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How PCOS Impacts Fertility

[00:00:00] Hey there, friends. Welcome to lunchtime Live with the center where we talk about fertility topics and answer your questions too. My name Ami Chokshi, I’m your host, and September is PCOS Awareness Month. And Dr. Claudia Benadiva, who is a lead physician and the medical director here at the Center for Advanced Reproductive Services will be sharing his expertise now over the years.
[00:00:22] Welcome Dr. Benadiva, First of all. Thank you, Ami. Thank you. My pleasure. Now, over the years you’ve seen many women diagnosed with PCOS here at this center. Can you talk a little bit about what PCOS is? Sure. Yeah. I would say it’s probably one of the most common problems that we see in our clinic and in general.
[00:00:43] And that is because it’s one of the most common hormonal disorders in in women. The statistics that affects five to 10% of women. So imagine that it’s a very, it’s a very large percentage of women that have P the, the name, , PCOS stands for ovarian syndrome. And some people have criticized that name because it’s a little bit of scary name.
[00:01:07] , polycystic amongs patients imagine their over is filled with a, some huge number of cysts that they need to get rid of. And some people have even suggested to change the name. Maybe it should be changed. The problem is been used for so many years that we’re all used to call it PCOS. And basically it’s, it’s It’s a genetic disorder.
[00:01:27] Nobody has really found the exact reason. But it’s, it’s really suspected to have it underlying genetic basis. And it’s not just fertility problem, it’s more what we know today is that it’s more of a metabolic disease. So women with PCOS have other issues. A lot of women have.
[00:01:45] Excess weight. They’re overweight, they have obesity, and that’s part of the problem. They have a insulin resistance, so their bodies are more resistant to the insulin, so they, they, they make, they have to make more in insulin to get. Their blood sugars under control and sometimes they develop diabetes.
[00:02:02] One of the big issues with PCOS is the risk of developing diabetes over, over the years. Mm. So the fertility aspect is just one of the problems. The ones that , obviously the one that we. The most because patients that we see are interested in having babies. So we deal with the, their fertility aspects.
[00:02:22] But that’s not the only one. Women with, with PCOS have irregular cycles. They also have sometimes the excess hair growth and, and they may have different issues that takes them to see the doctor. And how do you, how, how is it diagnosed in the, in the office? Yeah. Well, it’s, it’s interesting because.
[00:02:43] A lot of women get surprised sometimes. When I saw somebody this morning actually and they never told me that I had PCOS. And so it’s really pretty simple to make the diagnosis because you don’t need that much. You just need to get a little bit of a history of the patient and ideally do an ultrasound, a transvaal ultrasound to look at the ovaries because.
[00:03:05] The criteria that is kind of universally accepted the patient has needs to have two out of three criteria, and these are being called the rotor them criteria cuz. There was a meeting in the city of Rotterdam where they came out with this criteria, and that’s been sort of universally accepted as a definition or to diagnose PCOS.
[00:03:26] So if you have two out of the three and two out of the three, they’re very easy to determine. One is irregular cycle, so women don’t all relate regularly. Every month they get very irregular period. So that just needs to keep a menstrual calendar or just ask the patient, you get your period every month.
[00:03:43] So if you don’t, so that’s one out of the three. The second one is also clinical is any. Evidence of some excess androgen production, any andros or male hormones. So women with PCOS, a lot of the times the ovaries will produce an excess of male hormones like testosterone, so that can cause excessive care growth.
[00:04:06] In the face or body or acne, right? So if the patient has excessive care growth or acne, then you got number two. And the third one is the called polycystic over is on ultrasound. And again, this is not. Large, huge cyst. , in the over, they’re actually tiny little fluid filled ss, less than a quarter of an inch that are called follicles and they’re this fluid fill ss, anything with fluid is cyst, so that’s what they call it, polycystic.
[00:04:37] So these are just the ads. So they’re the immature X that are not getting released every month because the cycles are not regular. So they start accumulating in the ry. So when you do an ultrasound, if you see more than 12 of those little follicles in the accumulating, in the ary, so that fits the ultrasound, , definition.
[00:04:59] For the same reason the Aries are usually a little bit of large. So if they’re large volume, more than 10 cubic centimeters, that’s also part of the ultrasound definition. So if you do a vaginal ultrasound, you see more than. A little. Okay. Fors and those are the eggs. So that’s why a lot of patients sometimes ask me, Can you get rid of the c?
