PCOS/Metabolic Syndrome

Having irregular, longer-lasting or absent periods? Metabolic syndrome/PCOS may be the culprit, which makes getting pregnant more challenging.

Metabolic syndrome — or polycystic ovary syndrome (PCOS) — is a common cause of infertility in females, with several GoFertility patients finding out they have PCOS when they struggle to get pregnant.

During a female’s monthly period, the ovaries release an egg into the uterus in a process known as ovulation. Women with metabolic syndrome do not ovulate or ovulate infrequently. This results in absent, irregular or longer-lasting periods, which makes pregnancy more difficult and increases the risk of additional health problems developing.

How common is metabolic syndrome and what are its symptoms?

Metabolic syndrome is very common, with the Cleveland Clinic stating up to 15 percent of women in their reproductive years have the condition. Women can get PCOS any time after puberty, with the majority diagnosed in their 20s or 30s upon trying to get pregnant. Females who have obesity or a biological family history of metabolic syndrome might have increased risk of getting the condition.

Many patients don’t recognize they have PCOS until they have challenges getting pregnant or mysteriously gain weight. Metabolic syndrome symptoms and signs are typically more severe with females who are obese. Common symptoms include:

  • Cysts on enlarged ovaries, which are painless and appear on ultrasounds
  • Irregular periods or no periods at all; may also include heavy bleeding during periods
  • Excessive hair growth, typically on the face, arms, chest, abdomen, back and buttocks
  • Thinning hair and hair loss on the head
  • Acne, particularly on the back, chest and face
  • Dark patches of skin, especially in the neck, armpits, groin and beneath the breasts
  • Skin tags
  • Obesity, with 40 to 80 percent of individuals with PCOS having a difficult time maintaining a proper weight
  • Chronic low-grade inflammation

How is metabolic syndrome diagnosed and treated?

The Center for Reproductive Medicine and Robotic Surgery in St. Louis will complete a physical exam and discuss your symptoms with you. Dr. Saji Jacob — a certified OB/GYN, reproductive endocrinologist, embryologist and infertility specialist — and our highly trained team may advise ordering blood tests, a pelvic exam or a pelvic ultrasound to assist in making the diagnosis. Typically — if two of these three symptoms are present in a patient — metabolic syndrome can be diagnosed:

1. Irregular, infrequent, long-lasting or absent periods

2. Scans showing fluid sacs on your ovaries, which are usually arranged like a string of pearls.

3. Blood tests demonstrating high levels of free testosterone or high LH/FSH ratio

Every case and patient at GoFertility is different, and Dr. Jacob will take his time to understand your symptoms so proper treatment can be administered. A majority of our patients don’t do well with home remedies or over-the-counter medications that cause egg quality to be poor. With absent or infrequent ovulation resulting in no eggs or immature ones, many of our patients opt for in-vitro fertilization (IVF) as their next step.

In IVF, Dr. Jacob and our laboratory team carefully examine eggs to ensure they are mature and healthy before fertilization by a sperm begins. The fertilized eggs develop into embryos and then to Day 5 embryos (blastocysts) prior to being placed in the uterus. GoFertility specializes in IVF and has bested the national pregnancy rate per embryo transfer every year since 2011 when we opened. Dr. Jacob is one of only a few dual board-certified specialists in the country.

We were selected as one of the top-50 fertility clinics in the country in 2023 by Newsweek, one of just two Missouri clinics to earn this recognition. Give us a call or email today if you believe you may have PCOS, and we’ll work with you to diagnose and treat this condition.

 Want to learn more about the three pathways leading to the development of PCOS? Click here for more.

Insulin Resistance Pathway

After we have any meal, sugar is absorbed from the small intestine within 15 to 30 minutes. Naturally, the blood sugar level goes up and your brain senses it. The brain sends a signal to the pancreas to pump insulin into the blood stream. Insulin is a hormone that brings down the blood sugar level by pushing glucose into the cells.

If the insulin is not working properly, the pancreas has to pump more insulin to keep the blood sugar level normal. This condition is called insulin resistance. The high insulin levels in the blood cause failure of eggs in the ovaries to develop and ovulate, which results in infertility. This condition can be treated by losing weight and/or taking a medication called Metformin.

Androgen Pathway

In some women there is increased conversion of estrogen to androgen due to the hyperactivity of the enzyme. These patients have increased levels of free testosterone and testosterone precursors, which may result in increased male-type hair growth, oily skin, acne and/or balding. The high level of free testosterone causes failure of the follicles to grow and ovulates the egg, which results in infertility. This condition can be treated by a medication called Aldactone.

Pituitary Pathway

Synergic back-to-back production of FSH and LH hormones from the pituitary gland in the brain is essential for normal ovulation. In the initial part of the menstrual (ovarian) cycle, FSH hormones produced by the pituitary gland stimulate the follicles to grow in the ovary.

When follicles reach a certain size, the pituitary gland produces the hormone LH which induces ovulation of the egg from the follicle. Sometimes the pituitary gland produces LH instead of FSH and the follicles get confused and stuck without ovulating the egg. This leads to infertility.

A patient may have one, two or three pathways. Our team of experts will conduct appropriate tests to identify the exact cause of the metabolic syndrome/PCOS and will advise you on the appropriate treatments.