Deborah Howell (Host): You know, as so many couples can testify, the path to parenthood is not always an easy one. Happily, there is help along the way for those who have a condition called PCOS. I'm Deborah Howell, and our guest today is Stephanie Green, an Advanced Practice Provider at Boston IVF at the Women's Hospital, and today will be letting you in on everything you need to know about PCOS. Welcome Stephanie.

Stephanie Green, ANCP- BC: Thanks for having me, Deborah.

Host: It is all our pleasure. Let's begin with this question, in a nutshell, what is PCOS?

Stephanie Green, ANCP- BC: PCOS stands for polycystic ovarian syndrome, and it's the most common endocrine disorder of reproductive age women and the most frequent cause of anovulatory infertility. Anovulatory infertility means women that are having difficulty conceiving, because they don't ovulate. The prevalence ranges from nine to 18%, but the etiology really remains unknown. It's a specifically a syndrome with a collection of specific signs and symptoms rather than a well-defined disorder. Because of this, there can be variable clinical presentations.

Host: Wow. And what are the main reasons women with PCOS present for care?

Stephanie Green, ANCP- BC: Typically they first show up because they're having menstrual disturbances, such as not having normal periods. Their periods may be really irregular or they may not be having periods at all. Also, they present because of hyperandrogenism and infertility issues.

Host: Let's step back just a second. What is hyperandrogenism and what are some of the symptoms of hyperandrogenism?

Stephanie Green, ANCP- BC: Yeah, that's a big word. Hyperandrogenism really is like, it just means high levels of androgens and androgens are male sex hormones that are in the female body that can cause such things as acne, changes in the female shape, decrease in breast size, increase in body hair in a male pattern, such as on the face or chin or abdomen, lack of menstrual period and excessively oily skin.

Host: Okay. Understandable. Now, how is PCOS diagnosed?

Stephanie Green, ANCP- BC: Well, it's kind of difficult, because there's not a blood test, like one thing that you can do to diagnose PCOS. It's really practitioners use a criteria that's called the Rotterdam criteria, which requires two of the following three symptoms to diagnose a female with PCOS. And those are, oligoovulation, which are irregular periods, cycles less than 25 days or more than 35 days apart, clinical and or biochemical signs of hyperandrogenism and polycystic appearing ovaries on ultrasound.

Host: And is PCOS associated with any potential long-term health complications?

Stephanie Green, ANCP- BC: Yes. It is actually, including diabetes, obesity, heart disease, uterine cancer. That's why it's so important for practitioners to identify these metabolic abnormalities to mediate any future health risks that a patient may have.

Host: What are some of the lifestyle interventions that patients can do to help manage their PCOS, particularly those with obesity?

Stephanie Green, ANCP- BC: The lifestyle intervention should address weight loss or prevention of weight gain through dietary modifications and regular exercise. A body weight reduction of five to 10% has been shown to exert a significant benefit on psychological, reproductive, and metabolic outcomes. In addition, BMI is a clear factor for infertility treatments with reduced pregnancy rates among obese patients compared to normal weight patients. Consultation with a nutritionist, regular exercise for at least 30 minutes a day, can reduce cardiovascular risks that are associated with PCOS and assist them in their efforts to achieve pregnancy.

Host: Good to know. Stephanie, I'm curious, do all women who have PCOS struggle with obesity?

Stephanie Green, ANCP- BC: I'm glad you asked that because no, they don't actually. There is a special subset of patients who have what we call lean PCOS. This is where they have a normal BMI, but they have greater insulin resistance compared to weight match controls. They also manifest various metabolic abnormalities such as dyslipidemia, which is high cholesterol, triglycerides, prothrombotic tendencies, which are blood clotting issues and increased inflammatory markers. Unfortunately, their diagnosis is often delayed or missed altogether because they don't exhibit the typical PCOS symptoms.

Host: And that's a subset though.

Stephanie Green, ANCP- BC: Yes, that's right.

Host: And what fertility options are available for those with PCOS to help them achieve pregnancy?

Stephanie Green, ANCP- BC: Well, the primary goal in treatment is to obviously help the patient ovulate effectively, cause the main thing with this disorder is inadequate or no ovulation. This can be helped by medications such as Clomid or Femara, which are oral choices. And then there's also IVF utilizing injectable medications. But each treatment plan is specifically designed for the individual couple and would be discussed fully at their office visits.

Host: And now once pregnant are PCOS patients at higher risk of any obstetrical complications.

Stephanie Green, ANCP- BC: Yes, they are actually. Some of the higher risks things are pregnancy-induced hypertension, gestational diabetes, and sometimes even preterm birth. Those risks are also further exacerbated by obesity.

Host: One more reason to just stay on top of it if you have that diagnosis. You've given us such great information today, Stephanie. Is there anything else you'd like to add to our conversation?

Stephanie Green, ANCP- BC: Yeah, I would just mention that sometimes these things can be hard to address and we want them to know that we're here for them. We would love to help them achieve pregnancy. And if there's any questions that they may have, they can also discuss things with their regular OBGYN provider as well.

Host: Well, thank you so much for being with us today to talk about PCOS. We really, really appreciate you being here.

Stephanie Green, ANCP- BC: Thank you so much for having me.

Host: And for more information, you can go to www.deaconess.com/theWomen'sHospital/services/fertilitycare. And that wraps up this episode of the podcast series from Deaconess, the Women's Hospital, A Place for All Your Life.

Please remember to subscribe, rate, and review this podcast and all the other Deaconess Women Hospital podcasts. For more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.