[00:05:17] I said no. you don’t wanna get rid of the C cuz these are your eggs. What we want is to, , replace them so you ovulate and you can have a baby. And If a patient has two out of the three, so that’s according to this rotor than criteria, famous rotor than criteria. That’s the definition of PCOS.
[00:05:35] So it will have the diagnosis made. Okay. And how does PCOS impact fertility? Well, the, the main way that affects fertility is by affecting the normal cycle, the normal ovation. So, , you need to get pregnant, you need to have an egg release that’s called ovulation, and that egg needs to be fertilized in sperm, make an embryo implant, et cetera.
[00:06:01] So the main issue, women with PCOS, because they don’t have regular cycles, they don’t have normal ov. Sometimes they don’t ate at all. Okay? Sometimes they ate, but in a, not in a regular basis. So they ovate sporadically. And if you don’t release an egg regularly, it would be hard to get pregnant.
[00:06:22] Not impossible, but you need an egg, you need sperm. So we have, , many different options to make that happen. . Okay. And does, does having PCOS mean that you, that a person, someone needs to go straight to ivf, how is it treated? Actually no. No, not at all. If I have to guess, I think that the majority of.
[00:06:42] Patients with PCOS that we see don’t need ivf. I think it’s a small percentage because the problem is with ovulation, if we can get the patient to ovate by some other more simple treatments then they will not need ivf. So before ivf there are many other treatment options. One. The one that is always recommended first is maybe not the easiest one to achieve, but is the number one in the list is lifestyle changes.
[00:07:13] Large percentage of patient PCOS are obese, are overweight, and that kind of compounds the problem, increases that insulin resistance that I mention. A few minutes ago. So if you lose weight, and according to the studies, women don’t need to lose that much weight to get the benefit. Even just 5% of weight loss is beneficial.
[00:07:35] So weight loss exercise increased, , physical activity could be. To restore the regular cycles. We have for many years, , a very, very wonderful oral medications pills that help women over it, and they work really well for, for patients with PCOS, the, probably the, the best well known is CL or CL Insight rate is a generic name or cl.
[00:08:01] It’s most famous or popular fertility drug. Women take it sometimes for other reasons, but very, very helpful for PCOS being used for many, many years. And it’s just one, , just a pill that it’s taken for five days and could be enough to help. , we store normal ovulation and help a achieve a pregnancy.
[00:08:24] There’s another pill that actually has become more and more popular and more recently is considered the first choice even before climate. It’s called letrozole and it’s taken in a similar way, five days the cycle. And it works very well. Some of the studies show that it may even be a little better than climates in both climate or letters of are the most popular options for the initial.
[00:08:50] Treatment of PCOS I mentioned that insulin resistance as part of this syndrome. So there are medications to treat the insulin resistance. So if we determine that a patient has insulin resistance and there are some easy blood tests to check for that, like the two hour glucose test.
[00:09:09] They give the patient to drink some sugar, some glucose, and then check the blood sugar one and two hours later and see what happens. And if it goes up too high means that there’s not enough insulin being made, then that makes the diagnosis. So this patient’s benefit from some diabetic drugs like metformin.
[00:09:28] So metformin is something that. Patients PCOS have heard or they have been treated with by their primary care or even their, their o B gyn because it’s so well known and so popular. It’s used for people with diabetes, but because of the how close PCOS and diabetes are in many ways. . Metformin is, is.
[00:09:50] For women with PCOS that have that insulin resistance that I mentioned before, that is, is very common. So adding metformin and not probably by itself, but in, in addition to everything we discussed, the weight loss exercise, let resolve vomit and metformin formin. So all al. Help us to kind of fix this problem that is so common.
[00:10:14] Okay. And you mentioned lifestyle factors impacting your fertility losing 5% of your weight loss could, or losing 5% of weight could be helper. Is there anything else that you’d like to add to that? Well, yeah, the diet and and increased physical activity exercise. This is a metabolic disease and, and the thing that sometimes women who have PCOS need to remember is that the story doesn’t end when they get pregnant.
[00:10:40] I mean, that is obviously our call and we celebrate, , when that happens. But because this is sort of a. These disease, they’re gonna carry that all their lives. So in the future they may, , not, you worry about the fertility because you already got pregnant, have children. But there be other issues like high blood pressure, hypertension, obesity, that type two diabetes, increasing cardiovascular.
[00:11:05] There is all this. Metabolic component of the PCOS is just as important because it’s long term, , the pregnancy we can help. And then the rest of your life, , these patients have to deal with all these health issues. So as I think it’s very, very important that they don’t forget that and they check for, , diabetes and they stay on a healthy diet.
