The widespread belief that "you can't get pregnant with PCOS" has become a source of anxiety and distress for many. However, this is more myth than fact.
Published Sep 27, 2024 | 7:00 AM ⚊ Updated Sep 27, 2024 | 7:00 AM
PCOS.(Representational image/Creative Commons)
Dheeshan and Smitha (names changed), both software professionals, had been dating for three years, and everything seemed to be heading toward a perfect future together. They had plans to get engaged, buy a home, and start a family — things that every young couple dreams of.
However, in the past few months, Smitha noticed that something was off with her body. Her periods were irregular, she had gained weight without any specific reason, and she started developing acne, something she hadn’t dealt with in years. Concerned, she went to see her gynaecologist, and after several tests, she was diagnosed with Polycystic Ovary Syndrome (PCOS).
When Smitha told Dheshan’s family about the diagnosis, she expected them to be supportive. Instead, the family’s first reaction was distant and cold. She was asked questions like, “Does this mean you might not be able to have kids?” and “What if this gets worse?”
Though Smitha tried to reassure him that PCOS could be managed with treatment and lifestyle changes, Dheeshan’s family grew more anxious, started putting pressure on him and, unfortunately, they had to part ways.
Doctors South First spoke to explained that the Dheeshan and Smitha couple were not the first ones to be under such a belief. For years, women with polycystic ovary syndrome (PCOS) have been told that their chances of conceiving naturally are slim to none.
The widespread belief that “you can’t get pregnant with PCOS” has become a source of anxiety and distress for many. However, this is more myth than fact.
Speaking to South First, Dr Devika Gunasheela, infertility specialist and chairperson of Gunasheela Fertility Centre said, “While PCOS can make conception more challenging, it doesn’t mean that pregnancy is impossible. One has to distinguish between the polycystic appearance of the ovaries (PCO) and Polycystic Ovarian Syndrome (PCOS) which also contains a lot of metabolic issues and hormonal issues. One has to visit an infertility expert and find out where in the spectrum of PCO she is.”
PCOS is a hormonal disorder affecting up to 10 percent of women of reproductive age. Dr Devika explained that it is characterised by irregular menstrual cycles, high levels of testosterone (male hormones), obesity, high insulin resistance, hair growth in male pattern — over the chin, upper lips, lower limbs, both sides of the face etc — and the presence of multiple small cysts on the ovaries.
Doctors explain that these symptoms can lead to irregular ovulation, which makes it harder for women to conceive. However, irregular ovulation is not the same as no ovulation. Women with PCOS still ovulate, though it might not be as predictable or frequent.
Meanwhile, Dr Radhika Potluri, Regional Medical Head and Fertility Specialist at Oasis Fertility located in Hyderabad, told South First that at least 50 percent of married women with fertility issues are diagnosed with PCOS.
The centre claims to be the first to introduce drug-free treatment CAPA IVM (Biphasic In Vitro Maturation), for those who are worried about injections, the physical, emotional and financial burden of In Vitro Fertilisation (IVF) and who prefer a cheaper and less intensive alternate.
“It is not true that they cannot get pregnant at all. They might not ovulate like normal people, so medical intervention is needed. But there are definitely treatment options even in severely complicated cases, where we might have to put them through methods like ovulation induction to help them get pregnant,” she said.
Dr Deepti Sharma, Senior Consultant at the Department of Obstetrics and Gynaecology in Amrita Hospital Faridabad, said there has been a nearly 70 percent rise in the number of PCOS cases in recent times.
She attributed the rise in PCOS cases to lifestyle changes, particularly increased sedentary behaviour and consumption of processed, high-calorie food, leading to insulin resistance.
“Several ideas have been provided to explain the reasons for PCOS. The function of insulin resistance (IR), which is independent of fat, is significant. It is associated with hyperinsulinemia, which drives excessive ovarian androgen production. Insulin resistance is amplified by obesity,” she added.
Dr Potluri explained that the symptoms of PCOS could be observed during adolescence.
“When girls reach menarche, it is common for some of them to not get their periods every month. They may not understand whether this is a normal phenomenon or if it is due to PCOS. They often present with irregular cycles, weight gain, and excessive hair growth on the face, chin, upper lip, chest, etc, resembling a male pattern of hair growth. However, these symptoms can often go unnoticed,” says Dr Potluri.
