My other major fertility issue is polycystic ovary syndrome, commonly referred to as PCOS. To me, PCOS is more difficult to understand than endometriosis. Bare with me as I do my best to explain it... And keep in mind that I'm doing my best to understand all of it.
I was diagnosed with PCOS at my first consultation appointment with my reproductive endocrinologist. He performed an ultrasound that revealed I had 12 cysts on one ovary and 17 on the other. Multiple cysts on the ovaries doesn't automatically reveal PCOS, though, just as an absence of cysts doesn't mean you don't have PCOS. Confusing already, huh?
See, before all of this, I had read plenty about PCOS. In fact, I had even consulted my doctors about it because I had the irregular cycles that sometimes characterize PCOS. All of my doctors dismissed this possibility because I don't fit the typical profile of a PCOS patient. Women with PCOS tend to be over weight, have excess hair growth in areas that don't normally grow hair -- upper lip, tummy, feet, etc. I don't carry extra weight, I'm not necessarily "hairy", or not by my doctors' standards. I don't have a lot of acne. It just wasn't a concern to any of them.
Ultimately, I was surprised to be diagnosed because I had been so sure that it wasn't a possibility for me. Come to find out, I did have some irregular hair patterns. Hair that grew down from my belly button shouldn't be there -- this was something that had bothered me since I was in high school, but I had several girlfriends with the same thing, so I felt fairly normal. I'm not talking a man's happy trail here... just blonde hair, but hair that was more noticeable to me than the very, very fine fuzz that covers my body. In addition, my RE gently pointed out hair growing on my feet that was also an indicator. Does this mean that if you have a little tummy hair and hair growing from your big toes that you have PCOS? Probably not. But apparently my combination of signs led to my diagnosis ... Plus all those cysts on my ovaries.
I really felt terrified that this diagnosis was going to be the end of the road for me. The only people I had ever known or heard of that had PCOS couldn't have their own children. In my mind, this meant I wasn't going to be treated. I wanted to cry right then and there, but I didn't know these people. I was alone. I just wanted to get through the appointment.
My doctor and nurse were wonderful about making sure I could see what they saw and that I understood what was going on. It continues to be a lot for me to process, but they eased my mind about the treatability of my situation. This was not the end of the road -- and it wasn't even the end of the road when we found that we needed to treat not only PCOS but endometriosis, too.
What exactly is PCOS?
Polycystic ovarian syndrom is a hormonal disorder that's characterized by the presence of actual cysts on the ovaries. There are certain indicators of PCOS -- some of which I've listed above -- that include weight gain, unusual hair growth patterns, irregular or absent menstrual cycles, acne, and inability to achieve pregnancy.
Apparently the exact cause of PCOS is unknown, but I've asked them to explain to me what they do know. There is a connection between PCOS and Type 2 Diabetes because of an insulin resistance. Many women with PCOS who are overweight may be diabetic or pre-diabetic because of this insulin resistance. Metformin, a drug prescribed to diabetic patients, has been used to treat PCOS with great results. Women who aren't classic PCOS patients may not be at risk of developing diabetes as many with PCOS are. Instead, their insulin resistance may only affect their ovaries. Weird, huh? It doesn't make sense to me either. So I'm one of those gals -- with the weird insulin resisting ovaries.
Unfortunately, there are risks that come with PCOS. There is an increased risk of heart disease, Type 2 diabetes, endometrial cancer, high blood pressure, etc.
How does PCOS affect fertility?
In my individual case, I had a total of 27 cysts on my ovaries during my ultrasound back in March. These cysts were fluid-filled follicles. My doctor explained that my body was producing plenty of hormone -- such as LH -- but that my body was putting energy into producing several follicles. None of them were going to mature into anything, and instead they were preventing ovulation. Obviously without ovulation, I couldn't become pregnant. Even if I were to ovulate every once in awhile, it would be difficult to predict timing because of the irregularity of my cycles.
My treatment:
In the couple of months leading up to our first IVF attempt, my doctor has me on a low dose of Metformin, the drug often prescribed to diabetics. My blood sugar levels were tested, and they are low to begin with. Metformin lowers blood sugar, though, so although the drug will do its magic on my cysts, it's also going to lower my blood sugar further. I was instructed to take one tablet every night with a heavy meal -- hopefully the heavy meal would help keep my blood sugar up. I felt the effects in the first couple weeks of taking Metformin because I easily got light-headed, was really tired, needed to eat frequently, etc. At my next appointment, which will be in October, I should have more information on how the Metformin is working and my PCOS status.
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