How does PCOS affect weight and fertility?

Season three of the popular television drama This is Us recently premiered on NBC. During the first episode, one of the main characters, Kate, is diagnosed with Polycystic Ovary Syndrome. Commonly referred to as PCOS, this hormonal condition affects nearly 1 in 10 women of childbearing age.

Timing of the health discovery is particularly important since Kate and her husband are trying to get pregnant. The show has also documented the character’s struggle with her weight since puberty as fans look on with empathy.

Kate’s diagnosis now helps to explain her infertility struggles and obesity, as it does for many Americans.

What is Polycystic Ovary Syndrome (PCOS)?

The exact cause of PCOS is not clear, but it is a set of symptoms caused by a problem with a woman’s hormones. It mainly affects the small organs that store a woman’s eggs, her ovaries. It can also affect the rest of the body.

“Symptoms include irregular menstrual cycles, abnormal hair growth, acne and weight gain,” says Dr. Chason. “An evaluation may find higher levels of androgen hormones, glucose intolerance, and enlarged ovaries with a high number of small follicles (cysts). It can be difficult to diagnose because PCOS has a wide range of symptoms. Even professional societies debate the most accurate standards for diagnosis.”

Understanding PCOS and fertility

The hormonal imbalance contributes to the high levels of androgens, one type being testosterone. Higher than normal androgen levels can prevent ovulation. Ovulation happens when a mature egg is released from an ovary. This happens so it can be fertilized by a male sperm.

“Most women with PCOS are not ovulating regularly or at all,” Dr. Chason says. An increase in testosterone causes eggs in the ovaries to never fully mature. The immature eggs then cause irregular ovulation, making it difficult to get pregnant.

In most women, eggs that do not mature break down. In those with PCOS, the eggs stay trapped in the ovaries and begin to pile up. In addition, many women with PCOS have insulin resistance. The disorder can increase the risk of miscarriage as well as the risk of diabetes before or during pregnancy.

The connection between excess weight and infertility

Women with PCOS often have difficulties with metabolism. Though gaining weight does not happen to everyone, it is a common symptom. Excess weight interferes with ovulation. It’s also a risk factor for infertility and miscarriage apart from PCOS. This is because obesity changes the release of a key hormone called LH (luteinizing hormone) and also increases testosterone levels. Both contribute to hormone imbalance and immature eggs within the ovary.

Dr. Doyle sees many women with PCOS come through her door. “Many of our female patients in the AAMC Metabolic and Weight Loss Surgery program suffer from PCOS as they begin their journey,” she says. “Almost 60 percent of women who suffer are obese. Similarly, half of sufferers have metabolic syndrome, a condition that increases the possibility of other health risks like diabetes and high blood pressure.”

PCOS treatment and the odds of getting pregnant

Lifestyle changes are the first line of therapy since exercise and weight loss can alter endocrine changes. This can’t cure PCOS, but it helps reduce symptoms and prevent some health problems. Often, losing weight decreases testosterone levels and regulates menstrual cycles. It also decreases a woman’s risk of diabetes and cardiovascular disease.

A full set of treatment for PCOS depends on many things: age, how bad it is, general wellbeing, etc. Dr. Chason says that for women with PCOS who are not trying to get pregnant, birth control pills can normalize periods and decrease abnormal hair growth. The pill regulates testosterone.

For women who would like to be pregnant, oral medications are available to induce ovulation. There is also in vitro fertilization (IVF), as Kate tries on the show. “Even with fertility treatment, a healthy weight is key to having a healthy pregnancy and delivery,” says Dr. Chason. “If a woman has irregular periods, a couple should find a specialist right away for an evaluation rather than keep trying on their own. Maintaining a healthy lifestyle and seeking expert help can make a world of difference.”

READ MORE: 7 tips for successful weight loss

Weight loss surgery

Another option to help PCOS sufferers become pregnant is weight loss surgery. “I’ve had many patients who had weight loss surgery,” Dr. Chason says. “All of them saw an improvement in their overall health, often stopping their blood pressure or diabetes medications. In addition, their periods became more regular. Some of them then got pregnant on their own. Others still needed help, but they responded more quickly and easily to fertility treatment.”

Dr. Doyle says her team has helped hundreds of patients find a path to a healthier life. The nutrition planning and weight loss surgery relieves many of the symptoms related to PCOS. In fact, the rate of PCOS in weight loss surgery patients falls nearly 60 percent before surgery and another 7 percent after surgery. This success stems from patients both losing weight and maintaining their weight loss. “Almost 90 percent of PCOS patients resume normal menstrual cycles after surgery. Nearly 60 percent also report improvement in other PCOS symptoms, like less abnormal hair growth and better control of hormones.”