She added that PCOS could be diagnosed through a combination of clinical evaluations and laboratory tests. While ultrasound may not always help in diagnosing PCOS, Dr Potluri emphasised the importance of clinical evaluation, including a detailed medical history, family history of PCOS, diabetes, and other health conditions.
Blood tests to check hormone levels — such as elevated testosterone, androgen, and insulin resistance — are also crucial.
Adding to this, Dr Manjula NV, Consultant in Obstetrics and Gynecology at Ramaiah Memorial Hospital in Bengaluru, estimated that one in five (20%) Indian women suffer from PCOS.
“It is a hormonal disorder affecting a significant number of women and can be diagnosed early by recognising symptoms such as irregular periods, excessive hair growth, and acne. Gynaecologists often use hormone tests and pelvic ultrasounds to detect ovarian cysts and assess family history for potential fertility issues. Insulin resistance is also evaluated, as it commonly accompanies PCOS. It is important to understand that PCOS is not a disease but a lifelong condition that manifests differently at various ages, making early diagnosis crucial for effective management,” she added.
To manage and prevent PCOS complications, adopting a healthy lifestyle is key, stresses Dr Manjula. She said, “Regular exercise and a balanced diet play a vital role in managing symptoms and improving insulin sensitivity,”
The two important factors – awareness and timely intervention are essential, as PCOS can have serious health impacts if not monitored.
Regular check-ups help track hormone levels and detect issues early. Exercise not only supports weight management but also enhances ovulation and insulin levels, making it a crucial aspect of effective PCOS management.
Dr Potluri said even though a sedentary lifestyle and stress factors are some common reasons for the increase in PCOS conditions, genetics is the main reason for PCOS.
“If there is a family history of PCOS there is a high chance that a person could have PCOS. PCOS during pregnancy and uncontrolled diabetes during pregnancy can also play a role,” she added.
A healthy lifestyle is absolutely important to manage PCOS, explained Dr Anu Katragadda. She said it could be due to inflammation in the body or genetic factor.
Even though there may not be any problems once they conceive, PCOS can sometimes be associated with hormonal imbalances that result in insulin resistance. This can lead to complications such as hypertension during pregnancy, gestational diabetes, and long-term health issues like heart problems and obesity.
“There is a trend that I am noticing in my clinical practice. Out of 10 women, about two will have poor-quality eggs. Since PCOS is a long-term condition, we cannot cure it 100 percent, but we can reduce the long-term complications such as metabolic problems, endometrial cancer, etc. We need to advise patients that it is a long-term condition, and they should be vigilant with regular health checks,” Dr Potluri added.
Another misconception is that PCOS will automatically lead to complications during pregnancy or affect the baby.
While women with PCOS are at a higher risk for certain complications like gestational diabetes and preeclampsia, many women go on to have normal pregnancies with proper prenatal care. Regular monitoring and early interventions can mitigate these risks and ensure a healthy pregnancy.
Preeclampsia is a high blood pressure (hypertension) disorder that can occur during pregnancy.
For women struggling to conceive due to irregular cycles, doctors may recommend fertility medications such as Clomid or Letrozole, which help stimulate ovulation.
Dr Anu Katragadda, Managing Director of Anu Test Tube Baby Centre in Hyderabad, said: “If you’ve been diagnosed with PCOS and are struggling to conceive, don’t be discouraged by myths. Speak with a fertility specialist who understands the nuances of PCOS,”
She said treatments depend on women’s choice, “If she wants cycles to be regularised then hormones are advised.”
Meanwhile, she stressed that weight loss as part of the treatment plan is very important. “Even if a woman loses 5 percent of her body weight she can conceive naturally,” she added.
Hence, lifestyle change plays a major role in PCOS control. Anti-diabetic drug metformin also helps in ovulation but must be taken only under the suggestion of a doctor. Also, there is a technique called laparoscopic ovarian drilling which can be done for those who are not respondng to drugs. If none of this works, then Intrauterine Insemination (IUI) and IVF methods can be used.
Dr Potluri added that there are advanced methods like In-Vitro Maturation (IVM) which helps patients with polycystic conditions.
(Edited by Muhammed Fazil)
