Lisa's story

When I turned 18 I ceremoniously popped my first contraceptive pill and sailed through the next decade with regular-as-Larry periods and not even a glimmer of cramps or PMS. When I turned 31, I tossed those same pills into the bin and announced to the world that we were "trying". And then nothing happened… no period, no cramps, no baby. Six months later I took my reluctant ovaries off to the gynae for a check-up. A scan revealed a white and waxy covering on them – a clear sign I was suffering from polycystic ovarian syndrome. PCOS? Me? But women with PCOS are overweight, hairy and addled with acne? I was enviously skinny and didn’t even need to shave my legs most of the time.

But the overriding symptom was there. I was given a short course of a drug called Provera – ironically a form of contraceptive pill – to kick-start my periods and when Aunt Flo finally showed her head 10 days later I was over the moon. But my excitement was short-lived – a "day 21" blood test confirmed that I wasn’t ovulating. No egg means no baby. Because I hadn’t had a period for six months and was clearly not ovulating, my gynae was willing to proceed with fertility treatment after a barrage of blood tests ruled out any other possible causes for my anovulation. After another course of Provera I was given Clomid, the most common fertility drug that is used locally.

This was it – I was going to be pregnant at last. But PCOS was a stubborn adversary and when my period didn’t show up, and an army of pregnancy tests all came up negative, I realised that my battle with infertility had just got serious. Seventy to ninety percent of women fall pregnant within six to nine months of taking Clomid. I wasn’t one of them. My gynae doubled my dose, but after two more unsuccessful rounds he sent me off to a fertility specialist. Walking into a fertility clinic is a humbling experience. You realise just how many women there are out there who are desperate to have babies – and you are one of them. A new round of blood tests – and the required sperm analysis – unearthed more red herrings. My husband’s sperm had poor motility. High levels of certain hormones revealed that I might be experiencing early menopause. My doctor urged me to put on a couple of kilos as he felt my weight was a little low. I was beside myself.

And so I went where desperate people go – online. In a support group for women with PCOS I discovered others that didn’t fit the normal profile of the syndrome – and ovulating was only one of the many hurdles that I might have to climb. "MaybeBaby" was struggling to find a GP who would diagnose her officially so she could go on an IVF waiting list. "Clomid Queen" had successfully conceived five times but had miscarried each of them. Because I was now officially "clomiphene resistant", my next step was injectibles . Unlike the cheerfully cheap Clomid, these drugs come with designer label price tags. This is the point that the medical aids gently deliver the words "for your own account".

So, credit card in hand, I began pumping myself with hormones. I'd dash across town every couple of days to have an internal scan to check my follicle development. The aim of this costly new development was to "ripen" the follicles in my ovaries to a point where one developed enough so that another drug could be injected to "force" ovulation. If this works, natural conception, artificial insemination or IVF are all options. I was getting uncomfortably familiar with what my insides look like. As my bum filled with tiny bruises from the injections, my heart filled with hope. I'd prod my enlarged ovaries at night, cheering them on towards the finish line.

Unfortunately, they heard me and suddenly I was faced with dozens of follicles all ripe and ready to take the next step. My doctor shook his head as he nudged my aching ovaries with the dildo-like internal scan. It was time to retreat. Any more fertility drugs I injected could cause me to develop a potentially life-threatening condition called ovarian hyperstimulation syndrome, a situation that occurs when all the follicles ripen at once.

After a year of gentle negotiating with my ovaries, it was time to call in the big guns. Laser guns, to be precise. Ovarian drilling anyone? Nope, it didn’t sound like fun to me either. The procedure – performed through non-invasive keyhole surgery – literally zaps each ovary with six to 10 holes. No-one knows exactly why it works, but it’s thought that reducing the waxy covering of polycystic ovaries assists in hormonally balancing your reproductive system. There are a couple of cons (it tends to be less successful in women who smoke and can lead to scar formation that can block your fallopian tubes) but I was overwhelmed by the success stories shared with me online.

My recovery was quick and a month later – to the day – my period made a welcome appearance. I put my husband on a strict schedule ("Do it days eight, nine, 10 ,12, 14 and 16, "SoulCyster’s" baby-making recipe recommended) and went on holiday. It took six dodgy-looking Thai pregnancy tests to believe I was pregnant. Those two blue lines appearing felt like I was crossing the finish line of the Comrades Marathon.

When my son finally makes his grand appearance a few months from now, I’m sure the agony of my experience will vanish with his first breath. Will he know how hard I worked to get him? Nope. All he’ll worry about is eating, sleeping and pooping. And I thought all the difficult work was over…

What is PCOS?

Polycystic ovarian syndrome affects an estimated five to 10 percent of women of childbearing age. In women without PCOS, during each menstrual cycle, egg-containing follicles grow on the ovaries. One egg matures faster and is eventually released (called ovulation), while the other follicles disappear.

In polycystic ovaries a number of undeveloped follicles remain and form benign oestrogen-releasing cysts that throw the natural hormones off balance, leading to anovulation and possibly a pattern of other symptoms, including unwanted hair growth, acne and menstrual abnormalities.

Can you have polycystic ovaries without having PCOS?
Yes, although most women with polycystic ovaries have PCOS.

What are the symptoms?
About half of women who have polycystic ovarian syndrome are obese, have excessive hair growth and acne. The condition has long-term health implications as women with PCOS may have an increased risk of developing diabetes and heart disease.

How is it diagnosed?
Your gynaecologist will look at your symptoms, order a series of blood tests to measure your hormone levels, and perform an internal ultrasound to check for cysts.

