Scientists closer to pinpointing cause of PCOS
By Dr Rozeena Musa, specialist at City Fertility Centre Brisbane Southside
Polycystic ovary syndrome (PCOS) is the most common cause of female infertility, with one in five women affected by it worldwide, and roughly three-quarters of these women struggling to fall pregnant. Until now the cause has been unknown, but researchers have recently found that it may be caused by a hormone imbalance in pregnancy that is passed on to the baby.
Excess exposure in the womb to a hormone called anti-Müllerian hormone (AMH) may trigger the PCOS syndrome before birth.
The French National Institute of Health and Medical Research found that pregnant women with PCOS have 30 per cent higher levels of AMH than normal. Since the syndrome is known to run in families, the researchers wonder whether this hormonal imbalance in pregnancy might induce the same condition in the daughters of those affected.
Putting the theory to test on mice in a laboratory setting, the researchers found the AMH excess raised the level of testosterone, but this was able to be reversed using cetrorelix, an IVF drug routinely used to control women’s hormones.
The team is now planning a clinical trial of cetrorelix in women with the condition, and hopes to start before the end of the year. The researchers hope it will minimise the symptoms of PCOS and result in restoring ovulation and eventually increasing the pregnancy rate in these women.
Until these results are known, here is a summary of how PCOS can currently impact fertility and what treatment options are available:
How can PCOS impact fertility?
PCOS can have a substantial impact on fertility due to the abnormal progression of the ovarian follicles. Normally during the month, the follicles go through certain hormonal cycle responses and they reach a stage when there is a release of an egg through ovulation. Then if fertilisation with a sperm occurs, an embryo can be created. However, with PCOS, there is abnormal follicular growth in response to the hormone cycle, often followed by a lack of ovulation, and progesterone is produced, causing significant subfertility with unopposed estrogen. This not only affects fertility but also other aspects of health.
What are the treatment options for PCOS?
If fertility is the main priority for a woman with PCOS, the first line of treatment, which can have a huge impact, is lifestyle, diet and exercise. A healthy lifestyle improves all of the symptoms of PCOS, including fertility. If an overweight woman loses at least 5 per cent of her weight, she can sometimes go to spontaneous ovulation on her own. Her chances of not only getting pregnant but sustaining a healthy pregnancy with a good outcome are significantly improved. Lifestyle should never be underestimated.
The second step is ovulation induction, which can be done by clomiphene citrate (Clomid or Serophene), which is a tablet, through a certain regimen, or can be done with an FSH injection of a small dose. It depends on the clinical scenario. Up to 40 per cent of women using clomiphene will have success in ovulating, resulting in pregnancy rates comparable to those of the general population. Both ways, they need support through the process, clinically and personally.
If infertility is not the immediate concern, the combined oral contraceptive pill (OCP) can be prescribed to reduce acne and hirsutism and maintain regular menstrual periods. Most importantly, the OCP provides constant progesterone to protect the endometrium and decrease the risk of uterine cancer from the unopposed estrogen that is a common feature of PCOS.
Women with PCOS also need second-yearly Glucose Tolerance Tests (GTT) and regular metabolic screening such as a cholesterol check.
Unfortunately, PCOS is a chronic condition (just like asthma is), and while women living with it can never completely be free from it, they can control and minimise the effect of it on their life and health through careful management with their healthcare professionals. The results of the abovementioned study will also be interesting to follow, potentially resulting in new treatment options for women with PCOS into the future.
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