Polycystic Ovary Syndrome (PCOS) is one of the leading causes of infertility in women due to its complex hormonal imbalances and metabolic effects. Here’s how PCOS affects fertility:
Ovulatory Dysfunction in PCOS
One of the primary reasons PCOS leads to infertility is ovulatory dysfunction, where ovulation either occurs irregularly or not at all. This happens due to the following factors:
Imbalanced Hormones in PCOS
Women with PCOS often have elevated levels of androgens (male hormones such as testosterone, DHEAS, androstenedione, and/or dihydrotestosterone), which can disrupt the growth and release of eggs from the ovaries.
Increased Luteinizing Hormone (LH)
LH, which helps trigger ovulation, is often elevated in PCOS. However, a persistent high level of LH disrupts the normal maturation of eggs.
Low Follicle-Stimulating Hormone (FSH)
FSH is essential for stimulating the development of ovarian follicles. When its level is low or inconsistent, it leads to the formation of tiny, immature follicles that never mature enough to release an egg (anovulation).
Insulin Resistance and Infertility
Many women with PCOS also have insulin resistance, which means their bodies struggle to use insulin effectively. Elevated insulin levels can lead to:
Increased Androgen Production
The ovaries respond to high insulin levels by producing more androgens. This further disrupts the menstrual cycle and ovulation.
Weight Gain
Insulin resistance is linked to weight gain, particularly around the abdomen. Obesity exacerbates hormonal imbalances and makes ovulation less likely.
Hormonal Imbalance and Infertility
Elevated Androgens
High levels of androgens in PCOS not only affect the menstrual cycle but also impact the development of ovarian follicles, leading to irregular ovulation or anovulation (lack of ovulation).
Elevated Prolactin
Some women with PCOS may have elevated prolactin levels. This hormone, usually responsible for milk production, can interfere with ovulation by suppressing the production of FSH and LH.
Impaired Egg Quality
In addition to affecting ovulation, hormonal imbalances in PCOS can also impair the quality of the eggs, reducing the likelihood of successful fertilization.
Irregular Menstrual Cycles
Irregular or absent menstrual periods are common in women with PCOS. Regular ovulation means regular menstrual cycles. Without regular ovulation, there are fewer opportunities to conceive, as the release of a mature egg is necessary for fertilization.
Endometrial Health and Fertility
A prolonged lack of ovulation can affect the lining of the uterus (endometrium). Without regular shedding of the lining through menstruation, the endometrium can become too thick, which may lead to implantation problems even if an egg is fertilized.
Obesity and Its Impact on Fertility
While not all women with PCOS are overweight, obesity is a common feature and contributes to worsened insulin resistance, hormonal imbalance, and inflammation, further complicating ovulation and adding to infertility.
Inflammation in PCOS
Low-grade inflammation is often present in PCOS. Chronic inflammation can contribute to insulin resistance and hormonal imbalances, disrupting ovulation and causing infertility.
How Can PCOS Fertility Be Improved?
- Lifestyle Changes: Weight loss through diet and exercise can improve insulin sensitivity, regulate menstrual cycles, and enhance fertility in women with PCOS.
- Vitamins, Minerals, and Herbs: Certain vitamins, minerals and herbs improve insulin sensitivity, balance hormones, and address PCOS-related infertility.
Understanding these mechanisms can help women with PCOS take steps toward improving their fertility through naturopathic medicine interventions, lifestyle changes, or a combination of both.