Maggie McKay (Host): If you're considering help with fertility, today we'll discuss the facts about PCOS with Reproductive Endocrinologist, Dr. Ravi Agarwal. Welcome to Fertile Edge, a podcast from the Reproductive Science Center of the San Francisco Bay Area. I'm your host, Maggie McKay. Thank you so much for joining us today, Dr. Agarwal. Would you please introduce yourself?

Ravi Agarwal, MD: Sure, happy to be here. I'm Dr. Ravi Agarwal and I'm an Infertility Specialist at the Reproductive Science Center here in the Bay Area.

Host: Let's start with what is PCOS?

Ravi Agarwal, MD: So PCOS is short for polycystic ovarian syndrome, and it is actually very common, affects about 10 percent of reproductive aged women, and is marked by being an endocrine disorder, meaning that it is a imbalance of hormones in your body. Specifically the main hormone that's abnormal is an androgen called testosterone. And patients with PCOS tend to produce that hormone in higher levels, which can then cause all the telltale symptoms of PCOS.

Host: So what are the indicators of PCOS?

Ravi Agarwal, MD: I think it's very important to know that PCOS is a spectrum of illness, and it really depends on each person's age, their ethnicity, their weight, many factors about them. But some of the most common are to have irregular periods, to have signs of elevated testosterone, including acne, hair growth you can have weight issues, you can be overweight, you can be underweight, in fact, also and also you can have some other consequences of having high testosterone levels, such as cholesterol abnormalities, prediabetes, and other abnormalities in a blood test like that.

Host: How do you test for PCOS?

Ravi Agarwal, MD: It's actually a pretty comprehensive exam that requires not just blood tests, but also ultrasound and a physical exam looking for the entire constellation of symptoms. We officially diagnose patients with PCOS if they have two of three either symptoms or diagnostic tests. Either the periods are irregular, meaning that you have less than eight periods per year, you have either clinical or laboratory evidence of that elevated testosterone level, which can be picked up on blood tests or on that physical exam. Or your ultrasound shows that your ovaries have a very characteristic appearance of someone with PCOS, meaning that you can see very high number of small cysts on your ovaries.

Host: And when should someone with PCOS reach out to a fertility specialist?

Ravi Agarwal, MD: I think the treatment for PCOS really depends on what stage of life you're in, what your goals are. If you aren't ready to get pregnant, then it really is just managing whatever your symptoms of PCOS are and a fertility specialist or even a regular gynecologist can definitely help you with that. But if you're trying to get pregnant, then it's probably best to speak to a fertility specialist right away, early in your journey.

The main issue that women with PCOS have in trying to get pregnant is that they either are not ovulating at all, or ovulation is a little bit unpredictable and irregular. Ovulation is the first domino in the whole getting pregnant cascade. Patients with PCOS often require fertility treatment to help them get pregnant.

Host: What are the treatment options for someone trying to conceive with PCOS?

Ravi Agarwal, MD: Yeah. I think, that's a very nuanced question. And I think it really depends again on what your goals are. Most patients with PCOS do require some sort of treatment to help them get pregnant. Again, going back to the issue with ovulation. The easiest treatment is just to overcome the main issue, which is just to help you take a medication that helps you ovulate The most common medications are called either Clomid or Letrozole, oral medications that can just kick start the process and then couples are free to either have intercourse at home or undergo what's called an intrauterine insemination in the clinic. If that doesn't work for couples or if couples are a little bit older, then patients PCOS might require in vitro fertilization, a slightly more aggressive treatment to help them get pregnant, but very effective nonetheless.

Host: Does PCOS ever go away?

Ravi Agarwal, MD: It's a great question. We don't think that PCOS is ever curable but we do think that symptoms do get milder as women get older and the severity of symptoms actually improves as well. So the treatment, the management, the rigor with which you need to control those symptoms definitely get easier as women get older.

Host: So let's say you want three children. Are you going to have to deal with this every time?

Ravi Agarwal, MD: You know, we do again, because unfortunately we don't think that PCOS and the main issue with fertility, that irregular ovulation gets better with time, most patients with PCOS do require some sort of treatment for every pregnancy that they do want.

Host: Okay. Dr. Agarwal, is there anything else you'd like to add or you would like people to know that we didn't talk about yet?

Ravi Agarwal, MD: I would just like to, you know, emphasize that PCOS has a whole spectrum of conditions and there's no classic presentation for it. Even if you were a little bit concerned that you might have it, there's, you meet even one of the criteria or one concerning feature of PCOS, I encourage you to get checked out.

I think early diagnosis of PCOS is key. We know that PCOS is, not just affects women fertility, but can actually have lifelong consequences. Women with PCOS are at higher risk for diabetes, heart disease, and an early diagnosis and management of those conditions is really key to preventing any issues down the road.

Host: Well thank you so much for sharing your expertise and making the time to explain what PCOS is.

Ravi Agarwal, MD: Of course.

Host: Again, that's Dr. Ravi Agarwal. To learn more about PCOS and to schedule with an RSC Bay physician, please call 888-377-4483.

And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Fertile Edge, a podcast from the Reproductive Science Center of the San Francisco Bay Area.