When I meet a young patient in my practice she will often tell me that she wants to start a family but is having difficulty getting pregnant. As we talk further, it becomes clear to me that a part of the problem is that she is having irregular periods, sometimes as infrequently as every two to three months. Upon further questioning I will find out that she has put on a little weight, maybe ten pounds or so, over the past two or three years. As is typical in many instances, her weight gain coincides with her periods becoming irregular. In addition, she is beginning to notice more facial hair and acne.
While infertility is defined as the inability to conceive after one year of actively trying, with irregular periods it is difficult to know when you are ovulating to even begin trying. Your difficulty conceiving may be due to a condition called polycystic ovary syndrome (PCOS). PCOS is a very common hormonal problem in women, especially in Indian women. It affects 5 to 7.5 percent of all women during their childbearing years,1 and may be higher for Indian women. Although the cause is unclear, there are some common characteristics. They are:
- Irregular periods due to the lack of ovulation (Anovulation)
- Excessive facial and body hair growth (Hirsuitism)
- Thinning of scalp hair
- Weight in abdominal area (present in 50-60% of patients with PCOS, with a tendency for fat distribution along the torso.)
While the specific cause of Polycystic Ovarian Syndrome is unknown, we do know that a normal ovary depends on the selection of a follicle in the ovary in which an egg will mature. In order for this to happen, an ovary responds to two hormones produced in the pituitary gland of the brain, follicle stimulating hormone (FSH) and luteinizing hormone (LH). In PCOS, there is excess secretion of LH which leads to the hormonal imbalances that cause the lack of ovulation and the other symptoms of PCOS.
Diagnosis of PCOS is made based upon a person’s symptoms, as well as lab tests to evaluate a woman’s hormone levels. Once the diagnosis of PCOS is made, a patient should also then have her cholesterol and glucose levels tested because of the increased risk of diabetes, heart disease and hypertension.
Treatment of infertility in patients with PCOS will often require medications such as metformin and clomiphene citrate (Clomid) to stimulate and improve the quality of ovulation. Also of great importance are lifestyle changes one can make that will reverse the effects of PCOS.
PCOS and Lifestyle Changes
Through diet and exercise, a weight reduction of as little as 5-7% is associated with improvement in menstrual cycles and skin appearance. With weight loss, you can reduce the risk of diabetes and cardiac disease by as much as 58%!2 And with the weight loss and the resumption of regular periods and ovulation, your chances of getting pregnant are greatly improved.
PCOS and the Indian Woman
I have observed that many of my Indian patients experiencing fertility difficulties are immigrants to the United States from India. In many instances, the difficulties conceiving (PCOS) can be traced to what would be called "culture shock," brought on by significant lifestyle changes experienced when a woman moves from India to America. Diet is markedly different, food portions are huge, junk food is everywhere, exercise is not a priority, and the pace, particularly in Silicon Valley and other large metro areas, is extremely hectic— to name a few lifestyle changes. Of course, there is the added stress of new surroundings, a new family situation, new friends, and so on. It is no wonder, then, that hormones are imbalanced and conception is difficult.
Don’t Assume the Worst
Many patients that are experiencing difficulties conceiving assume the worst — that any problem is a major one and any solution must be major as well. Expensive in vitro fertilization is one such solution that comes up frequently. The key to treatment is to identify the issues that caused the problem to begin with, and then begin treatment sooner rather than later.
What to Do?
Don’t put off seeing a physician if you are having difficulties conceiving. When you see your physician, be sure and talk about yourself and share your observations and concerns. This may seem obvious, but we all fall into routines, even physicians. Lab tests are just part of the equation. The other part, many say the more important part, is making sure your physician knows the “whole” you: your life, your concerns, your major life changes such as moving here from another country, and your observations about your body. The more complete the picture, the greater the likelihood of an accurate diagnosis.
In many instances— and this is for all woman— the effects of PCOS can be can be corrected through the lifestyle changes and medication mentioned previously. The big difference with Indian woman who are immigrants to the United States is that the factors that led up to PCOS and fertility problems are relatively recent, i.e. since immigrating, and therefore more easily corrected.