Polycystic Ovary Syndrome (PCOS)

PCOS is also among the leading causes of infertility. Infertility is defined as the inability for women of childbearing age to get pregnant after at least one year of actively trying to conceive, and for men, the inability to impregnate a woman. Women who can become pregnant but who cannot carry a pregnancy to birth may also be considered infertile. According to the CDC, the incidence of infertility is higher in black women and is steadily increasing.

In a polycystic ovary, cysts can complicate pregnancy by interfering with the release of an egg during the normal reproductive cycle. During ovulation, reproductive hormones signal the ovaries to release a mature egg. However, individuals with PCOS have abnormal hormone levels that can prevent the egg from growing and maturing (Morrill, RN, 2022). According to MedlinePlus (2020), abnormally high levels of androgens and abnormal levels of other sex hormones increase the risk of complications with conceiving and developing a pregnancy by preventing the release of egg cells from the ovaries and preventing regular menstrual periods.

Making sure you have adequate levels of Vitamin D can help reduce the symptoms of PCOS including infertility. According to Szabolcs Várbíró et al. (2022), Vitamin D levels are linked to both infertility and the severity of PCOS. Frequent and significant Vitamin D deficiency is often found in women with PCOS, and fertility in women with and without PCOS is improved by vitamin D supplementation. Increased Vitamin D levels also improves insulin resistance, which may be responsible for the higher rate of miscarriages in PCOS. 

Possible treatments for infertility for women with PCOS suggested by Xu, et al. (2022) include, but are not limited to:

• Dietary Therapy: Infertility rates in women with PCOS can be improved with weight loss. This often results in a higher rate of pregnancy as well as a decrease in the rate of miscarriages. In women with PCOS who are overweight or obese, even a 5% to 10% weight loss significantly improves metabolic and fertility outcomes (Jessica L. Chan, MD et al, 2023).
• Vitamin D: Appropriate Vitamin D levels improve the quality of embryos, leading to a higher rate of pregnancy and birth in women with PCOS (Várbíró et al, 2022).
• In vitro fertilization (IVF): A specialist retrieves mature eggs from the ovaries which are then fertilized by sperm in a lab. Then, the fertilized egg is implanted back into the uterus.
• Laparoscopic Ovarian Drilling (LOD): A minimally invasive surgery in which a thin, lighted laparoscope is put through a small surgical cut near the belly button. A surgeon uses the laparoscope’s tiny camera to guide them as they cut small holes in the ovaries with a laser. This procedure helps lower the amount of testosterone made by the ovaries to help with ovulation. This technique is highly recommended because it can help with the development of pregnancy in 84% of the women with PCOS who are facing infertility. 

Research led by the University of New South Wales in Australia showed that mice with androgen receptors removed from their ovaries still allowed for PCOS to arise; however, mice that had receptors for androgens removed from their brains did not develop PCOS (MacDonald, 2018). This study supports the idea that excess androgen triggers the condition, but it also presents the idea that the impact of androgens on the brain may be more important than on the ovaries in the development of PCOS. Therefore, if a way is found to stop excess androgen from reaching or affecting the brain, it could potentially treat PCOS. 

The connection between PCOS and obesity is complex. Weight gain and obesity contribute to the development of PCOS, but there are also mechanisms in which the development of PCOS can contribute to weight gain and prevent weight loss (Thomas M. Barber et al, 2019). Obesity is highly associated with PCOS and intensifies features of PCOS such as infertility and insulin resistance. Insulin resistance happens when cells in your muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from your blood. As a result, your pancreas makes more insulin to help glucose enter your cells (Chan et al, 2023). An abnormally high amount of insulin in the blood is often associated with type 2 diabetes (Mayo Clinic).