What are the treatment options if you're trying to get pregnant?
Losing weight can help improve your ovulation. Fertility drugs are regularly used to stimulate the growth of eggs. These include tablets containing clomiphene citrate eg Clomid, or fertility injections containing FSH (Follicle stimulating hormone) eg Menogon. Ovulation is triggered by using an injection called HCG (Human Chorionic Gonadotrophin). This is used to determine exactly when intercourse should occur.

How does Clomid work?
Clomid stimulates the ovaries to mature an increased number of follicles, increasing the likelihood of ovulation and pregnancy. It also increases the chance of multiple pregnancies by five per cent.

How does PCOS affect pregnancy?
Unfortunately, the syndrome is thought to increase the incidence of miscarriage in early pregnancy by up to one in five, although there is conflicting data on this, warns Dr Zephne van der Spuy. There is ongoing research to back up theories that controlling insulin levels and ovarian drilling can reduce this risk.

Help and support

Go to Clomid support group, www.webmd.com. Share your side-effects or worries with others in the same boat. For example, vaginal dryness can diminish the chances of conception. A natural lubricant called Preseed (available at Dischem Pharmacies) was recommended by other users. No question is too embarrassing. PCOS support group, www.verity-pcos.org.uk is a UK-based charity with a warm and welcoming community of PCOS sufferers. Groups include "trying to conceive", "pregnancy and motherhood" and even a group of "normal weight" sufferers.

To chart, or not to chart...
A popular way to track ovulation is Basal Body Temperature charting. Using a special thermometer (available from most pharmacies for about R100), you take your morning “waking” temperature. You chart these over the course of your cycle, with a gradual rise in temperature indicating ovulation has occurred. Be warned, women with PCOS often have irregular temperatures and fertility drugs tend to make one ovulate later than normal. This website is useful, however, if you are on Clomid to help you predict the best time for babymaking or to establish if you are ovulating at all. You are also able to view other women with PCOS’ charts online. www.fertilityfriend.com

What the experts say...

THE DIETICIAN Tabitha Hume

• What is the link between food and PCOS?
  Diet certainly contributes to the disorder. PCOS sufferers are insulin-resistant – their bodies do not allow insulin to effectively convert the glucose (derived from carbohydrates) into the muscles to be converted to energy. The body has to produce excess insulin to achieve this, which means your body is literally in full-time “storage mode”, storing each and every bit of fat that is eaten, as well as causing the other symptoms of PCOS.


• Can a change in diet restore fertility?
  Yes, however a low-carb diet may worsen the insulin resistance problem, after short-term success, leading to rebound weight gain. You need to slow down the release of glucose in the blood by choosing low Glycaemic Index carbohydrates that minimise insulin production (a full GI list is available at www.tabithahume.com). Other diet strategies include: eating regularly; cutting out all saturated fats (eg dairy products) and limiting the intake of other fats (olives, avocados etc); eating plenty of fresh fruits and vegetables; eating only lean meats; including two servings of fish per week; taking a vitamin B supplement.


• What about fertility treatments and diet?
  During fertility treatment, people can be very emotional and will crave high GI-carbohydrates because they flood the body with glucose, but they can worsen the hormonal rollercoaster. Stack up with fat-free high-GI goods instead.


• What pre-pregnancy supplements should I take?
  A 1 000mg salmon oil or flaxseed supplement; staminogro to improve fertility, a good multivitamin and folic acid and an all-round calcium supplement.

For more information, or to book an appointment, contact Tabitha on 011-706-7625/011-706-1231.

Recommended reading: Eating for Sustained Energy 2 by Gabi Steenkamp and Liesbet Delport

THE HOLISTIC HEALER Dr Colin La Grange

• What major factor contributes to PCOS?
  Stress is one of the key causes. In some cases stress levels increase the levels of cortisol, our “stress hormone”. This causes insulin resistance. Women have entered a work environment that is geared towards stress creation, while female physiology is not designed to function with such extremes. The cyclical nature of the reproductive and stress system in women causes a swing in the hormone levels from one extreme to another far more violently than in men.


• What alternative treatments do you recommend for PCOS?
  In our treatment program, we treat PCOS using acupuncture, laser, light and colour therapy, NSA (Network Spinal Analysis), reflexology, herbal and homoeopathic medication (including Chinese medicine), with a focus on sugar, insulin and androgen balance. Weight loss is often a major factor in the success of PCOS treatment. Since sufferers of PCOS tend to carry the stress of many of the people in their circle, they also need to take time for themselves.


• Can your therapies reduce the risk of miscarriage?
  Yes. The lowered risk from our treatment is to support the optimum growth of the follicle so the egg within it, and the corpus luteum which comes from it, are both great quality and are therefore sustainable.

To find out more about the LIFE CENTRE, visit www.lagrangeinstitute.com

THE SPECIALIST Obstetrician Dr Zephne van der Spuy

• Where is the latest research into PCOS and fertility focused?
  My personal work focuses on research into abnormal lipid (fat) profiles and family patterns in women with PCOS. If we can pick up a potential risk for developing the syndrome in adolescent women, we can help them manage the condition into adult life.


• What are the newest treatments being used?
  The use of metformin has become popular and there’s good data to suggest it improves the outcome when used in conjunction with other treatments. For example, certain patients are more likely to respond to clomiphene citrate when taking it. Some data suggests it might help those who have had recurrent miscarriages.


• What’s the first step when trying to conceive if you have PCOS?
  If you are overweight, lose a few kilos. A five per cent weight loss is enough to make a huge impact.


• Does pregnancy "cure" PCOS?
  Unfortunately, there is no cure for PCOS but it can be effectively managed. PCOS improves in your forties, however. As the number of follicles in the ovaries reduces, fewer hormones are produced and periods tend to regulate.