PCOD: Infertility & Maternal Issues

Polycystic ovary Disease (PCOD) is a health problem in which a woman's hormones fall out of balance. Women with PCOD deal with the effects of these differing levels of hormones on their appearance, metabolism, and more importantly their menstrual cycle, the ability to conceive and undergo a safe pregnancy.

How PCOS affects fertility

Ovulation, or release of an egg from the ovaries during the menstrual cycle is crucial step for commencement of pregnancy, the other two being fertilisation of the egg by sperm and implantation of the fertilised egg in the uterus. Four hormones namely, follicle stimulating hormone (FSH), oestrogen, luteinizing hormone (LH), and progesterone play an important role in successful ovulation. It is important for them to be in balance to avoid hormone disorders like PCOS.

1. Follicle stimulating hormone (FSH) is released from the pituitary gland in brain at the start of a menstrual cycle to stimulate development and maturation of an egg in the follicles.
2. Oestrogen - Released in the ovaries, oestrogen levels rise in the first half of menstrual cycle to prepare the body for ovulation by causing thickening of the uterine wall lining.
3. Luteinising hormone (LH) - LH levels rise sharply towards the middle of the cycle to stimulate the release of the egg from the ovary (ovulation) into the fallopian tube where it can be fertilised by an incoming sperm.
4. Progesterone - LH surge is followed by rise in progesterone levels, a hormone that prepares uterus for possible implantation of a fertilized egg.

Disruption of menstrual cycle

In women with PCOD, the hypothalamus releases Gonadotropin-releasing hormone (GnRH) in much higher amounts than normal. GnRH is responsible for directing the release of FSH and LH from the brain's pituitary gland. In PCOD, imbalance occurs by increased LH and decreased FSH. Less FSH means that fewer eggs undergo maturation, oestrogen release remains high and there is an excessive production of male hormones (androgens). The combined effect of these is lowered progesterone levels.

An imbalanced hormone production causes irregular or absent ovulation. Some women with PCOD ovulate occasionally; others do not ovulate at all. Ovulation is necessary for a sperm to fertilise a mature egg. Ovulation problems are the most common causes of infertility.

Other effects of hormonal imbalance include:

1. Increase in levels of androgens like testosterone causes excessive hair growth (hirsutism) on face, abdomen and chest, along with male pattern baldness or hair thinning in some cases.
2. Elevated oestrogen levels cause excessive build-up of the uterine wall, a condition known as endometrial hyperplasia. It causes the uterus to become bulky and leads to heavy menstrual bleeding.

Complications during pregnancy

Women with PCOS are at an increased risk of following complications during pregnancy:

1. Miscarriage - Women with PCOD are at higher risk of miscarriage in the early months of pregnancy as compared to women without PCOD.
2. Gestational diabetes - A recent research published in the British Medical Journal reports that risk of gestational diabetes is doubled in women with PCOD.
3. Pregnancy-induced high blood pressure - Increased blood pressure may occur in the second half of pregnancy and can lead to preeclampsia if not treated, and may also affect the delivery of baby.
4. Preeclampsia - This refers to sudden high blood pressure after 20 weeks of pregnancy and can affect the mother's liver, brain and kidneys.
5. Caesarean birth - Pregnancy complications due to PCOD like high blood pressure can increase the likelihood of C-sections in pregnant women with PCOD.

Having PCOD while being pregnant might not necessarily mean a high-risk pregnancy, but it would require special monitoring by the obstetrician or gynaecologist.

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