PCOS and Infertility- Shady Grove

Fertility Fact: The causes of Polycystic Ovary Syndrome (PCOS) are unclear, but the main underlying problem is a hormonal imbalance.

While the exact causes of PCOS remain unclear, what is known are the effects PCOS can have on your body and your fertility. Women with PCOS create a higher than normal level of androgens.  Androgens are normally present in both sexes, but typically considered “male hormones.”  Elevated levels in women will impact PCOS is the most common ovulatory disorder.the development of eggs and interfere with ovulation.  For this reason, women with PCOS will not ovulate with regularity, if at all. Besides the interference with ovulation, PCOS can also lead to long-term health issues such as diabetes and heart disease. A proper diagnosis is the first step to better overall health.

According to Shady Grove Fertility physician, Dr. Joseph Doyle, “Polycystic Ovary Syndrome is the most common endocrine problem in the female population.  Though it can create considerable frustration in those trying to become pregnant, there are a number of treatment options that can bring success.”

The PCOS Cycle
Too much androgen, not enough progesterone

A woman’s ovaries have small fluid-filled sacs called follicles, where eggs develop.  As the egg grows in the ovary the follicle will enlarge. Upon maturation of the egg, the follicle will open and the egg is released, captured by the fallopian tubes, and travels to the uterus.

The difference for women that suffer from PCOS is that the egg doesn’t fully mature, but stops growing in early development. As repeated waves of follicles stop growing in early development, many small follicles (also called cysts) accumulate, giving the ovary a “poly-cystic” appearance. Due to the lack of ovulation, progesterone is not made in the female body and the menstrual cycle will become irregular or completely absent.

PCOS Symptoms

PCOS presents itself in a range of ways in different women and tend to be mild at first.  The primary symptom of PCOS is irregular menstrual cycles. In addition, some women also experience weight gain and trouble losing weight, acne, excess body hair growth and thinning hair on scalp.

Diagnosing PCOS

Women are often diagnosed with PCOS in their teens but impacts women throughout their reproductive years. While there is no “PCOS Test,” your Shady Grove Fertility physician will review your medical history and perform basic fertility testing, including blood work to check hormone and sugar levels as well as an ultrasound to evaluate the appearance of the ovaries and uterine lining. Read more on diagnosing PCOS.

Treating PCOS

Treatment of PCOS focuses on normalizing hormone levels and the menstrual cycle, which is achieved through a range of lifestyle changes and medications. The treatment will be determined based on whether you want to become pregnant, the severity of symptoms, and how at risk you are for other medical conditions. A combination of lifestyle changes and fertility medication is often advised for women with PCOS trying to conceive. Read “PCOS: One Size Doesn’t Fit All” for more on treating polycystic ovary syndrome.


Redbook- The Fertility Tests Every Woman Should Have by age 30

TMI alert: I still remember the day I first got my period as a seventh-grader. I went on a bike ride with my best friend later that afternoon, and I proudly proclaimed, “I’m a woman now!” (Talk about a Judy Blume moment.) Ever since then, my period has always come like clockwork—with relatively minimal cramps and PMS.

When I turned my attention to baby-making a few years ago, I expected it to be somewhat easy, as doctors had always assured me that regular periods typically signal that there shouldn’t be much to worry about fertility-wise. So, after almost a year passed with no positive pregnancy test, I decided to see my gynecologist for a preliminary battery of tests (such as FSH and progesterone—both important hormones for reproduction). After, she left me an excited voicemail saying that everything “looked perfect!”

But when another six months yielded no progress, I couldn’t ignore the nagging feeling that I needed to do more. I met with my gynecologist again in February and we decided to do an IUI (intra-uterine insemination) procedure. I inquired about the possibility of enhancing the process with Clomid, but she refused, saying that there’d been no past indication that my eggs would need extra stimulation.

When I showed up for the first ultrasound, my gynecologist couldn’t find any egg follicles. Zero. None were showing up on the ultrasound—and the IUI wasn’t going to happen. “I would have ordered Clomid for you if I would have known,” she mused. I felt devastated. Things were, alas, not so perfect.

At that point, I knew it was time to see a fertility doctor (a.k.a. reproductive endocrinologist) for a more specialized analysis. After several bloodwork panels and ultrasounds, the new doctor sat me down to share that she was “concerned.” My antral follicle count was six, and my levels of anti-Müllerian hormone (AMH) had come back as .45, revealing that I have a condition known as “diminished ovarian reserve.”

