“PCOS—polycystic ovarian syndrome—is a frequent precursor of diabetes and among the most common causes of infertility,” notes Dr. Sameh Toma, medical director of the North Carolina Center for Reproductive Medicine with offices in Cary and Greensboro. As many as 10 percent of women of reproductive age have the disorder, he notes.
“Research indicates that premenopausal women who have PCOS are seven times more likely to suffer from adult onset diabetes—type 2—than women without this health problem,” says Dr. Toma. “In addition, it’s increasingly clear that many women with PCOS are at greater risk for heart disease and stroke, endometrial cancer, and other serious ailments.”
What are the factors linking infertility to PCOS?
Many patients have insulin resistance and blood sugar disturbances. Resistance means that they require more insulin to maintain their sugar balance. Diabetes is simply a more severe form of insulin resistance. Other common characteristics of PCOS are an excess of male hormones, chronic anovulation, and frequently, the appearance of multiple small ovarian cysts on a vaginal ultrasound exam. Symptoms typically include irregular menstrual cycles—the principal cause of infertility—obesity, acne, excessive coarse hair growth, and infertility. In many instances, losing weight is a key issue in the treatment plan. With weight loss, almost all of the metabolic disturbances characterized by resistance to the hormone insulin are corrected. Weight loss is at the top of the list of desired treatment outcomes. Most often, a low-carbohydrate diet is recommended for patients with diabetes as well as for the PCOS patient.
Treatment of insulin resistance itself is important. The goal is to normalize the blood sugars before there is a pregnancy, and that can be done with an insulin-sensitizing drug called metformin—a drug designed to decrease insulin resistance. A standard procedure in this office is to offer a glucose tolerance test to every patient who we find with the polycystic ovarian syndrome. It is a test that requires about two hours to complete, and when it’s done, the patient and we know definitively if she has diabetes.
Is it a high-risk situation if a woman with diabetes, or with polycystic ovarian syndrome, becomes pregnant?
Those factors mixed with pregnancy would require extremely close monitoring by a high-risk obstetrician. It’s critical to keep blood sugars under control. If blood sugars are kept under control, then the risk of abnormalities to the baby is reduced very substantially. Weight
Is in vitro fertilization a good option for the PCOS or diabetic woman?
IVF is often an excellent option. With IVF, coupled with the use of an insulin-sensitizing drug such as metformin, we can overcome both the metabolic abnormalities and the androgen abnormalities in the ovaries because we are taking the eggs out of that environment. With diabetics, there is a very high risk of miscarriages due to these abnormalities. A healthy woman has a 10 to 15 percent risk of miscarriage with a pregnancy, and a woman with diabetes or with PCOS has about a 30 percent risk of miscarriage. With IVF, as we remove the eggs from that environment, and add progesterone in the uterus, we are able to reduce the rate of miscarriages significantly.
