As a primary care doctor, I am often the first stop for women struggling with fertility. Perhaps the most common story I hear is from the 30-something, generally healthy woman who stopped her birth control in an effort to get pregnant. She'd been on it "forever," and now her cycles are irregular and unpredictable. She has tried to use ovulation kits to help time intercourse, but she is frustrated that she and her husband have been trying for several months without success. If this sounds like you, you are not alone!
One of the most common reasons for female infertility is Polycystic Ovarian Syndrome (PCOS). The easiest way to think about PCOS is that some women have a bit of extra testosterone in their bodies, and this can suppress normal, monthly ovulation. Because of this extra testosterone some woman will also experience acne and extra hair growth, but this does not happen to all women with PCOS. In order to make the diagnosis, your doctor will check hormone levels, both to see if you have an elevated testosterone level and to rule out other causes of irregular periods. Your doctor may also check an ultrasound of your ovaries - because ovulation is not happening regularly, there may be many small eggs or "cysts" seen, hence the name of the syndrome.
If you have PCOS, there are ways to reset your body's hormones to help your ovaries ovulate. Under the guidance of a reproductive endocrinologist, most women with PCOS will be able to take oral medication to induce ovulation. The two medications that are commonly used are Clomid and Letrozole. While taking those medications, women are monitored regularly with blood tests and ultrasounds to track their hormone levels and the development of an egg (commonly called a follicle) to assist with timing intercourse. To maximize the chances of conceiving, some doctors will supplement medication use with Intrauterine Insemination (IUI) - this is a process in which sperm from the male is placed inside the woman's uterus via a syringe inserting vaginally. The goal is to maximize the number of sperm that will reach the egg. If after several attempts this process does not result in pregnancy, then In Vitro Fertilization (IVF) is the next step. Women undergoing IVF take a variety of hormones, both in pill and injection form, to help their ovaries develop several follicles. Again, these women are monitored closely with blood tests and ultrasounds, and when the follicles are ready or "mature," a procedure is done to remove them from each ovary. In a laboratory, the follicles are then combined with the male's sperm with the goal to generate several fertilized eggs, or embryos. One or multiple embryos can then be put back into the female's uterus to hopefully result in pregnancy.
Despite all of the medical advances we have to assist women who struggle with infertility, it can still be a stressful process with a lot of ups and downs. Be open and honest with your doctor when you have questions, concerns or fears so that they can be addressed, and so you can be reassured. And don't underestimate the power you have to maximize your own fertility! Eating healthy, exercising, taking the appropriate prenatal vitamins, and taking care of your own mental health are critical as you embark on this journey.
Written by Dr. Lori Noble, MD. Lori Noble is an internal and family medicine physician with Penn Medicine. She is well-versed in women's health and PCOS. When Lori isn't busy caring for her patients, she enjoys spending time with her family. We're fortunate to have her as a member of our scientific advisory board.