Selected Podcast
PCOS and Fertility
Join Dr. Asima Ahmad as she tackles the topic of Polycystic Ovary Syndrome during September’s PCOS Awareness Month. As someone diagnosed with PCOS who has also treated countless women with the same medical issue, she shares everything there is to know about PCOS - what it is, how it impacts fertility and overall health, and how it can be effectively treated and managed.
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Learn more about Asima Ahmad, MD
Asima Ahmad, MD
Dr. Asima K. Ahmad is a board-certified reproductive endocrinologist and obstetrician and gynecologist with a passion for improving access to care for all patients, irrespective of social, economic, or financial circumstance. Dr. Ahmad earned combined medical and public health degrees from the University of Chicago’s Pritzker School of Medicine and the Harvard School of Public Health.Learn more about Asima Ahmad, MD
Transcription:
Deborah: Well, fertility treatment is a journey, and it's not always a perfectly smooth ride. Today, we'll talk about one of the bumps in the road to fertility, PCOS. Joining us today is Dr. Asima Ahmad, a reproductive endocrinologist at Fertility Centers of Illinois. She's also a co-founder of Carrot Fertility, where she acts as Chief Medical Officer to increase access to fertility care. Dr. Ahmad is here today to answer your questions about PCOS and fertility.
This is the Time To Talk Fertility podcast. I'm your host, Deborah Howell. Dr. Ahmad, can you start us off by sharing what PCOS is?
Dr Asima Ahmad: Absolutely. So PCOS or polycystic ovary syndrome is a disorder that causes hormonal imbalance and irregular ovulation. So individuals who have PCOS can present with symptoms of, for example, irregular menstrual cycles, obesity, excessive hair growth, severe acne, and sometimes even infertility. The diagnosis of PCOS can also increase your risk for developing heart disease, high blood pressure, metabolic syndrome or diabetes.
Deborah: How common is PCOS?
Dr Asima Ahmad: It's actually very common. So depending on the population you're reviewing and the diagnostic criteria being used, it can affect as many as 5% to 20% of women.
Deborah: Wow. I've heard that PCOs is commonly misdiagnosed. Why is that?
Dr Asima Ahmad: There can be several reasons for this. One of the reasons is that there is more than one way to diagnose PCOS. For example, I use the Rotterdam criteria. When using certain criteria, it is important that each aspect is evaluated using the modalities and cutoffs recommended. For instance, in the Rotterdam criteria, polycystic appearing ovaries requires an antral follicle count of 12 or more follicles in at least one ovary or an ovarian volume of 10 CCs or more. This information is obtained with a very detailed pelvic ultrasound. If you think that your PCOS may have been misdiagnosed, it is never a bad idea to seek a second opinion. You can do this with a reproductive endocrinologist, for instance, as this is what we are trained to diagnose and treat.
Deborah: Sure. Now, I have a two-part question for you. How can a woman be sure she's being evaluated properly? And what type of medical specialist is best to diagnose PCOS?
Dr Asima Ahmad: I think I may have answered part of this in the previous question, but a woman should ask the clinician what diagnostic criteria are being used for the evaluation and the diagnosis. The clinician should ask her specific questions about the regularity of her menstrual cycle, hair growth, acne or other unexplained changes like hair loss or change in voice and should also perform an ultrasound.
Once these items are evaluated, she should understand whether or not she does meet diagnostic criteria for the diagnosis. So going back to the Rotterdam criteria, you need at least two of the following items: irregular cycles, which can be described using the words oligomenorrhea or amenorrhea, and this is not explained to the other condition; clinical or biochemical hyperandrogenism, so this means clinical findings, like excess hair growth or elevated androgens, like elevated testosterone and/or polycystic-appearing ovaries.
In terms of the diagnosis, ideally a reproductive endocrinologist or medical endocrinologist can help with the diagnosis of PCOS. Your OB-GYN may also be able to do this.
Deborah: Okay. And Dr. Ahmad, I know that you yourself have PCOS. Can you share your journey with us?.
Dr Asima Ahmad: Absolutely. So I always had irregular cycles and adult acne, but no one could tell me why. It was always played off as not a big deal or this happens to a lot of people. And I remember having a pelvic ultrasound in my late '20s and being told I had polycystic-appearing ovaries. It was actually during my medical training that I put two and two together and approached my clinician about PCOS and if I met diagnostic criteria. Luckily, at that point, I knew what to look for and was able to help guide my diagnosis.
