Polycystic Ovary Syndrome: Challenges in Conceiving Again

Polycystic Ovary Syndrome (PCOS)

About three years ago, I went to a large hospital for an examination due to irregular menstruation and was diagnosed with polycystic ovary syndrome (PCOS).
Prior to the examination, I had been taking medication to regulate my menstrual cycle for six months, but after stopping the medication, my periods ceased again.
At that time, I weighed between 47-50 kg and was 158 cm tall.
Being young, I didn't think much of it, but I was considering marriage and having children.
The doctor prescribed ovulation induction medication, and I became pregnant after the first cycle.
Six months after giving birth, I returned to the hospital for a check-up, and the doctor said the PCOS had resolved.
Now my son is two years old, and my husband and I have not used contraception for two years, but I have not become pregnant again.
Recently, I underwent an ultrasound examination and found that the polycystic ovaries have returned, and the doctor mentioned that it is even more severe than before, with multiple cysts present.
The doctor also ordered blood tests, and the results showed elevated male hormone levels.
I do not have issues with hair loss or excessive hair growth; my only concern is being overweight, currently weighing between 63-67 kg, with oily skin and acne.
The doctor has scheduled me for a hysterosalpingography, which I have not yet completed.
Sometimes I experience dull pain in my lower abdomen; I do not have pain during my menstrual period, but I occasionally feel a dull ache in my lower abdomen for unknown reasons, primarily on the right side.
At times, I also experience a sensation of heaviness in my lower abdomen, which can make it difficult to sit or walk.
I really want to conceive a second child, but it has been two years without success.

Chun, 20~29 year old female. Ask Date: 2016/10/18

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the general definition of infertility is the inability to conceive after one year of regular sexual intercourse.
In cases of infertility, both partners should undergo examinations at a gynecologist, including semen analysis, hysterosalpingography, ovulation testing, and hormone blood tests, among others.
If it is simply polycystic ovary syndrome, ovulation medications are usually helpful.
If there are still concerns, it is advisable to consult a regularly seen gynecologist.
Wishing you good health.

Reply Date: 2016/10/18

More Info

Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder that affects many women of reproductive age. It is characterized by irregular menstrual cycles, excess androgen levels, and polycystic ovaries. Your experience reflects the challenges many women face when dealing with PCOS, especially when trying to conceive.

From your description, it appears that you initially had a successful pregnancy after being treated with ovulation-inducing medications. However, the recurrence of PCOS symptoms, including irregular cycles and elevated male hormones, has made it difficult for you to conceive again. This situation is not uncommon; many women with PCOS experience fluctuations in their symptoms, which can impact fertility.

Understanding Your Current Situation
1. Hormonal Imbalance: The elevated levels of male hormones (androgens) can lead to various symptoms, including weight gain, oily skin, and acne. These hormonal imbalances can also interfere with ovulation, making it more challenging to conceive.

2. Weight Management: Your current weight of 63-67 kg, given your height of 158 cm, suggests that you may be overweight. Weight management is crucial for women with PCOS, as even a modest weight loss of 5-10% can significantly improve insulin sensitivity, regulate menstrual cycles, and enhance fertility.

3. Menstrual Irregularities: The irregularities in your menstrual cycle are a hallmark of PCOS. Regular ovulation is essential for conception, and if you are not ovulating regularly, it can hinder your chances of getting pregnant.

4. Pelvic Pain: The discomfort you are experiencing in your lower abdomen, particularly on the right side, could be related to ovarian cysts or other pelvic issues. It is essential to discuss these symptoms with your healthcare provider, as they may require further evaluation.

Steps to Consider for Improving Fertility
1. Consultation with a Specialist: Since you have been diagnosed with PCOS and are experiencing difficulties conceiving, it may be beneficial to consult a reproductive endocrinologist. They can provide specialized care and may suggest treatments tailored to your specific situation.

2. Lifestyle Modifications: Focus on a balanced diet rich in whole foods, lean proteins, and healthy fats while reducing processed foods and sugars. Regular physical activity can also help manage weight and improve insulin sensitivity.

3. Medications: Your doctor may recommend medications such as Clomiphene Citrate to stimulate ovulation. If you do not respond to oral medications, injectable fertility treatments may be considered.

4. Monitoring Ovulation: Keeping track of your menstrual cycle and ovulation can help identify the best times for conception. Ovulation predictor kits can be useful tools for this purpose.

5. Addressing Underlying Conditions: If your doctor suspects other underlying issues, such as blocked fallopian tubes or uterine abnormalities, further tests may be necessary. Addressing these conditions can improve your chances of conception.

6. Emotional Support: The emotional toll of infertility can be significant. Consider seeking support from counseling or support groups for women facing similar challenges.

Conclusion
While PCOS can complicate the journey to conception, many women with this condition successfully become pregnant with the right support and treatment. It is essential to work closely with your healthcare provider to develop a comprehensive plan that addresses your unique needs. Remember, you are not alone in this journey, and there are resources and support available to help you navigate the challenges of PCOS and fertility.

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