When it comes to infertility, there are two groups of PCOS women.
There are those who’ve known about their PCOS condition before trying to get pregnant. And those who’ve had problems getting pregnant and then been told they have PCOS – which explains why they’ve been having problems getting pregnant.
The first group have probably been prepared for the struggle by their doctors, or by learning about PCOS. For the second group, the diagnosis of PCOS, while it may have been a shock also provides some relief, explaining a myriad of previously misunderstood symptoms.
Either way, both groups now find themselves trying to achieve a pregnancy the hard way. The information on this page has been structured to reflect the different stages on the fertility journey. Some may overlap, but they are all important to the couples struggling to become parents.
Lifestyle Factors
PCOS is a condition best managed by improving your lifestyle. Improvements in diet and exercise will decrease the severity of annoying PCOS symptoms and will improve your fertility and help regulate your menstrual cycle. This section includes details of relatively simple things you can do to enhance your fertility.
Weight Loss and Exercise
- Proven to boost your fertility and regulate cycles.
- Will reduce complications in pregnancy eg. Lower the chances of gestational diabetes and hypertension.
- The ‘weight-loss and exercise’ mantra is repeated so often by the medical fraternity that patients get a little numb to the message. This is especially true when weight loss seems virtually impossible using traditional low fat / high carb diets. Eat smarter, by choosing a low GI / high protein diet.
- Exercise improves insulin sensitivity and therefore weight loss.
- Exercise reduces other risk factors like high blood pressure.
General Health Issues
- Quit smoking & recreational drug use – Smoking is a known cause of infertility.
- Drink adequate water – During IVF procedures, you are routinely advised to drink at least three litres of water a day as it can lessen the complications of Ovarian Hyper Stimulation Syndrome (OHSS). This is a good habit to develop for the duration of fertility treatment and pregnancy, since your body is having unusual demands made of it.
- Ensure adequate rest.
- Avoid high caffeine drinks and consuming too much coffee & cola soft drinks.
- Males, in particular, should avoid spas and saunas during fertility treatments.
Financial Issues
Fertility treatment is not cheap. Consider your options regarding private health insurance before you start trying to conceive. There may be waiting periods before you are covered for IVF and related procedures. It is also a good time to consider what level of coverage any pregnancy achieved would have.
Some private health insurers have 12-month waiting periods on newborn babies, meaning you have anticipate their birth. This is an almost impossible task for the woman with PCOS who may spend several years trying to conceive. It seems ridiculous to pay several years of cover for an unborn child. Do your research. You may find that your child would, in fact, be covered, but only in cases of accute (ie. Life threatening) illness. Shop around. Different funds provide different levels of care and different waiting periods for newborn children.
The Medicare Safety Net provides extra financial assistance once you have incurred a certain amount of expense. It works on a calendar year. If you are considering expensive fertility treatments, think about their cost and how you can be assisted by the safety net. Three treatments in one calendar year will cost you less than two treatments in one year, followed by another in the subsequent year. This is because you will need to incur two thresholds, versus one. Current information regarding the Medicare Safety Net thresholds is available on the Medicare website.
The Government has proposed changes to the level of support it will provide to couples requiring procedures like IVF. This proposal is being passionately argued by fertility advocate groups across Australia, in the hope that the Government will continue to support people who genuinely need fertility assistance. It will be necessary to keep your eye on the Medicare web-site for any changes to Government policy.
The Pill
In his book, PCOS: The Hidden Epidemic, Dr Samuel Thatcher explains that egg follicles need to be exposed to at least three healthy menstrual cycles to develop enough to maintain a pregnancy. For most women with PCOS, this is an impossible challenge. To counter this, Thatcher suggests staying on the pill until you are ready to try to conceive, and then try to conceive on the very first cycle after you stop. There is a wash-out effect, meaning that you will be more fertile for the first couple of cycles, so use this to your benefit.
Temperatures
Measuring basal body temperatures can track or predict ovulation. Some PCOS patients have fairly regular periods (or bleeds) but don’t actually ovulate. A collection of three months of erratic basal body temperatures, combined with erratic cycle lengths will indicate to you that you are not actually ovulating. Either way, this information can be useful to a doctor because it provides an initial understanding of your menstrual cycle. Don’t bother measuring basal body temperatures if you are on the pill as they will be skewed by the hormones in the pill.
Naturopathy
Naturopaths have the capacity to enhance the effectiveness of medical treatments through the provision of complementary therapies. There are herbal remedies proven to improve insulin-resistance, regulate menstrual cycles and provide general strength to the immune system. Naturopaths can help you to improve your diet and lifestyle, and given that fertility depends on the correct balance of a symphony of factors in both your body and your partner’s, it is worth considering their advice.