In some cases, given the irregularity of cycles, some women can't predict ovulation or do not ovulate regularly and have difficulty conceiving. In my case, I was lucky and I did not have difficulty conceiving.
Deborah: Thank God for that. Okay. And now what PCOS symptoms should women watch out for? Besides that acne, are some more worrisome than others?
Dr Asima Ahmad: Yes. Any of the symptoms described earlier are all very important. However, one that I find very important is if they notice that they do not ovulate regularly or do not have regular cycles or regular menses or periods. So if someone's not shedding that uterine lining regularly, that can put them at risk for developing hyperplasia, which then puts them at risk for developing uterine cancer. Also, if they're trying to conceive and can't predict ovulation, it may be a good idea to speak to reproductive endocrinologist or their OB-GYN to assist them with ovulation and timing their intercourse.
Deborah: Fair enough. Now, are there some medical issues or ethnicities that are commonly linked to a PCOS diagnosis?
Dr Asima Ahmad: Yeah. So there was this systematic review meta-analysis done in 2017. In other words, just really big study looking at other smaller studies. And they showed an increasing prevalence, so lower to higher, for the following ethnicities: Chinese, Caucasian, Middle Eastern, African-American. There were some limitations to this study and it didn't include all ethnic groups and also the studies being used tend to use different diagnostic criteria. So there are probably more studies looking into this to be able to provide additional information.
One thing to also keep in mind is the presentation of PCOS can also be different amongst different ethnic groups. So for instance, South Asian and Middle Eastern women may present as more hirsute or more excessive hair growth. Hispanic women, for instance, may have higher rates of metabolic syndrome. So knowing your ethnic background and the diagnosis of PCOS can actually help manage your specific type of PCOS better.
Deborah: Sure. Now, here's the big question. How does PCOS impact fertility?
Dr Asima Ahmad: Some women with PCOS do not ovulate at all or have longer periods or time between ovulation. When a person ovulates, the egg is viable for about 12 to 24 hours. And if it's not predictable, one can miss that window of time and may not be able to time intercourse or even an intrauterine insemination or IUI as well. So knowing their time of ovulation is very important to be able to do that.
Deborah: I know that not all women with PCOS will experience infertility. What should we know?
Dr Asima Ahmad: That even though PCOS might not cause infertility, there are still things that you can focus on to improve your overall health. Given that increased risk for metabolic syndrome, heart disease, and diabetes, it's important to keep an eye on your overall health. So monitoring these parameters consistently can help prevent development of these conditions.
Deborah: So Dr. Ahmad, many women take birth control to manage PCOS. So it may be a shock to go off birth control and experience symptoms while also trying for a baby, which can be stressful, of course. What advice would you offer?
Dr Asima Ahmad: I would say when you're at that point where you're ready to try conceiving, alert your physician, whether that's your OB-GYN or your reproductive endocrinologists that you're considering going on this path. That way, they can be involved in your journey and kind of assist you if you notice your ovulation is irregular sooner rather than later, and that can help you achieve pregnancy sooner.
Deborah: Okay. And for those with PCOS who may need help to become pregnant, what's a common route of treatment?
Dr Asima Ahmad: I would say the most common route of treatment is ovulation induction using oral medications, such as Clomid or letrozole. In many cases, your doctor will also do an ultrasound and/or check your hormones to see how you're responding to the treatment and see if you need to make any modifications. But I would say ovulation induction is the most common.
Deborah: Right. Now, is there anything women can do on their own to lessen PCOS symptoms and boost their fertility?
Dr Asima Ahmad: Yes. Nutrition, exercise and weight management are all very important. For example, as our weight increases and even as our diet changes, our hormones in our body can change and thus worsen some of the symptoms associated with PCOS, including those irregular cycles and ovulation. So managing those well can help to lessen those symptoms and boost their fertility.
Deborah: And how does PCOS affect overall health and long-term health?
Dr Asima Ahmad: It's the increased risk of developing metabolic syndrome, heart disease, high blood pressure and diabetes. And some women also hold on to their weight a little bit more and have difficulty shedding that weight.
Deborah: So what can people do if PCOS is impacting their health?
Dr Asima Ahmad: I think it's really important to let your healthcare provider know so they can help you come up with a plan that is unique to your body and goals. Just as what we all women know, we don't respond to the same diets, to the same exercises, and to the same treatments. So it's always important to keep them in the loop with their healthcare provider so they can help assist coming up with the best plan for you.
