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Infertility Is...The Result of a Medical Condition


a blog by Laurence A. Jacobs, M.D., Fertility Centers of Illinois, April 24, 2013

Medical conditions like Polycystic Ovarian Syndrome (PCOS) can cause cardiovascular and endocrine system health risks, including infertility.

Polycystic ovarian syndrome (PCOS) can have many variable and subtle symptoms. Unfortunately, some doctors may overlook the diagnosis in young women not trying for pregnancy, especially if they are simply interested in regulating periods with medications, such as Provera or birth control pills. PCOS has several potential implications for fertility and is the most common form of female-related infertility caused by the absence of ovulation. However, PCOS may also lead to numerous serious general health problems. PCOS Awareness is an important first step. There's no single test to definitively diagnose PCOS. For this reason, it is important to have a thorough evaluation to help rule out other conditions such as adrenal or thyroid disease, and to accurately confirm the diagnosis of PCOS.

Symptoms may include:

  • Oligo- amenorrhea (irregular or absent periods)
  • Oligo-anovulation (infrequent or absent ovulation)
  • Infertility
  • Hirsutism (excessive hair growth) face, chest or abdomen
  • Acne
  • Obesity or weight gain

Researchers have determined that most women with PCOS have an endocrine imbalance known as “insulin resistance” in which the body doesn’t handle insulin normally. The resulting higher insulin levels lead to more fat storage (obesity) and also disrupt proper ovarian hormone production (increased male hormone), thus preventing ovulation. Insulin resistance ultimately can produce all the symptoms of PCOS (anovulation, absent periods, infertility, obesity, and hirsutism), as well as contributing to the numerous serious health risks.

Many experts agree that in order to diagnose PCOS, you must first rule out other endocrine conditions such as thyroid and adrenal diseases. For a diagnosis of PCOS, women must have two out of three of the following diagnostic criteria:

  • History of irregular or absent menstrual cycles and/or no ovulation
  • Hirsutism and or high blood levels of male hormones –androgens
  • Ultrasound evidence of polycystic appearing ovaries using specific criteria

We do know that women with PCOS are at risk for several other health concerns, including:

  • Obesity, a condition in which the body stores more fat than is healthy for a person
  • Impaired glucose tolerance, which means that blood sugar levels are higher than normal
  • Insulin resistance, a condition in which the cells in the body don't use the insulin the body makes, thus higher levels of insulin are needed to get glucose into the cells for energy
  • Metabolic syndrome, which is sometimes considered a sign of diabetes because it means the body has trouble balancing insulin and glucose levels
  • Diabetes, a condition in which the body either stops making extra insulin or it doesn't properly use the insulin that is available, thus blood glucose levels get higher
  • Cardiovascular disease, which is problems related to the heart and blood vessels that can lead to heart attack or stroke.
  • Obstructive sleep apnea, a condition in which a person does not get enough air into the lungs when they sleep, which lowers oxygen levels.
  • Endometrial hyperplasia & cancer (Uterine) at a relatively young age

There are several ways to treat PCOS that can improve a woman's health and symptoms. Changes in lifestyle (eating a healthy diet, exercising and losing weight) are an important first step. When women with PCOS are able to correct the insulin resistance with proper low-carb/good carb diets and exercise, normal ovarian function (ovulation and normal female hormone production) often returns. Regular exercise and/or weight loss of 5 to 10% can be very beneficial for health and fertility problems. Use of insulin-sensitizing medications, such as Metformin, can be very helpful.

For those seeking pregnancy, ovulation inducing medications are often successful in leading to proper ovulation, but don’t always result in a successful pregnancy. Frequently, intrauterine inseminations (IUIs) and/or In Vitro Fertilization (IVF) may be needed.


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