Insight on PCOS, from fertility specialist, Prof Siebert

Mari Hudson, RSG radio announcer, interviewed Aevitas fertility specialist, Prof Igno Siebert on the topic, PCOS (Polycystic Ovary Syndrome). Prof Siebert is a fertility specialist and endoscopic surgeon at Aevitas Fertility Clinic. He has a special interest in PCOS and Endometriosis. Furthermore, Prof Siebert is also involved at the Gynaecology and Obstetrics Department, Tygerberg Hospital, Stellenbosch University. Below is a summary article of the interview and the following will be discussed:

  • What is Polycystic Ovary Syndrome?
  • What are the main signs and symptoms of Polycystic Ovary Syndrome?
  • What’s the cause of Polycystic Ovary Syndrome?
  • How is Polycystic Ovary Syndrome treated?

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome is one of the most common endocrinological problems (hormonal imbalance) found in young women. It is present in 1 out of 10 young women. Usually the reason why women with Polycystic Ovary Syndrome eventually seek medical assistance, is infertility. However, the syndrome could have gone undiagnosed for a long time.

What are the signs & symptoms of PCOS?

  1. No/irregular ovulation. Therefore, fertility is affected.
  2. Abnormal hair growth (male patterns of facial hair growth e.g. moustache, beard)
  3. Follicles/cysts form on the ovaries. This can be seen through ultra sound examination.
  4. Insulin resistance and overweight. Insulin resistance can cause long term health problems.

Why is fertility affected by PCOS?

Women are born with 1 – 2 million eggs. Each egg is imbedded in a follicle. The egg inside it’s follicle can be pictured as a seed inside it’s fruit. By the age of about 50, there are no eggs left. Therefore, the older you get the smaller your chances of falling pregnant. Every month, a specific follicle is selected for ovulation. However, in PCOS no ovulation takes place, because no follicle selection took place. Hence, no egg is released.

What causes PCOS?

The cause is unknown. However, speculation is that PCOS could be genetically inherited.

Could being overweight cause the problem?

No. However, typically 2/3’s of women with PCOS will be overweight.  Being overweight is linked to insulin resistance and these two factors can be linked to PCOS.

*Being overweight is not part of the diagnosis of PCOS. Although, being overweight while having PCOS, is like throwing oil on a fire.

How is PCOS treated?

  1. Weight loss and lifestyle factors (e.g. exercise) as long-term management of PCOS.
    These factors play the biggest role in managing PCOS. Once the weight is addressed ovulation often starts spontaneously and pregnancy can occur naturally. Furthermore, in the long term, metabolic disease, such as Type 2 Diabetes can be prevented. As Type 2 Diabetes is linked to increased body mass and insulin resistance.If all other efforts have failed, bariatric surgery can be performed. However, this is not the primary solution. This decision needs to be made in association with the dietician, fertility specialist and bariatric surgeon. For bariatric surgery to be considered a woman’s BMI needs to be higher than 40 and she needed to have attempted all other interventions. Furthermore, if a woman’s BMI is above 35, she has complications such as blood pressure and has attempted all other interventions, bariatric surgery can be considered.
  2. Treating insulin resistance
    A study has proven medication such as Glucophage and Medformin (medication to help control blood sugar levels) have not assisted in improving fertility. However, weight loss and lifestyle factors can decrease insulin resistance and assist fertility.
  3. Treating anovulation
    Primarily the first answer is weight loss and lifestyle factors. However, medication such as Clomid can be given to assist ovulation, if required.

*It’s clear that lifestyle and weight loss is still the best treatment for PCOS in the short term and long term. If a woman with PCOS falls pregnant and she is still overweight and insulin resistant, she is at higher risk for complications during her pregnancy.

What does an eating plan look like for PCOS patients?

Guidelines in a nut shell:

  • Three meals a day
  • No fruit juice (to minimise the intake of fructose)
  • No carbohydrates after 4pm
  • Protein and salad/vegetables for supper.
  • Limitation (not exclusion) of carbohydrates during the day.

*This being said, it’s important to have the correct support. A study has shown that 90% of women who suffered from PCOS attempted diet and lifestyle changes on their own and 100% failed. However, those who attempted the lifestyle changes and diet under guidance of their specialist and dietician had a 60% success rate.

How does weight loss assist fertility in PCOS sufferers?

As previously mentioned, being overweight is linked to being insulin resistant. This means that too much insulin is secreted. Increase in insulin then causes the ovary and adrenal glands to secrete more male hormones. Male hormones are converted to female hormones in the fatty tissue of the body. The female hormones then stimulate the uterus, causing a lot of bleeding during menstruation, once it does occur.

*In conclusion, through weight loss there is decrease in insulin resistance. Therefore, less male hormones are produced, which leads to improved balance of the female hormones and potentially spontaneous ovulation.

How early can PCOS be diagnosed?

If a young girl presents as follows, the diagnosis of Polycystic Ovary Syndrome can be suspected and she should seek further assistance:

  • Irregular menstruation after two to three years of her first menstrual cycle.
  • Overweight
  • Skin related symptoms

*The earlier PCOS is diagnosed and addressedthe earlier a healthy lifestyle can be taught to prevent adverse effects at a later stage in life.

What are your chances of successful pregnancy if you have PCOS?

Someone with PCOS does not have a smaller chance of successful pregnancy than someone without PCOS. However, the correct support system is required and the road might be a little longer.

If you walk away with one lesson, walk away with this:

If diagnosed with PCOS, the best treatment and management for fertility, short- and long term- health, are lifestyle changes. These lifestyle changes includes exercise and a healthy eating plan.