✓ Polycystic ovary and infertility

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Polycystic ovary syndrome (abbreviated to PCOS) is a endrocrine disorder caused by one imbalance of sex hormones and represents one of the main causes of female infertility. It affects about 5-10% of women of reproductive age.

Symptoms

Symptoms can be varied, not necessarily present all together. Among the most common we find:

presence of multiple cysts in the ovaries, which are enlarged. The cysts are detectable by ultrasound;
irregular menstruationI totally absent (amenorrhea);
hirsutism, that is, excessive growth of hair on the face, chest and abdomen;
infertility o reduced fertility;
insulin resistance. It means that the cells of the body no longer respond correctly to insulin, a hormone responsible for regulating blood sugar levels. As a result, the body releases more insulin into the bloodstream in an attempt to reduce sugars. Women with the syndrome who also have obesity or overweight, an unhealthy lifestyle with regards to nutrition and exercise, family history of diabetes, are at greater risk of insulin resistance;
obesity;
acne;
thinning or perdita di capelli, with male pattern baldness.

We often notice that we suffer from PCOS when we look for a child and we see that it does not arrive, but the symptoms can appear already during the puberty.

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The consequences

As we have seen, the syndrome can cause infertility. In addition, affected women run a higher risk of developing certain diseases including diabetes, metabolic syndrome, hypertension, cardiovascular diseases, sleep apnea.

Overall, obesity, ovulatory disorders, insulin resistance, and diabetes (all common in women with the syndrome) tend to increase the risk of endometrial cancer.

Read also: Getting pregnant: pro-baby diet and substances in the book The Secret of Fertility

The causes

The exact causes are not yet well known, although we know that the syndrome is more common in women with obesity or who have mothers and sisters with the syndrome themselves (suggesting a hereditary component). The syndrome is very likely to be caused by the concomitance of several genetic and environmental factors.

What we do know, however, is that the symptoms observed depend on the hormonal imbalances typical of the syndrome, which include:

increased androgen levels, male hormones produced by the ovaries that inhibit ovulation and promote hirsutism and acne;
abnormalities in gonadotropin, LH and FSH levels. As a rule, the release of FSH and LH from the pituitary depends on the frequency of periodic stimulation of the pituitary gland by the gonadotropin-releasing hormone produced by the hypothalamus (GnRH). Women with PCOS show low or normal FSH levels but high LH levels. This FSH explains the presence of the characteristic multiple, small and immature follicles visible in the ovary in women with PCOS. None of these follicles reach a size greater than about 8 mm and, therefore, none of them become large enough to produce ovulation;
increased insulin levels.

Read also: Female infertility, ovulatory disorders

How the diagnosis takes place

The diagnosis is based on several elements:

medical examination, which allows to identify any signs of hyperandrogenism, such as hirsutism, e gynecological examination, with collection of information on menstrual and reproductive history;
transvaginal ultrasound to view the appearance of the ovaries and their size;
hormone dosages, performed with a blood sample, to assess the level of androgens in the blood.

How we intervene

There is no cure for polycystic ovary syndrome, but symptoms can be controlled with various medical therapies. In particular:

birth control pill (or other hormonal contraceptives), which helps regulate the cycle and improve acne and hirsutism. Obviously it is not indicated if you are looking for a pregnancy;
antiandrogen hormones, which improve baldness, hirsutism and acne;
metformin, drug used for the treatment of diabetes and in this case against insulin resistance, with the effect of lowering blood sugar.
inducers of ovulation such as clomiphene, gonadotropins and progestogens for those who have difficulty conceiving and are looking for a pregnancy.

In recent years, various studies have shown various positive effects of taking inositol supplements, a vitamin analogue, in people with polycystic ovary syndrome. Inositol, in fact, reduces androgen levels, improves insulin activity, so less insulin is produced, and regulates ovulation, which automatically improves fertility by increasing the chances of spontaneous conception.

Read also: Inositol, an aid for fertility It is also important to follow a healthy lifestyle, with a balanced diet and regular exercise: they do not work miracles but they give an important hand in relieving symptoms.

Sources for this article: information material of Humanitas Research Hospital; US Government Department of Women's Health information materials; Medline Plus information material; book The secret of fertility by Simonetta Basso and Stefania Piloni.

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