Deborah: All right. Communicate, communicate, communicate. So we're now living in an era of course of pandemic. In terms of COVID and PCOS, is there anything women should know?
Dr Asima Ahmad: Yes. We know that individuals with co-morbidities or, you know, medical conditions like diabetes, heart disease have an increased risk of getting sicker if they are infected with COVID compared to the average healthy adult. Now, given the increased risk of co-morbidities with PCOS, like the diabetes and the heart disease, women with PCOS can get more ill if they are infected with COVID.
Deborah: Okay. Now, in honor of PCOS Awareness Month, what do you wish more people knew?
Dr Asima Ahmad: I would say if you have any suspicion that you or someone you know has PCOS, please reach out to your doctor to be evaluated and diagnosed sooner rather than later. Many women have this condition, but if it's recognized early, you will learn to manage it and keep it under control. Sometimes even before it leads to development of other medical conditions like diabetes. So prevention of these conditions is just as important as the diagnosis and treatment.
Deborah: So I'm going to throw this in, is PCOS a progressive disease itself?
Dr Asima Ahmad: Not necessarily. There's actually some women that find that over time, their cycles become more regular and more predictable as they get older, so it's not necessarily progressive. But I feel that if you have it and you don't realize you have this increased risk, you may have developing pre-diabetes for instance, and not know. And this can happen even if you don't have a family history of diabetes that you have this increased risk. So sometimes it's not even on their radar. They're not even thinking about it.
Deborah: Right. Now, can you share a bit about your patients who've been treated for PCOS?
Dr Asima Ahmad: I would say about half of my patients come to clinic already having a suspicion that they may have PCOS, whereas the other half did not know. In either case, we were able to come up with a customized plan to help them build their families while also working on improving their overall health.
Deborah: Perfect. You know, we like to close out all episodes on a positive note. Can you share some words of hope with our listeners?
Dr Asima Ahmad: Absolutely. If you do have PCOS, know that you're not alone. Again, 5% to 20% of women share this condition. By recognizing it and managing it early, you can lead a healthy life and build your family the way you'd like.
Deborah: Well, Dr. Ahmad, we can't thank you enough for being on with us today. As always, very informative and just a delight to talk to you.
Dr Asima Ahmad: Thank you for having me.
Deborah: That was Dr. Asima Ahmad, a reproductive endocrinologist here at Fertility Centers of illinois. Call (877) 324-4483 or visit us online at fcionline.com to schedule a telemedicine consultation with one of our wonderful physicians. And if you enjoyed this podcast, you can find more like it in our podcast library. And be sure to give us a like and a follow if you do. This has been the Time To Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.
Deborah: Well, fertility treatment is a journey, and it's not always a perfectly smooth ride. Today, we'll talk about one of the bumps in the road to fertility, PCOS. Joining us today is Dr. Asima Ahmad, a reproductive endocrinologist at Fertility Centers of Illinois. She's also a co-founder of Carrot Fertility, where she acts as Chief Medical Officer to increase access to fertility care. Dr. Ahmad is here today to answer your questions about PCOS and fertility.
This is the Time To Talk Fertility podcast. I'm your host, Deborah Howell. Dr. Ahmad, can you start us off by sharing what PCOS is?
Dr Asima Ahmad: Absolutely. So PCOS or polycystic ovary syndrome is a disorder that causes hormonal imbalance and irregular ovulation. So individuals who have PCOS can present with symptoms of, for example, irregular menstrual cycles, obesity, excessive hair growth, severe acne, and sometimes even infertility. The diagnosis of PCOS can also increase your risk for developing heart disease, high blood pressure, metabolic syndrome or diabetes.
Deborah: How common is PCOS?
Dr Asima Ahmad: It's actually very common. So depending on the population you're reviewing and the diagnostic criteria being used, it can affect as many as 5% to 20% of women.
Deborah: Wow. I've heard that PCOs is commonly misdiagnosed. Why is that?
Dr Asima Ahmad: There can be several reasons for this. One of the reasons is that there is more than one way to diagnose PCOS. For example, I use the Rotterdam criteria. When using certain criteria, it is important that each aspect is evaluated using the modalities and cutoffs recommended. For instance, in the Rotterdam criteria, polycystic appearing ovaries requires an antral follicle count of 12 or more follicles in at least one ovary or an ovarian volume of 10 CCs or more. This information is obtained with a very detailed pelvic ultrasound. If you think that your PCOS may have been misdiagnosed, it is never a bad idea to seek a second opinion. You can do this with a reproductive endocrinologist, for instance, as this is what we are trained to diagnose and treat.
