Polycystic ovarian syndrome (PCOS) is very common – up to 1 in 10 women of child-bearing age have it. They may only find this out once they start trying for a baby. The combination of a hormonal imbalance and problems with metabolism can make this difficult – but not impossible. It’s one of the most common causes of infertility, but it’s also treatable.
Let’s talk you through the science of ovary function and what can be done about it in PCOS.
During normal ovulation, multiple eggs mature in the follicles inside your ovaries until the ripest egg is released into one of your fallopian tubes for a chance to fertilise with any sperm present.
If you have PCOS, the follicles do not develop properly so there is no release of a mature egg into the fallopian tube. Without the release of that egg, it is not possible for fertilisation to happen and therefore your fertility can be affected.
Although many women find out they have PCOS when they have difficulty conceiving, having PCOS does not mean that you cannot have children. This can happen spontaneously when eggs are released randomly, or it can happen with the help of medication or with assistance such as in vitro fertilisation (IVF) or surgery.
It’s recommended for anyone trying to conceive that you aim to have sex 3 to 4 times per week, regardless of when you predict your ovulation date is. This is also so if you suffer from PCOS, as you may have irregular or infrequent periods, so you are maximising the chance of a sperm meeting an egg by having regular sex.
By the by, it’s recommended to not increase the frequency of sex around your estimated ovulation time, as this may reduce the quantity or quality of sperm.
Although there is no cure for PCOS, lifestyle management is important. Losing weight is one of the best ways to improve your symptoms. This can be done through regular exercise and a healthy well-balanced diet and smaller portion sizes.
You may be eligible for NHS fertility treatment, and there are also private clinics available.
A fertility doctor may consider starting you on medication to stimulate ovulation called clomifene (or brand name Clomid). If that doesn’t work, then IVF may be a good option. This is where your eggs and your partner’s sperm are fertilised outside of the body and then placed back into your uterus to develop.
There is a small role that surgery plays in PCOS, where women undergo ovarian drilling. During this, small holes are made into the surface of the ovaries using a heated needle with electricity, in order to temporarily restore ovulation.
Most women will be able to conceive naturally within 1 to 2 years of trying. Natural fertility usually starts to decline around 32 year old, with a sharper drop around 37 years old. Women with PCOS often need longer to fall pregnant and are more likely to need fertility assistance due to the irregularity of ovulation.
It is widely understood that if you are under 35 years and have tried to fall pregnant for a year without success, you should speak to your doctor. For those over 35 years old, you should speak to your doctor after about 6 months of trying.
If you have not had any periods for 3 to 4 months, you should speak to your doctor.
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