Don’t self-medicate with herbal remedies – you need proper medical advice. Will herbal medicines sound harmless, they can interfere with medications or fertility treatments. Discuss using these treatments with a qualified naturopath and your qualified GP.
Herbs which may improve insulin sensitivity:
- Vanadium (found in dill seeds)
- Cinnamon
- Gymnema
- Goats Rue (forms the basis of diabetic drug, Metformin)
- Sarsaparilla
Herbs which may improve PCOS symptoms:
- Licorice(anti-androgenic, helpful for acne and hirsuitism)
- Peony (normalises ovulation)
Counselling and Support
Don’t be afraid to speak with a counsellor, pastor or psychologist about PCOS. It is a very private condition that tears at the very fabric of your womanhood. While you can grieve quietly over acne, obesity and hirsuitism, and cry privately over gender identity issues, infertility makes the condition public. Suddenly, your private pain must be discussed with partners, doctors and possibly friends and family. Medical treatment schedules might mean you have to discuss your condition with your employer. You will survive the process much more intact if you take the time to talk it through with a counsellor.
It may be appropriate to receive counselling both alone and with your partner. Your partner too, will be dealing with grief and feelings of inadequacy. Many fertility clinics offer staff counsellors - take advantage of their wisdom and their knowledge of the subject area. But be warned, not all well-meaning counsellors understand the deeper issues of PCOS and infertility.
POSAA’s forum provides a range of topic lists where you can connect with others in your situation. Take the time to join one or two of them. E-mailing other PCOS sufferers can be a liberating and healing way to start discussing your private pain. When you are contemplating fertility treatments, the Forum is a good place to gain information and support.
Diagnosis
When you first seek medical assistance to get pregnant, most doctors will go through a series of tests to determine why you are having trouble conceiving. A diagnosis of PCOS is reason enough to explain infertility, however it is common for doctors to investigate whether other factors may also be present. Doctors are looking for physical abnormalities, hormonal imbalances, menstrual cycle defects, endometriosis or problems with sperm.
Diagnosis and treatment are often combined. It is not always necessary to understand why you are not conceiving, in order to provide treatment. Cycle tracking, while being an opportunity to understand a patient’s menstrual cycle, can also be an opportunity for assisted reproduction therapies or timed intercourse.
Cycle tracking
Cycle tracking is often used to assist the doctor to understand your menstrual cycle. This can involve taking basal body temperatures and observations of cervical mucus and the position of the cervix. It can also be a more involved process of regular ultrasounds, blood tests and ovulation tests. These tests can sometimes be combined with medications, called challenge tests, to test the body’s responses to them.
While the process is designed to observe the body in its various phases of the menstrual cycle, it is also possible for some couples to become pregnant using this method. Doctors have more information available to predict when ovulation is likely to occur, and therefore intercourse can be timed to have the best outcome.
Blood tests
Blood testing is one of the most common forms of medical diagnosis. When testing fertility, hormone assay tests are used at various times of the menstrual cycle to assess the function of endocrine glands. The results are compared with those of fertile “control” subjects, in an attempt to understand the patient’s infertility.
Laparoscopy
The Laparoscopy is used for both diagnosis and treatment. This key hole surgery procedure is usually done in day surgery under general anaesthetic. Three holes are made, one in the navel and two at various positions on the lower abdomen. The stomach is inflated with gas to create a space for the doctor to work in. A laparoscope (a fibre optic rod with built-in light and camera) and surgical instruments are inserted through the three holes.
The patient will feel soreness for a few days afterwards, especially if treatment was undertaken. The organs in the lower abdomen can swell slightly as a result of being moved during the procedure. Also, it is possible for some of the gas to remain in the stomach cavity, resulting in some pain until it is absorbed by the body. The procedure carries with it all the normal risks of an operation under general anaesthetic.
Some doctors will require you to do a bowel preparation. This involves eating a low fibre diet for a few days before the procedure, and then drinking a strong laxative mixture on the day beforehand. This is done to clear your bowel and intestines. This greatly lowers the risk of infection, if the bowel is accidentally pierced during the procedure.
Some of the conditions doctors can assess and treat via laparoscopy include:
- Scar tissue from previous operations
- Damaged / blocked fallopian tubes
- Endometriosis
- Ovarian drilling / wedge resection
- ZIFT / GIFT
Hysteroscopy
This procedure is often carried out in conjunction with a laparoscopy so that the entire reproductive tract can be observed, in which case it is done under general anaesthetic. The uterus is filled with gas and a hysteroscope is used to examine the cervix and uterus. A camera or other surgical instruments are inserted through the hysteroscope to carry out treatments.