Deborah: Sure. Now, I have a two-part question for you. How can a woman be sure she's being evaluated properly? And what type of medical specialist is best to diagnose PCOS?
Dr Asima Ahmad: I think I may have answered part of this in the previous question, but a woman should ask the clinician what diagnostic criteria are being used for the evaluation and the diagnosis. The clinician should ask her specific questions about the regularity of her menstrual cycle, hair growth, acne or other unexplained changes like hair loss or change in voice and should also perform an ultrasound.
Once these items are evaluated, she should understand whether or not she does meet diagnostic criteria for the diagnosis. So going back to the Rotterdam criteria, you need at least two of the following items: irregular cycles, which can be described using the words oligomenorrhea or amenorrhea, and this is not explained to the other condition; clinical or biochemical hyperandrogenism, so this means clinical findings, like excess hair growth or elevated androgens, like elevated testosterone and/or polycystic-appearing ovaries.
In terms of the diagnosis, ideally a reproductive endocrinologist or medical endocrinologist can help with the diagnosis of PCOS. Your OB-GYN may also be able to do this.
Deborah: Okay. And Dr. Ahmad, I know that you yourself have PCOS. Can you share your journey with us?.
Dr Asima Ahmad: Absolutely. So I always had irregular cycles and adult acne, but no one could tell me why. It was always played off as not a big deal or this happens to a lot of people. And I remember having a pelvic ultrasound in my late '20s and being told I had polycystic-appearing ovaries. It was actually during my medical training that I put two and two together and approached my clinician about PCOS and if I met diagnostic criteria. Luckily, at that point, I knew what to look for and was able to help guide my diagnosis.
In some cases, given the irregularity of cycles, some women can't predict ovulation or do not ovulate regularly and have difficulty conceiving. In my case, I was lucky and I did not have difficulty conceiving.
Deborah: Thank God for that. Okay. And now what PCOS symptoms should women watch out for? Besides that acne, are some more worrisome than others?
Dr Asima Ahmad: Yes. Any of the symptoms described earlier are all very important. However, one that I find very important is if they notice that they do not ovulate regularly or do not have regular cycles or regular menses or periods. So if someone's not shedding that uterine lining regularly, that can put them at risk for developing hyperplasia, which then puts them at risk for developing uterine cancer. Also, if they're trying to conceive and can't predict ovulation, it may be a good idea to speak to reproductive endocrinologist or their OB-GYN to assist them with ovulation and timing their intercourse.
Deborah: Fair enough. Now, are there some medical issues or ethnicities that are commonly linked to a PCOS diagnosis?
Dr Asima Ahmad: Yeah. So there was this systematic review meta-analysis done in 2017. In other words, just really big study looking at other smaller studies. And they showed an increasing prevalence, so lower to higher, for the following ethnicities: Chinese, Caucasian, Middle Eastern, African-American. There were some limitations to this study and it didn't include all ethnic groups and also the studies being used tend to use different diagnostic criteria. So there are probably more studies looking into this to be able to provide additional information.
One thing to also keep in mind is the presentation of PCOS can also be different amongst different ethnic groups. So for instance, South Asian and Middle Eastern women may present as more hirsute or more excessive hair growth. Hispanic women, for instance, may have higher rates of metabolic syndrome. So knowing your ethnic background and the diagnosis of PCOS can actually help manage your specific type of PCOS better.
Deborah: Sure. Now, here's the big question. How does PCOS impact fertility?
Dr Asima Ahmad: Some women with PCOS do not ovulate at all or have longer periods or time between ovulation. When a person ovulates, the egg is viable for about 12 to 24 hours. And if it's not predictable, one can miss that window of time and may not be able to time intercourse or even an intrauterine insemination or IUI as well. So knowing their time of ovulation is very important to be able to do that.
Deborah: I know that not all women with PCOS will experience infertility. What should we know?
Dr Asima Ahmad: That even though PCOS might not cause infertility, there are still things that you can focus on to improve your overall health. Given that increased risk for metabolic syndrome, heart disease, and diabetes, it's important to keep an eye on your overall health. So monitoring these parameters consistently can help prevent development of these conditions.
Deborah: So Dr. Ahmad, many women take birth control to manage PCOS. So it may be a shock to go off birth control and experience symptoms while also trying for a baby, which can be stressful, of course. What advice would you offer?
