Polycystic Ovary Syndrome (PCOS) affects approximately six to 21 per cent of women of fertile age, causing difficulties in falling pregnant naturally. Shonagh Walker investigates the condition and reveals that you can fall pregnant with PCOS.

At age 31, author and business communication specialist Amber Daines-Unger (now 45) and her husband David decided it was time to start their family.

After taking the contraceptive pill throughout her twenties, Amber was realistic. She knew she may have to wait a few months before things started happening in the baby stakes.  But she didn’t expect she would still be trying to conceive more than 12 months later.

“I just wasn’t getting my period,” she recalls. “So, every month I’d think I was pregnant when I wasn’t.”

She laughs, “I went through so many pregnancy-testing sticks. “Ironically, I had spent all my twenties trying not to fall pregnant and then when I really wanted to, I couldn’t!”

Being naturally on the slender side, the thought that she may have Polycystic Ovary Syndrome (PCOS) didn’t even cross her mind, despite displaying some other common symptoms relating to the condition, such as oily skin, adult acne and extra hair growth on the face.

“In terms of health profile, I assumed I didn’t have an issue. I just put the other stuff down to my hormones being slightly out of balance because I was coming off the pill – nothing more serious than that.

“I was fit, slim, ate healthily and exercised. At 31, I truly didn’t think I would have that much trouble conceiving. I wasn’t aged over 35 when your fertility begins to decline.

“I saw a lot of different doctors, and they all told me to keep trying. None of them suggested PCOS as I apparently didn’t fit the typical profile. I finally came across a really fabulous holistic GP who tested me for insulin resistance, which is a key factor in lean people with PCOS.

“He diagnosed me with insulin resistance and then sent me to have an ultrasound, which showed I had PCOS. I was so lucky to have found the right doctor at the right time and that I didn’t have to go down the IVF path.”

Amber was prescribed an insulin resistance drug called Metformin. “It is used to help manage your blood sugar,” she explains. “I ovulated and fell pregnant almost straight away.”

“I actually didn’t even get the script filled out. I found out that exact same night that I was pregnant, which was amazing. I was on a low GI diet, and I made sure that I avoided refined sugar and bad carbohydrates. I was totally prepared to take the drug, but we were so lucky that we conceived naturally with our second boy, Remy, who is now eight years old.”

Both of Amber’s pregnancies were issue-free, healthy and easy.

“Both were absolutely smooth sailing,” she smiles. “The only thing that really stood out was that Zeke, my first boy, was very small when his due date arrived, so I was induced at 37 weeks. He had stopped growing in utero. So, he wasn’t premature, he was just a tiny 2.1 kilos and required a bit of neo-natal care in hospital to get his birthweight up.

“Aside from that, there were absolutely no other issues. And here’s a fun fact … both boys were born by natural birth (no C-section) on exactly the same day – just four years apart!”

While Amber’s story does make it sound easy, she reminds us that the PCOS journey is also fraught with emotion, as anyone who has the condition will attest.

“You are going through this whole process, and it comes with a mixed bag of emotions. I was frightened, anxious … I wanted to be perfectly honest with everyone about what was happening, but back then nobody really spoke about fertility issues the way they do now. People would only share when they had a baby, they certainly weren’t sharing the struggles. Now all these things are coming to light on social media. There are Instagram accounts and Facebook pages that highlight the conditions, which is fantastic.

“It is so important we share these things so we can support and help other women who may be experiencing it too. I believe we are lot more proactive about our own health nowadays too, which comes down to having the right information and knowing that other people have gone through something similar.

“It’s also important to remember that while age is a huge factor in fertility, you can still be in your 20s and have issues, related to conditions like PCOS, so I believe that all girls and women to be across their fertility health from a young age, even if they aren’t at the stage where they want to have a baby.”

“Polycystic ovarian syndrome is the most common hormone problem among women of fertile age. It can occur in teenage girls and women of all ages even after menopause, when ovulation ceases. This is because it can be related to insulin resistance, which in turn may lead to Type 2 Diabetes. Medically, we also refer to it as Syndrome X and Metabolic Syndrome.

