Trouble Getting Pregnant? You Might Have polycystic ovarian syndrome (PCOS) or Endometriosis

There are two conditions that might explain why women face infertility while lifestyle changes may lessen the problems.

About 12% of women of all ages are known to have problems conceiving or completing a pregnancy to term.

 Two of the most common causes of fertility in women are endometriosis and polycystic ovarian syndrome (PCOS).

Can't get pregnant? PCOS or Endometriosis may be the problem.

If you have been trying to get pregnant for months, ask your doctor if PCOS or endometriosis might be the cause of your infertility.

Endometriosis is a condition in which the tissue that lines the inside of your uterus grows outside the uterus but continues to act as it normally would: thickening, breaking down, and inducing bleeding as part of the monthly menstrual cycle (your ovulation calendar).

Three signs of endometriosis are:

    Painful periods (dysmenorrhea)

    Pain with intercourse

    Difficulty conceiving

If you experience at least two of these symptoms, you might consider discussing the need to be tested for endometriosis. Endometriosis is an unlikely cause of miscarriages on its own but when occurring with at least one other sign, it may suggest the need to discuss your concerns with your doctor. In addition, other symptoms such as heavy bleeding or bleeding between periods and pain during urination or bowel movements can also point to endometriosis.

Polycystic ovary syndrome, more commonly known as PCOS, is a complex condition that impacts hormonal, metabolic, and reproductive functions. PCOS is characterized by a very specific set of symptoms related to irregular menstrual cycles (your ovulation calendar) and excess of androgens.” Androgens are the sex hormones that are usually higher in men and are responsible for excessive hair growth as well as adult acne in women.

Even with Endometriosis or PCOS, Pregnancy is Not Impossible

Having endometriosis or PCOS doesn’t stop a woman from having a successful pregnancy; these women just may need to work harder and be more aware. Both endometriosis and PCOS can disrupt ovulation, but usually only PCOS will stop a pregnancy after conception.

If you are concerned about infertility, the experts suggest using a home ovulation tracker, or a fertility monitor; these tests assess the level of luteinizing hormone, which spikes at 24 to 48 hours prior to ovulation. This is a simple thing you can do to help inform your gynecologist about your ovulation calendar and may be a good conversation starter at your next visit.

Focusing On Specific Effects of Endometriosis on Pregnancy

Endometriosis isn’t a consistent condition. Rather, the severity of excess endometrial tissue growth will impact the degree to which endometriosis effects pregnancy.

Hormone levels are the key. Estrogen promotes endometrial growth while progestin, which is produced during ovulation, stops this growth. When you get and stay pregnant, progestin levels stay raised. So pregnancy is the best treatment for endometriosis. That said, the first line of treatment for endometriosis is typically an oral contraceptive because it mimics the hormonal state of pregnancy, which of course, is not what you want if you are trying to become pregnant.

In cases of mild endometriosis where there is no evidence of blocked Fallopian tubes, fertility drugs and/or insemination are often effective in aiding conception as the first line of treatment when intervention is indicated.

In fact, IVF rates of success are high; with the only caveat that age is a factor. The highest IVF success rates in patients who are under 35 years of age, although women ages 35-39 years still have good success rates.

So if you are 40 years or over IVF rates of success are high but, it may take a few extra cycles of IVF treatment, and you may need to be more proactive in trying to conceive. According to a 2016 evaluation of the Assisted Reproductive Technologies Database, women with endometriosis at a mean age of 34.5  years had high IVF success rates, averaging at 42.5% using IVF.

Lifestyle changes, while not a cure for endometriosis, may help some women.  Since endometriosis is an inflammatory condition, factors that increase inflammation including stress, lack of sleep, poor diet, and excess weight, can worsen symptoms. Reducing stress, getting better quality sleep, eating whole, unprocessed foods that promote a healthy weight may also help reduce symptoms of endometriosis.

Remember, having endometriosis does not stop the possibility of a successful pregnancy; should you have concerns, approach your doctor, so you can reduce your worries and get help finding a solution.

When polycystic ovarian syndrome (PCOS) May Challenge Your Ability to Be Pregnant

Women with PCOS may have trouble conceiving because excess circulating hormones (androgens) can impair ovulation. Women with PCOS also often have insulin resistance and higher levels of insulin-like growth factor that promote androgen production, adding to the problem, by leading to weight gain and type 2 diabetes. This array of symptoms places women with polycystic ovary syndrome at higher risk for gestational diabetes.

While it is well known that excess weight can increase the symptoms of PCOS and the hormonal imbalances driving PCOS can contribute to weight gain, no one knows for sure which comes first.

If you have PCOS, achieving weight loss represents one of the best solutions available to increase your prospects for fertility. In a recent National Institutes of Health-funded study, women who achieved modest weight loss with a change in diet and addition of exercise improved their rates of fertility substantially.    

Autoimmune Diseases May Reduce the Prospect of Pregnancy

Women with diabetes or other metabolic disorders are at increased risk of having other conditions that will likely add another layer of complexity to pregnancy, endometriosis, and PCOS. Women who have thyroid disorders may face an even more complicated path to pregnancy. Women who have hypothyroidism may find the effort to lose excess weight more difficult, and even sub clinical hypothyroidism can interfere with ovulation.

In exploring the reasons behind your infertility, the experts recommend that you have your thyroid hormone levels checked if you haven’t already had your blood work done. It’s important to work with your doctor to achieve a healthy thyroid function before attempting pregnancy.

Autoimmune disorders like systemic lupus can cause complications for women with endometriosis. Women who are under treatment for lupus usually receive steroids and immunosuppressant agents, which can worsen endometriosis symptoms by reducing the body’s ability to fight the growth of excess endometrial tissue. If you have these or other confounding conditions, you’ll be in good hand if you work with a team of specialists who can guide you to make decisions that are safest and most sensible for your health and pregnancy goals.

Endometriosis and PCOS are two of the most common reasons behind infertility for some women, but neither condition bars you from pregnancy. To address your concerns, the best suggestion, say the experts, is “Be proactive.”  And while increasing age can be an additional challenge, remember that age also brings wisdom and grit.

 

Of course, if you are experiencing symptoms of endometriosis or PCOS, schedule an appointment with your doctor right away. It’s important to know that routine gynecological screenings do not check for PCOS or endometriosis, and often findings by ultrasound or an MRI cannot confirm a diagnosis of these conditions either.