Besides the physical aspects of PCOS, the disease can also take a toll on mental health. According to Morrill, RN (2022), people with PCOS have higher anxiety, depression, and other mood disorders than individuals without PCOS. Researchers have found that there is a relationship between psychiatric disorders and PCOS through common connections between the nervous system and the endocrine system. For example, stressful events lead to the production of several hormones associated with the flight-or-fight response such as cortisol which then contributes to the overproduction of androgen hormones. Cortisol is a steroid hormone that mainly helps regulate your body’s response to stress among other functions (Cleveland Clinic). As a result of the overproduction of androgen, the development of PCOS is exacerbated (Steegers-Theunissen and Jilliam Greaves, MPH, RD, LDN). 

In addition to mood disorders, women with PCOS commonly have eating disorders like bulimia and binge-eating disorder (Steegers-Theunissen, 2021). This may be linked to the increased levels of testosterone as it boosts food cravings. In this way, PCOS may promote or exacerbate obesity.

Clinical trials are research studies performed to evaluate medical, surgical, or behavioral intervention. Information gathered helps develop medications and strategies to treat and prevent disease. Marginalized racial and ethnic groups are currently significantly underrepresented in clinical trials. In a PLOS (Public Library of Science) Medicine article entitled “Diversity in Clinical and Biomedical Research: A Promise Yet to Be Fulfilled,” the authors state that more clinical and biomedical research should, “provide meaningful opportunities to examine the complex relationship of ancestral influences, environmental exposures, and social factors.” To learn more about the benefits of diverse clinical trials click here.

Currently, the University of California, San Francisco is conducting a study in regards to PCOS and Insulin Resistance Exercise (2015-present). This study is expected to evaluate the extent of PCOS symptoms and the metabolic effects of starting a structured exercise program for women with both PCOS and insulin resistance. Although this study is not accepting new patients at this point, there are other studies that are looking for participants. You can visit CenterWatch to find out if there are actively recruiting clinical trials in your area.

Lifestyle changes can positively impact the overall health and well-being of individuals with PCOS.

• Exercise: Physical exercise and weight-loss activities are important because they promote normal endocrine and adrenal functions which has the potential to result in a decrease of the clinical characteristics of PCOS (Xu, et al. 2022). There are many forms of free exercise: running, walking, dancing, swimming, playing sports, doing aerobics, and practicing yoga or tai chi.
• Nutrition: You should aim at eating a heart-healthy diet with lots of vegetables, fruits, nuts, beans, and whole grains. Limit foods that are high in saturated fat, such as meats, cheeses, and fried foods. Accessing and affording healthy, organic foods may be difficult, but choosing organic foods is important to minimize your exposure to EDCs. Eating healthy foods and weight control are among the key treatments for PCOS.

Oftentimes, a lack of understanding of PCOS symptoms, healthcare gaslighting, or feeling alone in your struggle with these symptoms can be discouraging and isolating. According to Louise F. Pendry et al. (2015), online discussion forums have benefits at individual and social levels and are positively linked to well-being for stigmatized group members. Forums allow people to form communities and connect with like-minded individuals. 

Some popular and active forums for those with PCOS include, but are not limited to:

• AskPCOS
• PatientsLikeMe
• PCOS Challenge

PCOS CHALLENGE
The mission of PCOS Challenge is to “raise public awareness about PCOS and help girls and women with the condition overcome their symptoms and reduce their risk for related life-threatening diseases such as diabetes, cardiovascular disease, and cancer.” The organization was founded by Sasha Ottey, Researcher and Clinical Microbiologist because she recognized that PCOS is severely under-diagnosed and PCOS research is severely underfunded. The organization has a TV series, a podcast, and a magazine to increase awareness surrounding PCOS.

PCOS AWARENESS ASSOCIATION
The PCOS Awareness association is “dedicated to the advocacy of polycystic ovary syndrome (PCOS). The organization and its volunteers are dedicated to raising the awareness of this disorder worldwide, providing educational and support services to help people understand what the disorder is and how it can be treated. The Association also provides support for people diagnosed with PCOS to help them overcome the syndrome and decrease the impact of its associated health problems.” They have an online support forum called MyPCOSTeam.