Leading Cause of Hormone-Related Infertility

Polycystic ovary syndrome (PCOS) is a disorder that affects 1 in 10 women of childbearing age. “It is a combination of symptoms resulting from the inability to ovulate,” says Northwestern Medicine Reproductive Endocrinologist Christina E. Boots, MD.

Because women with PCOS are not able to ovulate regularly, it is the leading cause of hormone-related infertility. “If there’s no egg, there’s no chance of getting pregnant,” explains Dr. Boots. “It’s hard to get the timing just right.” While PCOS can be a challenging diagnosis, help is available to manage your symptoms and to grow your family.

Signs and Symptoms of PCOS

Although the exact cause is unknown, PCOS has been linked to genetics, heightened levels of male sex hormones (androgens) and insulin. These hormone imbalances can impact the metabolic system and result in some of the following symptoms:

• Irregular menstrual cycle. This includes infrequent periods (fewer than eight per year).
• Hair growth. Heightened levels of testosterone may result in male pattern hair growth, like facial hair, sideburns or whiskers.
• Acne. Acne may occur on the face.
• Alopecia. This type of hair loss results in thinning of the hair, including a widening part.
• Weight gain. The metabolic component of PCOS makes it easy to gain weight and much more difficult to lose weight.

Diagnostic testing may help confirm PCOS. For example, your physician may use an ultrasound to examine your ovaries. With PCOS, “ovaries are enlarged with multiple follicles on them,” says Dr. Boots. “These follicles have an egg inside of them, but it’s like a traffic jam in the ovary.”

A blood test can also be ordered to check your hormone levels.

Symptom management is important, as the effects of PCOS can put you at risk for complications or other long-term health problems. These can include:

• Diabetes. Those with PCOS are often insulin-resistant, which can lead to type 2 diabetes. While you can offset type 2 diabetes with healthy lifestyle changes, PCOS can complicate diabetes management. If you have PCOS and diabetes, your physician will work with you to develop an appropriate care plan.
• Heart disease. There is a link between PCOS and an increased risk for cardiovascular disease. This is likely related to the links between PCOS, diabetes, sleep apnea and being overweight.
• Depression or anxiety. Mental health concerns can result from hormonal imbalances that occur with PCOS, and research suggests a higher risk of mood disorders. “There is a whole interplay with self-confidence and body image, and some of that has to do with hormone dysfunction,” adds Dr. Boots.
• Cancer of the uterine lining. Unmanaged symptoms can lead to endometrial cancer.

What the Future Holds

While there is not a known cause of PCOS, research continues to evolve, with a focus on the role of genetics.

“At Northwestern Medicine, we are developing a model of a PCOS ovary so we can better understand how it works outside of the body and observe how medication may break the vicious cycle of too many hormones and insulin,” says Dr. Boots.

If you are struggling with PCOS, remember you’re not alone. The Northwestern Medicine Fertility and Reproductive Medicine team can discuss your options regarding infertility, pregnancy loss and other reproductive concerns. See how our infertility experts can help provide emotional support, manage your symptoms and help you build your family. They can help guide you through available treatment options, including intrauterine insemination (IUI) and in vitro fertilization (IVF).