Why am I not getting pregnant?
8/15/2024 by Lindsay Grace, APRN, C.N.P., M.S.N.
Infertility is defined as not achieving pregnancy after one year of regular, unprotected intercourse. This can be a common concern for many couples trying to start a family.
Of the many causes of infertility, one of the more common is polycystic ovarian syndrome, commonly known as PCOS. Polycystic ovarian syndrome is a hormonal disorder involving excess androgens, or male hormones.
The ovaries may have numerous fluid-filled follicles that can delay or prevent regular ovulation, which is the release of an egg. Women often experience irregular periods, weight gain, abnormal distribution of body hair and difficulty achieving pregnancy. This is due to the irregularity of ovulation. Polycystic ovarian syndrome will often go undiagnosed until women are trying to get pregnant.
How do you know if you have polycystic ovarian syndrome?
If a woman is having trouble getting pregnant and the signs and symptoms of polycystic ovarian syndrome are present, the work-up for diagnosis will often include laboratory hormone testing for the male hormone and testosterone, and commonly a pelvic ultrasound to evaluate the ovaries for the presence of greater than 25 follicles. Obesity, elevated blood sugar and high cholesterol can be associated conditions. Additional evaluations may be performed for these conditions, as well.
How is polycystic ovarian syndrome treated?
Treatment depends on the goal. If a woman hopes to become pregnant, achieving a healthy weight range is the first step. Even a 5% reduction in body weight can improve PCOS. This will often stimulate ovulation. Letrozole also can be used to stimulate ovulation in women with polycystic ovarian syndrome. Metformin — a drug commonly used to treat diabetes — is also sometimes used to reduce insulin resistance and reduce blood sugar, promoting ovulation.
In addition to infertility, endometrial cancer is a secondary complication of polycystic ovarian syndrome. In women who are not trying to become pregnant, combined hormone contraceptive pills can be used to regulate the menstrual cycle and reduce androgen production. Progesterone-based, long-acting and reversible contraception options, like an IUD, can be used for endometrial protection and to reduce the risk of cancer.
Overall, polycystic ovarian syndrome is a treatable condition, and most women can become pregnant and effectively manage the symptoms associated with it.
Lindsey Grace, APRN, C.N.P., M.S.N., is a family medicine nurse practitioner in the Department of Family Medicine at Mayo Clinic in Rochester, Minnesota. She has a special interest in women's health and is a staff member in the Primary Care Integrated Community Specialties Gynecology Clinic.