When done on its own, hysteroscopy can be done in a doctor’s rooms under local anaesthetic, with the patient receiving needles around the opening of the cervix. However, it is also done in day surgeries using epidural or general anaesthetic, depending on what is being undertaken.
Some of the conditions doctors can assess and treat via hysteroscopy include:
- Septums in the uterus
- Polyps
- Diagnosing unexplained bleeding
- Adhesions / Fibroids
Ultrasound – abdominal
This procedure is virtually painless, however the requirement for a full bladder can cause some discomfort. Usually you will be asked to drink between 600ml and 1 litre of water an hour prior to your appointment and hold it until after the ultrasound is complete. The operator will rub a sensor that looks a little bit like a computer mouse over your stomach. They may push quite hard at times, so squeeze your bladder in tight.
This technology allows the doctor to see the entire lower abdomen, looking at your organs from various angles. They can not see your ovaries in as much detail using this method as they can using a transvaginal ultrasound. In fact, your ovaries may appear normal on an abdominal ultrasound, but clearly polycystic on a transvaginal ultrasound. You may be given both ultrasounds in the one visit, allowing the operator to get a more accurate diagnosis.
Ultrasound – transvaginal
This painless procedure involves having a long thin probe inserted into the vagina. There is an ultrasound sensor on the tip of the probe, and the ovaries and womb can be observed in great detail using this method. Various elements can be identified and measured, and often the patient is able to watch along on a screen. It is worth asking the operator to explain to you what you are seeing if they haven’t volunteered the information.
Many gynaecologists have a transvaginal ultrasound machine in their rooms for routine diagnosis and cycle tracking. Expert ultrasound operators are specialist doctors with better equipment and generally more experience in using ultrasounds. While the physical operation of an ultrasound machine is learned quickly, these specialists are experienced in observing minute details about your body, or the unborn child that could be developing inside you.
Hysterosalpingogram
A hysterosalpingogram is a diagnostic procedure designed to observe and test the uterus and fallopian tubes. Fluid is inserted into the uterus via a tiny tube inserted into the cervix. As long as you have a skilled operator this is barely more painful than a pap smear, however novice operators can make it teeth-clenchingly painful.
Your vagina may be swabbed, although not all operators think this is necessary. A speculum and torch are then used to guide the operator as they pass a fine tube into the cervix. Fluid is injected through the tube and a tiny balloon is inflated at the opening of the cervix to hold the fluid in. The operator then uses a transvaginal ultrasound to observe the fluid as it fills the womb and flows into the fallopian tubes. Dye, or sparkling fluid known as a levovist, can be used to test the openness or patency of the fallopian tubes. The levovist appears brightly coloured on an ultrasound screen, allowing the operator to check for blockages.
From this procedure, doctors can assess:
- The volume of the uterus
- The presence, size and location of any polyps, fibroids or septums.
- The openness of the fallopian tubes
There is a minor risk of fainting after this procedure, due to an electrolyte imbalance caused by the fluids injected into the womb. While it should not be a painful procedure, it is suggested that you get someone to drive you home afterwards.
Semen Analysis
Sperm quality, volume and motility needs to be assessed at regular intervals through the fertility process. This is done by the collection of ejaculate, which needs to be tested while it is still warm. Sperm is collected, either by masturbation, or after having sex with a special condom. It must then be delivered to the laboratory as soon as possible. The sperm sample should be kept in a cosy pocket, or tucked inside clothing close to the skin, to keep it warm.
Different labs have varying guidelines for preparing for the test. Generally, the male should not have sex or masturbate for two days prior to the day of sperm collection. This is to ensure an accurate representation of his body’s ability to produce sperm.
Sperm production can be adversely affected by illness and environmental factors. If your partner has had the flu, a virus, or any illness involving raised body temperatures, they should allow about a month for their body to recover. Spas, saunas and long hot baths should be avoided as they too will damage sperm production.
This is your partner’s chance to feel the awkwardness you routinely endure as part of the fertility journey. While men are not usually good at expressing their feelings, they will be struggling with fear and inadequacy. They don’t want to be told they’re “shooting blanks” and just being tested is a threat to their manhood. This is your opportunity to repay all the gentle support they’ve given you through test after test. Do whatever it takes to boost your sweetheart’s ego through this harrowing process. If a poor result is received, he will need to be retested in a few months. Make sure he is healthy and well rested so you can get the best possible result.