Polycystic Ovarian Syndrome (PCOS) is a common but frequently misunderstood hormonal disorder. It affects about 1 in 10 women of reproductive age, with prevalence varying among ethnic groups. Its exact cause remains elusive, but it is believed to have genetic links, as it often runs in families. 

Women with PCOS experience a hormonal imbalance that prevents the maturation and release of eggs from the ovaries each month, leading to numerous small cysts within the ovaries (hence the name Polycystic Ovary Syndrome). A metabolic disease, PCOS is one of the most common causes of infertility. 

In the following article, we will explore the complexities of PCOS, including its diagnosis, symptoms, potential implications on fertility, and the available treatments.

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Understanding PCOS

PCOS is a condition characterised by several key features:

• Frequency: PCOS affects 1 in 10 women of reproductive age, and is one of the most common causes of infertility.
• Disrupted Ovulation: Women with PCOS experience an imbalance in their hormones, disrupting the regular maturation and release of eggs (ovulation) from the ovaries each month. The many unreleased eggs then become many small cysts in the ovaries.
• Higher Androgen Levels and Insulin Resistance: PCOS is often associated with elevated levels of androgens, often referred to as "male hormones," and insulin resistance, which can contribute to various symptoms and health issues.

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Symptoms and Signs of PCOS

PCOS can manifest through a wide array of symptoms, which may include:

• Irregular or Absent Menstruation: Many women with PCOS experience irregular menstrual cycles or may even miss periods altogether due to disrupted ovulation.
• Excessive Hair Growth: High levels of androgens can lead to unwanted hair growth in areas such as the face, chest, and back.
• Acne: Hormonal imbalances often contribute to acne breakouts, affecting the skin's health and appearance.
• Hair Loss: Some women with PCOS may encounter hair thinning or loss on the scalp.
• Weight Gain and Obesity: PCOS is frequently linked to difficulties in managing weight and an increased risk of obesity.

For women doing a fertility check, higher-than-usual egg reserve levels (tested through the Anti-Mullerian Hormone Test) may point towards the presence of polycystic ovaries. 

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Diagnosing PCOS

Diagnosing PCOS involves a thorough assessment, including:

• Medical History: Gathering information about a woman's medical history (e.g. if periods are regular) and symptoms.
• Physical Examination: Conducting a physical examination to identify any visible signs (e.g. facial hair).
• Blood Tests: Measuring hormone levels in the blood, (e.g. androgens like testosterone).
• Ultrasound Scan: Performing an ultrasound scan of the pelvis to detect the presence of multiple small cysts in the ovaries, a key characteristic of PCOS.

A diagnosis of PCOS is typically established when a woman presents at least 2 out of 3 of the following findings: irregular or absent menstruation, high androgen levels, and the presence of polycystic ovaries on ultrasound.

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Impact of PCOS on Fertility

PCOS can significantly impact fertility due to symptoms like irregular menstrual cycles, which affect the regularity of ovulation. Without consistent ovulation, the chances of releasing an egg for fertilisation are reduced, often leading to infertility issues.

However, conceiving with PCOS isn't out of reach. It's a widespread condition and is considered one of the most treatable causes of infertility in women. Women with PCOS are encouraged to discuss with their healthcare providers about ways to balance hormones and prepare for pregnancy.

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Treatment Options

Treatment for PCOS aims to alleviate symptoms and assist with fertility, tailored to the individual's needs:

• Irregular or Absent Menstruation: Oral contraceptive pills are often prescribed to restore regular menstrual cycles and hormonal balance.
• Difficulty in Getting Pregnant: Women trying to conceive may benefit from ovulation induction drugs and hormonal injections to stimulate ovulation.
• Excessive Hair Growth: Methods such as shaving, waxing, and IPL hair removal can help manage unwanted hair growth.
• Insulin Resistance: Medications like Metformin and other insulin-sensitising drugs may be recommended to improve insulin resistance and reduce the risk of type 2 diabetes.

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Egg Freezing and PCOS

Women with PCOS can certainly opt for egg freezing. This proactive measure can help increase the likelihood of having children in the future. It's generally recommended to freeze eggs at a younger age to ensure the highest egg quality.

It is important for women with PCOS to seek care from skilled fertility doctors during the egg freezing process. They have a higher risk of developing ovarian hyperstimulation syndrome (OHSS), particularly due to a greater number of follicles that may overreact to HCG, a possible drug used in egg freezing. In a study of 2,699 women with PCOS undergoing IVF, 75.2% had a normal response to controlled ovarian hyperstimulation (COH), while 24.8% experienced OHSS.

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Summing It Up

PCOS isn’t just a single issue, but a constellation of symptoms that many women have. As women with PCOS may face issues of infertility, it may be a wise move to consider egg freezing with an experienced fertility doctor.

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