Approximately six to eight percent of women across the world are affected by PCOS, and it accounts for a significant proportion of visits to fertility specialists.

It is associated with increased male hormones which lead to issues around menstruation and problems with the skin. Women and girls who have PCOS have tiny cysts on their ovaries. These are the result of immature follicles that did not grow and facilitate the release of an egg into the fallopian tubes.

PCOS is a bit of a silent condition, in that it isn’t really painful, however there are visible signs that you may have it.

In a nutshell, the classic presentation of PCOS is a young woman who is overweight, has irregular periods that may come every three or four months and when they do come, they are very heavy.  She may also experience increased acne on her face and increased hair growth on the chin and upper lip. However, there is more to the condition, as even very slender women can have PCOS.

Here is a more detailed list of the symptoms of PCOS:

• You are overweight
  While lean women like Amber can get PCOS, it is more typically associated with women who are overweight. Women and girls with PCOS also find losing weight quite difficult.

• Your periods are irregular or absent
  This is due to the ovulation process being hindered by the immature follicle.
• Your skin is oily and you have acne
  The presence of male hormones that we call androgens increase oil flow in the skin, which can result in acne if bacteria is also present.
• Your hair is thinning
  Women and girls with PCOS often also suffer from alopecia, or thinning hair/hair loss, again due to the increased male hormones.
• Increased hair growth on the face and body
  While the hair on your head is thinning, you may also find that there is an increase of hair growth on your face and certain areas of your body, like your nipples and belly button.
• You have pigmentation
  Pigmentation is common sign of PCOS and it usually presents in the skin around the neck. It is related to high levels of insulin and testosterone, Medically, we refer to it as acanthosis nigricans.
• Skin tags
  Again, skin tags may present in various places of the face and body, due to the imbalance in insulin and male to female hormones.
• Difficulty getting pregnant
  Women of fertile age with PCOS who are trying for a baby may find it difficult to conceive a baby naturally, which can be very emotionally draining. This is because the follicles that are responsible for releasing the egg into the fallopian tubes each month do not mature and do their job. We can often treat the condition with medication, as was the case for Amber, without having to explore IVF options. Other times, we may need to explore IVF options.

Diagnosing PCOS

“Often it is easy to diagnose PCOS, if the patient presents with the classic symptoms as described above. However, as we have already discussed, the clinical picture I’ve painted can also occur in a slim woman, which can make diagnosis harder.

“Some women with PCOS may only have severe acne, while others may only have erratic periods. Others may have perfect skin, but experience weight gain.

“This means we may need to conduct further testing, which could include a blood test to detect increased male hormones and /or an ultrasound to reveal a polycystic appearance of the ovaries.

There has been much debate by doctors and scientists over the past 30 years around PCOS, mainly as to what the definition of this condition should be, as it has such varying features. In 2003, a conference in Rotterdam came up with a new definition of PCOS to give more uniformity and lessen the ambiguity.

To be diagnosed with PCOS, you must have two of the three below criteria:

• Your blood test confirms the presence of increased male hormones we call Androgens, or you show clinical signs of increased male hormones. This means having signs such as acne, or increased hair growth on your face or body called hirsutism.
• You have infrequent or no periods (i.e., menstrual bleeding), this indicates infrequent ovulation (releasing of the egg from your ovary)
• You have a pelvic ultrasound showing at least one ovary to have many small cysts. It has to be 20 or greater cysts

If you think you have PCOS, see your GP or a fertility specialist to be tested.

The doctor would organize further tests, and these are:

• A pelvic ultrasound looking specifically at the appearance of your ovaries to see if they had the classic cystic picture.
• A blood test to check hormones from your brain and ovaries
  • Brain hormones: LH luteinising hormone, FSH follicle stimulating hormone
  • Ovarian hormones: estradiol an estrogen
  • Male hormones produced by the ovary: Testosterone, Androstenedione and free androgen index to see if they were raised above the normal levels.
• Associated tests with the insulin receptor and weight/BMI.

More Information

For more information on PCOS, please download Dr Raewyn’s e-book How To Get Pregnant With PCOS!