Polycystic Ovary Syndrome (PCOS) affects 5-10% of women of childbearing age. It is the most common cause of abnormal or absent ovulation among women experiencing infertility, representing about a third of all patients seeking fertility care. A PCOS diagnosis is made on clinical grounds and is characterized by irregular or absent ovulation, androgen excess (acne, hirsutism, and/or alopecia), and the ultrasound appearance of the ovaries.
The origins of PCOS are clearly genetically based and are linked to other metabolic and physiologic abnormalities such as type 2 diabetes, obesity, hypercholesterolemia, and heart disease. References to the syndrome go back as far as the ancient Egyptian papyri and show up repeatedly in ancient Greek and Hebrew literature as well as the medieval and Renaissance periods. It has such an ancient genetic stamp that it is now thought to predate the emergence of human racial diversity 50,000 years ago.
Has PCOS been a “fertility problem” all this time? Why would something that seems to decrease fertility be considered a “survival factor”? And, more importantly, what are the consequences of this ancient biology on 21st century lives?
We now understand that PCOS is associated with insulin resistance and the metabolic syndrome. This sort of metabolism is actually an advantage in times of food scarcity, since insulin resistance imparts a relative “fuel efficiency”. In other words, people with insulin resistance tended to survive when food was hard to get and everyone had to work hard physically to create shelter, keep warm, and stay safe. That has been the case for the vast majority of human history. Now that food is much easier to come by in the developed world and we don’t have to work so hard physically to get it, the consequences of insulin resistance are obesity, diabetes, heart disease, and some forms of cancer.
In the “old days”, women with PCOS were able to successfully conceive and, because of the relative metabolic efficiency and other hormonal changes, actually lived longer and more healthfully. A major difference now is that we generally wait until adulthood to start our families; in ancient times, adulthood started during the teen years. Keep in mind that the usual life span in those days was 35 to 40 years at best, so the teens were “middle aged”. In most of the world, this is no longer so.
Many women with PCOS fear that the diagnosis may mean they will never have children. This is categorically NOT true. Now that PCOS is recognized as a metabolic problem with wide-ranging associated issues, this understanding has radically changed how PCOS-related infertility is managed. Ovulation induction and improvement of the metabolic abnormalities in PCOS are now much easier to achieve with simple medications and healthy lifestyle changes. When managed properly, fertility rates among women with PCOS approach that of the normal fertile population. Here at Fertility Answers, we strive to help all of our patients conceive in the most healthful, natural, and efficient manner possible.