Dr Asima Ahmad: I would say when you're at that point where you're ready to try conceiving, alert your physician, whether that's your OB-GYN or your reproductive endocrinologists that you're considering going on this path. That way, they can be involved in your journey and kind of assist you if you notice your ovulation is irregular sooner rather than later, and that can help you achieve pregnancy sooner.
Deborah: Okay. And for those with PCOS who may need help to become pregnant, what's a common route of treatment?
Dr Asima Ahmad: I would say the most common route of treatment is ovulation induction using oral medications, such as Clomid or letrozole. In many cases, your doctor will also do an ultrasound and/or check your hormones to see how you're responding to the treatment and see if you need to make any modifications. But I would say ovulation induction is the most common.
Deborah: Right. Now, is there anything women can do on their own to lessen PCOS symptoms and boost their fertility?
Dr Asima Ahmad: Yes. Nutrition, exercise and weight management are all very important. For example, as our weight increases and even as our diet changes, our hormones in our body can change and thus worsen some of the symptoms associated with PCOS, including those irregular cycles and ovulation. So managing those well can help to lessen those symptoms and boost their fertility.
Deborah: And how does PCOS affect overall health and long-term health?
Dr Asima Ahmad: It's the increased risk of developing metabolic syndrome, heart disease, high blood pressure and diabetes. And some women also hold on to their weight a little bit more and have difficulty shedding that weight.
Deborah: So what can people do if PCOS is impacting their health?
Dr Asima Ahmad: I think it's really important to let your healthcare provider know so they can help you come up with a plan that is unique to your body and goals. Just as what we all women know, we don't respond to the same diets, to the same exercises, and to the same treatments. So it's always important to keep them in the loop with their healthcare provider so they can help assist coming up with the best plan for you.
Deborah: All right. Communicate, communicate, communicate. So we're now living in an era of course of pandemic. In terms of COVID and PCOS, is there anything women should know?
Dr Asima Ahmad: Yes. We know that individuals with co-morbidities or, you know, medical conditions like diabetes, heart disease have an increased risk of getting sicker if they are infected with COVID compared to the average healthy adult. Now, given the increased risk of co-morbidities with PCOS, like the diabetes and the heart disease, women with PCOS can get more ill if they are infected with COVID.
Deborah: Okay. Now, in honor of PCOS Awareness Month, what do you wish more people knew?
Dr Asima Ahmad: I would say if you have any suspicion that you or someone you know has PCOS, please reach out to your doctor to be evaluated and diagnosed sooner rather than later. Many women have this condition, but if it's recognized early, you will learn to manage it and keep it under control. Sometimes even before it leads to development of other medical conditions like diabetes. So prevention of these conditions is just as important as the diagnosis and treatment.
Deborah: So I'm going to throw this in, is PCOS a progressive disease itself?
Dr Asima Ahmad: Not necessarily. There's actually some women that find that over time, their cycles become more regular and more predictable as they get older, so it's not necessarily progressive. But I feel that if you have it and you don't realize you have this increased risk, you may have developing pre-diabetes for instance, and not know. And this can happen even if you don't have a family history of diabetes that you have this increased risk. So sometimes it's not even on their radar. They're not even thinking about it.
Deborah: Right. Now, can you share a bit about your patients who've been treated for PCOS?
Dr Asima Ahmad: I would say about half of my patients come to clinic already having a suspicion that they may have PCOS, whereas the other half did not know. In either case, we were able to come up with a customized plan to help them build their families while also working on improving their overall health.
Deborah: Perfect. You know, we like to close out all episodes on a positive note. Can you share some words of hope with our listeners?
Dr Asima Ahmad: Absolutely. If you do have PCOS, know that you're not alone. Again, 5% to 20% of women share this condition. By recognizing it and managing it early, you can lead a healthy life and build your family the way you'd like.
Deborah: Well, Dr. Ahmad, we can't thank you enough for being on with us today. As always, very informative and just a delight to talk to you.
Dr Asima Ahmad: Thank you for having me.
Deborah: That was Dr. Asima Ahmad, a reproductive endocrinologist here at Fertility Centers of illinois. Call (877) 324-4483 or visit us online at fcionline.com to schedule a telemedicine consultation with one of our wonderful physicians. And if you enjoyed this podcast, you can find more like it in our podcast library. And be sure to give us a like and a follow if you do. This has been the Time To Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.