PCOS: The leading cause of infertility in women

One in every 10 women suffers from polycystic ovary syndrome (PCOS), a condition that presents women with unexplained symptoms, leading to a medical concern that has robbed many in Nigeria the joy of motherhood.

In this report, Weekend Trust examines the complexity of the syndrome as a major contributor to infertility and ways the condition can be managed.

The Polycystic Ovarian Syndrome Oxford Academic 2023 publication referred to the PCOS as the most common endocrine disorder affecting women of reproductive age, with an estimated prevalence of 10% to 15 per cent worldwide, characterised by a wide array of clinical manifestations.

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According to a 2022 report by the National Institute of Health (NIH) on polycystic ovary syndrome, it is a set of symptoms related to a hormonal imbalance that causes metabolic issues such as diabetes due to insulin resistance and other aspects of health.

Dr Henry Uwandu, a consultant gynaecologist in Abuja, explained the condition during an interview with Weekend Trust, saying polycystic ovary syndrome got its name because of the small cysts that may be formed in the ovaries. Although not all women with polycystic ovaries develop cysts, it is one of the major and important landmarks of the diagnosis, he said.

Dr Uwandu added that the condition could disrupt normal ovarian function leading to issues such as irregular ovulation, anovulation (which means no ovulation at all), irregular menstruation, infertility and hyper androgynous (excessive male hormones in a female).

Outlining some symptoms of the PCOS he said, “Acanthoses, dark skin patches often seen on the neck, groin and under breast are suspected to be as a result of high insulin levels and high insulin resistance in the women. The last symptom is called PCOS, as the name suggests. Polly means many, cysts means small sacks of water in the ovary – this is one of the hall marks of the PCOS.”

Explaining her experiences, Theresa Yohanna, a resident of Plateau State had, during an interview with our reporter said, “I was 15 when the pain started. When it starts, I won’t be able to stand or walk. While it persisted, my parents took me to a hospital.”

Theresa said the doctors had suggested an operation to be carried out on her but subsequently resorted to pain killers. Happy that the operation was cancelled, Theresa said she wondered what the initial cause of the pain was.

Outlining the major contributors of mental disturbance among women with PCOS, Theresa said at 17, she had transitioned to a plus size and people said she was looking older than her sisters, a stigma that led to her decision for early marriage.

Speaking about a failed marriage due to infertility, Theresa said she was married for four years without getting pregnant and her husband’s impatience later led to their separation. Although, she was still unaware of what her condition was, she said her sister likened her symptoms to “polycystic ovarian syndrome,” a new discovery she made while surfing the internet.

Following this clue, Theresa decided to see a doctor once again and her condition was confirmed. And she said, “My dedication to the doctors’ instructions, exercise and good diet plan helped to improve my condition.”

Mercy Amanya, another woman who lives in the Karu area of Abuja, said, “Managing PCOS for the past years has been challenging.”

Considering her irregular period, and after confiding in her cousin who works in a hospital at Karu, an arrangement was made for a visit to the hospital, where she was diagnosed with the condition.

Mercy explained that her fear at the time came when she was told that she may not have children. She resorted to treatment immediately, which she said was expensive.

“My husband at the time proposed to me knowing about my condition.

He always told me not to be afraid, that we were going to be fine. Three months into the marriage, I got pregnant. As we speak, I have two kids – a boy and a girl.

“So, one can reverse the condition with a lot of dedication and obedience to doctors’ instructions. It may not happen at the time you are expecting it, but it will surely happen,” she said.

Mr Danjuma Asama, who had a PCOS partner, shared his experience with Weekend Trust, saying, “I was married to my ex-wife for five years, during which we tried to get pregnant but it never happened. I admit that we made a mistake by not going to hospital for a test.”

Asama said people who believed he should have had children pushed him into pressurising his wife to get pregnant, a situation that led to their separation.

“Shortly after our separation, I heard she was diagnosed with PCOS and she started treatment. I feel pained not going through that journey with her,” he said, and emphasised on the need for proper support and care to women fighting the condition, especially by their partners.

According to a 2015 research published by the British Journal of Public Practice on the potential implications of a PCOS diagnosis on a woman’s long-term health, 83.15 per cent of women are not given enough information on the long-term effect of their condition by health professionals, and even when information is given, it focuses more on fertility.

A 2024 study by the American Centre for Disease Control and Prevention (CDC) published in the Journal of Clinical Endocrinology and Metabolism stated that PCOS is a condition that can impact fertility and increase the risk of other chronic health conditions. More than half of people with PCOS develop type 2 diabetes by age 40.

Dr Henry Uwandu said, “PCOS and diabetes share a significant link, primarily through insulin resistance, one of the prominent petrological features of the disease. Women with PCOS cells do not respond to insulin normally. This means that when they eat food, the rate at which they metabolise glucose is reduced compared to the general population; and as a result, they have high levels of circulating glucose in their bodies.”

Rate of women with PCOS

The World Health Organisation (WHO) reports that PCOS is a significant public health concern and is one of the commonest hormonal disturbances affecting women of reproductive age. The condition affects an estimated 8 to 13 per cent of women of reproductive age; and up to 70 per cent of cases are undiagnosed.

The report states that the prevalence of PCOS is higher among some ethnicities, and these groups often experience more complications, particularly related to metabolic problems.

Dr Uwandu, however, noted that challenges in proper diagnosis of women experiencing PCOS include facilities and pack of trained doctors.

Managing the condition

According to the World Health Organisation (WHO) in its 2023 publication on polycystic ovary syndrome, the condition manifests in various ways. It states that the importance of managing PCOS extends far beyond its symptoms, emphasising on the importance of early detection.

Speaking on possible ways to manage PCOS, Uwandu said its real cause was unknown. He, however, linked it to genetic and environmental factors, adding that to live an optimal life and still achieve reproductive functions, women with the syndrome should adopt a healthy lifestyle, engaging in physical activities and lots of other treatment and supportive therapies.

Physical and mental impact of the syndrome

The WHO, in its 2023 report on the biological and psychological effects of PCOS, particularly those related to obesity, said body image and infertility could lead to mental health challenges and social stigma.

The Oxford Academic 2023 analysis on body image concerns in women with polycystic ovary syndrome showed that body dissatisfaction and lower self-esteem appeared to be even more prominent among women with PCOS experiencing hirsutism and fertility issues compared to those without these features.

Additionally, a higher prevalence of depressive and anxiety symptoms may be attributed to increased body image dissatisfaction and eating disorders among women with PCOS.

A psychiatrist, Dr Dorcas Jiga, who spoke on the possible psychological impact associated with the syndrome, said trauma among women with the condition was higher than usual because of symptoms like excess fat and infertility. She encouraged women to take care of their mental wellbeing, which is the key factor to managing the condition.

According to her, accepting the condition is the first step to mental stability for a better outcome. She added, “Maintaining mental health is knowing about the condition, what to expect and what can happen.”

Dr Jiga also said women with PCOS should familiarise with things that could improve their wellbeing, such as lifestyle changes and getting professional help. Most importantly, they should constantly monitor themselves against possible symptoms of depression.