I am 25 and was just diagnosed with polycystic ovarian syndrome (PCOS). My husband and I aren’t ready to have kids now, but we really want to become parents when we’re ready. Is there anything I can do to ensure I will be able to conceive in the future? Should I meet with a fertility specialist now, and what are my options?

Written by our medical expert Dr. Stephen Hudson, Director of the Victoria Fertility Centre in British Columbia, Canada. 

This is a very good question, and I think it demonstrates foresight and responsibility on your part to be addressing your concerns at this stage in your life.

First of all, for the sake of our readers, we’ll discuss some of the implications of PCOS (polycystic ovarian syndrome). Although, like all medical conditions, there are different levels of PCOS, up to 15% of all women may have some features of PCOS. So don’t feel alone!

The typical textbook PCOS “syndrome” may include features such as:

  1. Weight problems (carrying extra weight is more common)
  2. Skin problems such as unwanted facial and body hair, and acne
  3. Anovulatory cycles (irregular and sometimes infrequent periods, and occasionally very heavy periods). This is due to infrequent ovulations. Since ovulation is necessary for getting pregnant, this may present with difficulty conceiving.
  4. Metabolic imbalances, which may include insulin resistance (with a higher likelihood of prediabetes), higher male hormone levels, and unfavourable cholesterol (lipid) profiles
  5. Mood changes (caused by all of the above)

Although you are not planning to be pregnant now, I do feel it wise to consult with a fertility specialist to address the PCOS-related health concerns, and give you some guidance for optimizing your health and quality of life.

Assessment would start with a detailed medical history to identify any unwanted symptoms you may wish to have addressed. Examination would include a physical, pelvic exam with Pap smear and ultrasound to evaluate your uterus, the lining (endometrium) and a detailed assessment of your ovaries. Fertility specialists are very experienced at assessing ovaries, and there are different “degrees” of PCOS. If you are not ovulating at all, the lining of your uterus (endometrium) may become unhealthy from chronic estrogen exposure and inadequate progesterone (progesterone is only produced in ovulatory cycles). Sometimes it may be necessary to take a biopsy from the endometrium to check on the condition of the lining of your uterus. Blood tests would include hormone levels and other specific investigations based on your particular situation.

As for further recommendations, this is what may be suggested:

  1. Weight control. Check your BMI (body mass index) online. I suggest a diet low in wheat, and rich in raw foods (especially greens). There are many popular diets – but a low carb diet is essential both for weight control and managing insulin levels which are often fragile in individuals with PCOS.
  2. Daily aerobic exercise is very important in cases of PCOS both for physical and mental health. An hour a day is ideal.
  3. Supplements. There are specific supplements of benefit to women with PCOS – particularly Inositol. Inositol is a vitamin-like substance that naturally helps restore insulin function at a cellular level. It can help with regulating periods, with fertility and weight loss. Extra folic acid (1 – 2 mg per day) is also recommended. There are many supplements on the market, or you can ask your pharmacist or health store specialist for help. The usual recommended dose of Inositol is 4 g per day.
  4. Ovulation Induction for anovulation and irregular periods. Once you are trying to conceive – you may need ovulation induction. However, that is another subject. In the meantime it is important for you to have some progesterone exposure. If natural methods do not result in regulating your cycles, your doctor may recommend intermittent doses of Progesterone or the birth control pill. This would be to keep your uterus healthy, and prevent unexpected, very heavy bleeding. It should be noted that women with PCOS appear to be at increased risk for DVT (deep vein thrombosis) while on the birth control pill. So this would be an important subject to discuss with your doctor. An extra advantage of the pill is that it can help with skin problems.
  5. Medications. Metformin is a drug which is commonly used in PCOS. Detailed discussion about this is beyond the scope of my answer.

Overall, the good news is that in most cases women with PCOS are able to have healthy babies. Addressing your PCOS early on is responsible and ideal.

To read more about PCOS, click here.

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