Conditions Affecting Fertility

PCOS & Infertility

Polycystic Ovary Syndrome is a common endocrine or hormone disorder affecting women. The condition leads to an increased lifetime risk of gestational diabetes, type 2 diabetes mellitus and endometrial cancer. Reproductive disorders such as irregular menstrual bleeding and fertility problems are common. Other features include acne and hirsutism. There are associated psychological features often under-diagnosed such as depression and anxiety.

PCOS affects between 8-13% of women of reproductive age with varying prevalence in different ethnic populations. Australia has a high prevalence of PCOS with 21% of the indigenous population being diagnosed with the syndrome.

Reproductive Features

Irregular cycles or amenorrhoea are common features of Polycystic ovarian syndrome and occur as a consequence of infrequent ovulation or not ovulating. This is the leading cause of infertility in patients with PCOS, however, excess weight gain exacerbates these problems. Polycystic ovarian syndrome accounts for up to 90% of patients with delays conceiving due to not being able to ovulate and 60% of patients with PCOS are fertile but take on average a longer time to conceive.

Unfortunately PCOS has been found to increase the risk of pregnancy related complications. These include miscarriage, gestational diabetes, blood pressure disorders of pregnancy, induction of labour and caesarean delivery.

Other Features of PCOS

At least 60% of people diagnosed with polycystic ovarian syndrome have features of hair loss, acne or unwanted excess hair growth. Excess hair growth mostly occurs on the face, chest, back and abdomen.

Anxiety and depressive symptoms are common in all adolescents and women with PCOS at diagnosis and this is emerging as an important feature of the condition. An increase in depressive symptoms were found in almost half of the patients who had PCOS. In one study most women reported that psychological issues were not recognised by health care workers. Counselling support and referrals are available for patients with PCOS.

Long Term Risks

Polycystic ovarian syndrome has been associated with an increased risk of gestational diabetes, heart disease and diabetes mellitus. Other risks include endometrial cancer and elevated cholesterol.

Endometrial cancer has a two to six fold increased lifetime risk in patients with polycystic ovarian syndrome. There needs to be a very low threshold for screening and further investigation in patients with PCOS.

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