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Infertility in androgen excess and PCOS
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Women with androgen excess often experience difficulty becoming pregnant. Normal fertility requires that the ovary release an egg or ovum, which can be fertilized by the male sperm. After fertilization, the developing embryo must enter the uterus where the endometrium is appropriately developed to allow for the pregnancy to continue. As we have already discussed, women with PCOS do not ovulate in a normal fashion and as a result their endometrium is not developed properly developed. Infertility in androgen excess, including PCOS and other similar disorders, generally results from the lack of regular ovulation (see ‘ Irregular Ovulation and Abnormal Menstruation’). However, other mechanisms may also play a role. For example, it is possible, although not yet proven, that patients with PCOS have a greater risk of pregnancy loss or miscarriage, possibly due to the presence of obesity or insulin resistance. Patients with non-classic adrenal hyperplasia often have very elevated levels of progesterone and/or 17-hydroxyprogesterone, which may lead to an excessively thin endometrium lining, making it difficult for the pregnancy to implant (adhere to the endometrium) and grow.
It is important to remember that not all infertile women have androgen excess or PCOS. There are many causes of infertility, of which PCOS is only one. It is also important to remember that women with PCOS can become pregnant, in some cases naturally and in other cases with the help of medications or assisted reproductive technologies. Just because a woman has PCOS does not mean that she cannot become pregnant.
In most patients, although not all, infertility can be overcome by the use of ovulation-inducing drugs, such as clomiphene citrate, gonadotropins, or insulin-sensitizing agents like metformin.