[00:11:28] And a healthy diet is a low carbohydrate diet. High protein. But definitely low carbohydrate results if they had diabetes. So watch the blood pressure. Watch the cholesterol because that’s the rest of your life that you need to watch all these things. Okay? And increasing exercise and physical activity helps to lower.
[00:11:48] Insulin resistance, so that definitely helps everything else. Now, metabolic syndrome is one aspect that you talk about. Are there other types of PC OS that don’t involve, don’t have that, or is that a key component of this? Well, that, that’s a very good question because yes, there are different types. I, I’ve seen, , I’ve seen patients that are not obese. They call me Lean, PCOS. I’ve seen patients that don’t have any excess growth. And not everybody has the insulin resistance or the problems with their cholesterol or with their lipids. So there are cases of mild PCOS that only have just mild symptoms.
[00:12:30] So I think you remember those three rotor them criteria that I mentioned in the beginnings, you need to have two out of the three. They can, Any combination is responsible. Okay. So there, there, there are patients that have irregular cycles and polycystic over on ultrasound. They, but they don’t have the excess testosterone.
[00:12:50] . , they growth excess androgens. There are patients that they have the excess hydrogens and the re cycles, but their Aries don’t look like they don’t have PCOS over. So if the. Out of three combinations could be exchangeable and, and they define different types of problems. And that, so, and I’ve seen a lot of patients that they have in mild taste in P Cs and maybe they are able to keep their weight in check.
[00:13:16] And they are active and they exercise a lot. So their PCOS is minimal. Okay. Affect doesn’t affect their life. So that’s the ideal, in my opinion. That’s the ideal situation that you can keep it in, check with the lifestyle changes and improving your lifestyle. And one last question. Well, if someone is diagnosed with PCOS when they’re younger, does that automatically mean that they may need some help getting pregnant down the road?
[00:13:44] Hmm. That’s all. difficult question because it’s, it’s hard to predict things are gonna evolve over the years in the future. And I think it’s very likely, I think it’s very likely that they may need some help. But , , it depends also on their lifestyle. Let’s say, , adolescents and they’re overweight and they’re start developing PCOS, then they change, they start getting, Very active in sports and losing weight, and maybe they will become mild case and have a no issues when they try to get pregnant unfortunately, sometimes they progressively gain more and more and more weight and the PCOS gets worse.
[00:14:22] They, of course, they’re gonna need some extra help. So I don’t think it is, an automatic prediction that they’re gonna have fertility problems in the future. I think if they’re able to modify their genetics, I mean, unfortunately we’re all born with different genetic makeup, so if you are. Aware that that’s, , your genetics and you’re able to do everything that is gonna help you to deal with it in a better way.
[00:14:47] So I think those adolescents that sometimes are there with PCOS can, can avoid a lot of the problems in the future, hopefully. Okay. Is there anything else you’d like to share about PCOS that we haven’t already? Hmm. I think there are several things that we didn’t talk about that we didn’t cover.
[00:15:05] And one is that the treatment of PCOS, it really changes throughout the woman’s life. It depends what they’re, they’re looking for what their main problem is. And I would say before, like adolescent with PCOS or younger patients that are still not interested in getting pregnant, but they have some of the irregular cycles and maybe the excessive care.
[00:15:27] So we will focus the treatment on that. Okay. Birth control pills is a very, very, very good option for women with PCOS. Does a lot of good things. It does. Lower them. Excessive care helps with hair growth, it helps with the acne. It gives them regular cycles, so that’s very helpful.
[00:15:46] Sometimes we add some medications if they have acne or hair growth to try to improve that. , when they are interested in getting pregnant, we will obviously change the approach and we will focus on helping them overate and helping them consider later in life. Let’s say they already have children there, now they still have the PCOS.
[00:16:07] So we’re gonna focus more on the metabolic issues, right? We talk about the risk for diabetes, hypertension, heart disease, cholesterol, so all that. It needs to be taken care of. And uterine cancer is something , you know, may sound a a little scary, but it is increased risk in women with PCOS, especially if they don’t get periods and they don’t take anything for that and they go months to months without a period, there is an increased risk of developing new chain cancer.
[00:16:34] So it’s not a good idea to leave it untreated. Okay. And they should I guess pretty simple, like I said, with either birth control pills or any other medication to help bring the period every month or two that will totally prevent it. So it’s, it’s something not to forget sometimes. Okay, wonderful.
[00:16:51] So I wanna also thank you for being here, Dr. Benadiva, and thank you for joining us today. We’ll see you next week at 1230 for lunchtime live again.
[00:17:01] See then.