why do cysts contribute to infertility?
The cysts are secreting androgens (aka testosterone) that causes an irregular cycle. Now we must understand our cycle (this is covered in another blog in full detail). Around day 14 of our cycle we should ovulate, meaning our body has developed a mature egg and it has been released to travel down the fallopian tube. So first, your body must have the proper hormone levels to grow a mature egg. If our hormone levels are out of balance, you will not develop a mature egg. The result is a fluid-filled sac with an immature egg. If the egg does not exit the fallopian tube it will stay there. You enter the 2nd phase of your cycle, the luteal phase and there is no egg to fertilize or implant. This will affect progesterone levels and be a contributing factor to hormone imbalance. The question then becomes why is this happening?
There are 4 types of causes:
1. Insulin-dependent (Most Common)
2. Inflammatory
3. Post-birth control
4. Adrenal (when no cysts are present)
Insulin-dependent PCOS:
Insulin is released from your pancreas and helps you utilize glucose (energy from our food). You’ve probably heard that regulating your blood sugar levels is important. If you are eating high carbs and sugar your body pumps out more insulin. Too much insulin becomes a problem.
Many women with PCO has insulin resistance. This means the body can’t use insulin well. This is why diet is so important and regulating your blood sugar matters. In the presence of high insulin your body decreases sex hormone binding globulin. Sex hormone binding globulin (SHBG), is a protein in the blood that helps regulate hormones. That is one factor.
The next is the cyst secretes testosterone which increases overall testosterone levels. For a female we want to produce more estrogen and less testosterone. If women have increased testosterone and high insulin, the body will make DHT (aka toxic testosterone). DHT is 3x more potent than testosterone. High levels of DHT will cause these signs and symptoms = cystic acne, fascial hair, alopecia and many others. To simplify, insulin down-regulates the quality of your egg, decreases hormones that regulate sex hormones and increases toxic testosterone.
These factors set you up for infertility and cycle issues. The good news is that we can affect our hormone levels through diet and exercise.
How to treat PCOS?
We must balance your hormones. In the office we provide hormone testing. This is a comprehensive panel that shows us where your levels are. Diet is the number one component to change. Paleo or Mediterranean diets are favorable and help regulate blood sugar and decrease inflammation. We will look more closely at diet and PCOS in another blog.
-Dr.KS