Translation? My egg supply is much lower than it should be at my age, and the quality is likely compromised as well. Basically, my ovaries are in their 40s even though I’m in my late 30s. (Check out this website for a helpful chart of where your FSH and AMH levels should be at any given age.) Generally, the recipe for strong fertility is high AMH and low FSH, and I have the opposite.

“A woman is diagnosed with low ovarian reserve when she has either a low AMH level (14) or a low antral follicle count (< 8),” says Shefali Mavani Shastri, M.D., of Reproductive Medicine Associates of New Jersey. “There is no one perfect test, and they all have limitations, so I would recommend a combination [of all three tests] to obtain the best assessment of ovarian reserve.” (AMH and FSH are tested with bloodwork, and antral follicle count can be checked via ultrasound.)

As for causes of low ovarian reserve, experts say smoking, ovarian surgery, endometriosis, and cancer treatment can all contribute. None of that applies to me—so it can also be largely unexplained. “There are many factors, including genetics and environment, which may result in a more rapid decline in ovarian reserve,” says Shastri.

Two unsuccessful IUIs and one IVF later, I’m still on the quest to become a mother, and more than anything, I wish I’d had this test as soon as I got married at age 35. (I’m now 38.) Had I known, I would have started trying much sooner and had a better chance at conceiving. If I could go back and tell my younger self anything, it would be to get thee to a fertility doctor… pronto!

I would also share that gynecologists may not be best-equipped to assess reproductive issues; most do not test for AMH, which is considered by some to be the most accurate measurement of fertility. (I essentially wasted almost a year by working with my gynecologist instead of going straight to a reproductive endocrinologist.)

That’s my motivation for this post—letting women who want children know that it’s vital to assess your prospects early on with the help of a fertility doctor. That way, you can make more informed choices if need be (such as egg freezing, etc.). “While there are no specific guidelines recommending universal screening for ovarian reserve, age 30 may be an ideal age for screening in women who are otherwise low-risk,” says Shastri.

Though I can’t rewind time or refill my ovaries, I’m still hopeful—not only for myself, but that this information may empower other women to catch issues early… and avoid having to go down the same bumpy road that I have.

Have you had your ovarian reserve tested? What age did you start to think about your fertility?


3 Ways to Respond to Infertility Advice- Huffington Post

For those who haven’t dealt with infertility, it’s difficult to imagine the plight. That is understandable, since it’s even hard for those of us who have experienced infertility to explain it in words.

How do you convey the feelings of longing for a child? Something you’ve never known, but can still feel? Like a piece of your heart is missing or a wish that is always just out of reach. How do you describe the poison that grows at the pit of your stomach with each failure? How do you label what is not so much physical pain, but an emotional weight pressing heavier and heavier against your body? How can you possibly help others fathom your relentless despair?

There are a lot of articles on what not to say to the fertility challenged. The soundest advice is to avoid sharing your advice. But we humans have a tough time keeping in our opinions. So the advice will come. And when it does, here’s what we can do about it.

Make the Most Of It

We’ve all heard it. “Just relax.” “Go on vacation.” “Stop stressing — it will happen!” Most of the infertility advice is not very helpful, but sometimes there are nuggets that just might surprise you. People share their stories with you because there is hope in them. The “magic pills” that worked for their friend who tried to conceive for years and then got pregnant after a couple months. The “Robitussin trick” that makes it easier for sperm and egg to meet. The great acupuncturist who helped your cousin get pregnant when the fertility doctors said she had no chance.

Don’t assume their advice isn’t valid. You just might find that sometimes, there are helpful nuggets to be found if you don’t tune all of the advice out.

View Their Advice as Love

When the well-meaning advice comes rolling in, imagine the words surrounding and comforting you. Instead of steaming over what seems like a careless comment, avoid the negative energy and see it as a positive. Your friends and family are trying to help. Sometimes, they just don’t know how. Yes, the advice can be very annoying. But you have the power to view the glass as half full instead of half empty.

Tell Them How to Help

You can help your loved ones by telling them what they can do for you. Are they good at research? Ask them to find an answer to a question that’s been nagging at you. Are they good listeners? Tell them you’ll reach out to them when you need a shoulder to cry on. Do they have a flexible schedule? Bring them along to some of the tougher appointments when your partner can’t be there with you.

Be honest with them. Tell them the encouraging words, “I love you, I’m here for you, and I’m listening,” are more helpful than anything else they can say.

Infertility is a tough road to travel alone. Having friends and family by your side will give you the extra strength you need on the toughest days.