POLYCYSTIC OVARY SYNDROME
More people are now aware of polycystic ovary syndrome, thanks in part to celebrity “cysters” – a play on “cyst” and “sister”. EVELINE GAN talks to the doctors about the infertility condition and two women who overcame it.
The infertility condition that celeb mums want you to know about.
When Hartini Ab Ghani was diagnosed with polycystic ovary syndrome (PCOS) at 18, she wasn’t overly concerned about her irregular periods at that age. Nor the fact that the hormonal disorder, which causes small cysts on the ovaries, may cause infertility.
But that became Hartini’s major stumbling block when she was ready to start a family. With PCOS, Hartini says it was virtually impossible for her to become pregnant naturally.
“The scans showed many ‘bubbles’ (cysts) in my ovaries. While my eggs were there, they weren’t coming out and I wasn’t ovulating. Even after I took medication, underwent surgery as well as intrauterine insemination (IUI), nothing happened,” shares Hartini, 36, a senior specialist at the Singapore University of Technology and Design. “It was really frustrating.”
IUI is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilisation.
The # TTC saboteur
One of the leading causes of infertility, PCOS affects as many as one in 10 to 20 women of childbearing age, says Dr Seng Shay Way, a specialist in obstetrics and gynaecology and consultant at the Rafes Women’s Centre.
More people are made aware of the hormonal disorder today, thanks in part to celebrity “cysters” – a play on the words “cyst” and “sister” often used on social media to refer to women with PCOS – such as American model-actress Jaime King and local social media star Velda Tan (pictured, top right). Both have shared their #ttc (trying to conceive) struggles online.
Jaime, 38, took almost ve years of trying and suffered ve heartbreaking miscarriages before welcoming her rst child in 2013.
In July, Velda, who founded fashion brand Collate The Label and Love, Bonito, shared on her Instagram account @belluspuera that her road to conceiving “wasn’t quite a walk in the park”.
At one point, she found that she wasn’t ovulating anymore. “Over the next year, I was put on horrible cycles of medication to stimulate egg growth, with no result, only more pain, more weight gain, and cycle after cycle of disappointment,” Velda wrote.
She is about ve months’ pregnant, and continues to be open in sharing her infertility struggles to inspire other women.
There are no ofcial PCOS statistics in Singapore. But Dr Serena Lim, an associate consultant at Singapore General Hospital’s (SGH) department of obstetrics and gynaecology, says it is “not surprising” if PCOS is on an uptrend among women here, given the rising obesity rates and greater awareness about women’s health issues.
Researchers cannot pinpoint the exact cause, but believe it could be due to a combination of genetic and environmental factors.
What is known, says Dr Lim, is that the condition tends to run in families (you have a greater chance of getting it if your mother or sister has it, for example) and is more common among South Asian women. Being overweight also increases your risk.
Studies have also shown that PCOS sufferers are less responsive to insulin, a hormone that helps prevent high blood sugar. They also appear to have low-grade inammation in the body, says Dr Seng.
Signs not always obvious
Women with PCOS may nd it harder to conceive because the hormonal imbalances affect ovulation, narrowing the window of fertile period when a mature egg is released from the ovary.
This reduces the chance of the sperm meeting the egg and becoming pregnant, SGH’s Dr Lim explains.
Plus, they tend to have slightly higher than normal levels of the male hormone, testosterone, Dr Lim says. As such, they may develop masculine characteristics like excess hair on the face, chest and stomach, male-pattern hair loss, a deeper voice, acne and weight gain, Dr Seng adds.
The signs aren’t always obvious, though. Apart from irregular menses – a sign which many women tend to attribute to stress – Hartini shares that she did not experience other classic symptoms like weight gain or hair growth in unlikely areas.
“It is a heterogenous disorder with different symptoms and severity,” Dr Lim says.
For example, while obesity can raise PCOS risk, about 30 per cent are of normal weight. If they put on too much weight, any symptoms they experience could worsen.
‘‘I was put on horrible cycles of medication to stimulate egg growth, with no result, only more pain, more weight gain, and cycle after cycle of disappointment.’’
Higher risk of pregnancy complications
Studies show that becoming pregnancy is only the rst hurdle. PCOS troubles may continue even during pregnancy, putting mums-to-be at a higher risk of certain complications including miscarriage, gestational diabetes and preeclampsia (high blood pressure in pregnancy) as well as a C-section delivery, Dr Seng shares.
Malaysian blogger Audrey Ooi, 32, better known as Fourfeetnine online, is one sufferer who has experienced the pregnancy complications rst-hand.
At around 28 weeks of her rst pregnancy, Audrey developed preeclampsia. She fought to keep her baby in her womb until 31 weeks to give him a better shot at survival, risking health complications herself. In severe cases, mums with preeclampsia can get seizures, strokes, become blind or die from it.
Against the odds, both mother and child survived the ordeal. The high blood pressure came back during her second pregnancy, but was kept under control until she delivered her daughter at 36 weeks.
Now, the good news
Not all women with the condition may nd it hard to conceive, Dr Lim says. It can be treated and the odds of conceiving naturally “are very good”, Dr Seng adds.
According to the experts, it helps to watch what you eat and to exercise regularly. For overweight patients, for instance, losing just ve to 10 per cent of body weight can reverse some symptoms without the need for medication, Dr Lim says.
Reaching a healthy weight and blood sugar levels before you conceive can lower pregnancy complications risks, Dr Seng adds.
There is also medication in the form of tablets or injections to help a woman ovulate. More than 95 per cent of patients who seek treatment for fertility are usually put on medication rst, Dr Lim says.
If that doesn’t work, Dr Lim says there are other options, such as keyhole surgery known as ovarian drilling, which may be helpful in certain patients, particularly those of normal weight.
This procedure involves “burning” holes in some parts of the ovaries – using laser or an electric current – which may balance hormone levels and restore ovulation.
When ovarian drilling and other fertility treatments failed to work for Hartini, she turned to in vitro fertilisation (IVF). She conceived successfully, but miscarried twin babies in her second trimester.
Last year, she nally closed her seven-year-long heartbreaking #ttc chapter by welcoming Baby Eiman, whom she delivered naturally at 36 weeks.
Her journey to grow her family hasn’t ended. Hartini intends to go through IVF again next year to give Eiman a sibling. She tells her fellow “cysters” who are struggling to conceive not to give up.
“There was a point where my husband and I thought of giving up after we buried our twin babies. But we decided to give it another shot. At the end of the day, even if we don’t succeed, at least we know we’ve tried our best,” she says.