Polycystic ovary syndrome or PCOS is one of the most common causes of infertility among people with ovaries, according to the Office of Women's Health (OWH).
In fact, PCOS is the most common hormone-related issue in women having difficulty conceiving, says David Diaz, MD, reproductive endocrinologist and fertility expert at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
The condition affects between 6 and 12 percent of those with childbearing reproductive organs in the United States, according to the Centers for Disease Control and Prevention (CDC).
But it is possible to get pregnant with PCOS. Here's what you need to know about PCOS and fertility and what treatments are available.
What Is PCOS?
Polycystic ovary syndrome is derived from the Greek words poly, which means "many" and kystis, meaning, "bladder, pouch," Dr. Diaz explains. Hence, the name implies that an organ — in this case, the ovaries — has "many cysts."
Due to an imbalance of hormones, the eggs in the ovaries of people with PCOS either don't develop normally or aren't released as they should be. As a result, small cysts develop on the ovaries. But having cysts on the ovaries doesn't necessarily mean that you have PCOS, Dr. Diaz says. PCOS is only diagnosed with the presence of ovary cysts along with other symptoms.
"In treating PCOS, it is best not to use a cookie-cutter approach since no two patients are alike."
For people with PCOS, it's common for doctors to find more than 15 to 20 sacs that are eggs in development on each ovary (compared to the normal six to seven typically found), Dr. Diaz says.
"This means there is no lack of eggs, but that they are simply stunted in their growth process," Dr. Diaz notes.
How PCOS Affects Fertility
The exact cause of PCOS is not known, but it's thought to be a combination of different factors, including genetics, that lead to insulin resistance — the body's inability to use the hormone insulin properly — and a change in hormone regulation, which will ultimately interfere with normal ovulation (the process of an egg being released from the ovaries).
Many people don't get diagnosed with PCOS until they are trying to get pregnant and are unable to conceive.
PCOS is different for everyone, Dr. Diaz says. For instance, some people will be more sensitive to hormone changes, which could make their symptoms more severe.
Common PCOS Symptoms
Although PCOS varies from one person to another, common symptoms, per the OWH, include:
- Interrupted ovulation: Your period is controlled by your hormones, and if you have PCOS, your hormones aren't regulated properly, per the OWH. Because of this, ovulation can be interrupted, or you may not ovulate at all. In some cases, the egg doesn't develop properly or isn't released at all. And without ovulation — or a properly developed egg — you can't get pregnant. Physically, not ovulating can look like irregular periods, spotting or in some cases, heavy bleeding.
- Infertility: The primary way that PCOS causes infertility is because it stops ovulation from occurring. Without ovulation, there is no egg released that can be fertilized, and therefore no pregnancy. The lack of ovulation can also lead to other problems with your menstrual cycle.
- Excessive androgen hormone production: People with PCOS often have higher-than-normal levels of androgen hormones (aka "male" hormones). Elevated androgens can prevent ovulation and cause heavy, prolonged periods, along with other side effects.
- Metabolic syndrome: This occurs in about 30 percent of people with PCOS and is linked to obesity, insulin resistance, high blood pressure and elevated blood fats, according to a July 2018 article in Obstetrics and Gynecology. Metabolic syndrome interferes with the function of the hormones you need to ovulate, per the International Journal of Women’s Health and Reproduction Sciences.
What's difficult about PCOS symptoms is that they are often linked together as well, so the symptoms can become a vicious loop.
For example, Dr. Diaz explains that the menstrual cycle is regulated by the ovaries, which are in turn regulated by hormones. Any abnormality due to high insulin levels and insulin resistance disturbs the normal release of the hormones needed for ovulation, which then throws off the menstrual cycle.
High insulin levels also activate the formation of androgen hormones, which in turn, also stop normal ovulation from occurring. And finally, the high rates of obesity in PCOS patients results in excessive levels of androgens and estrogen, which will stop the hormones needed to regulate ovulation.
How Do You Know if You Have PCOS?
Diagnosing PCOS can be tricky, since it's different for everyone. There is no one single test that can show you have it. Instead, clinicians look for clues that can point to the root causes of your symptoms, Dr. Diaz says.
Doctors typically look for signs of PCOS using a combination of blood tests, physical examination and a pelvic ultrasound.
PCOS Treatment Options if You're Trying to Conceive
While there is no one cure for PCOS, treatment is possible, Dr. Diaz says.
"PCOS is a multi-factorial condition, meaning there are many different organ systems involved," he explains. "Familiarity with hormonal function and a clear understanding of the endocrine system are paramount in designing a treatment plan. In treating PCOS, it is best not to use a cookie-cutter approach since no two patients are alike."
Individuals with PCOS should work with their doctors to come up with a treatment plan that addresses their own specific needs. Dr. Diaz says. However, the following treatments are often used for people with PCOS looking to get pregnant.
Weight loss has positive effects on PCOS symptoms, from regulating periods to improving hair growth and acne. It can also help your chances of getting pregnant, according to the American College of Obstetricians and Gynecologists (ACOG).
In fact, weight loss is often the first treatment recommended for people with PCOS who have weight to lose. About 40 to 60 percent of people with PCOS are considered to have overweight or obesity, per a December 2019 article in Clinical Medicine Insights Reproductive Health.
Compared to taking birth-control pills, lifestyle modifications aimed at weight-loss improved ovulation rates for people with PCOS, per a November 2015 study in the Journal of Clinical Endocrinology & Metabolism.
However, because of the complexities of losing weight with PCOS (the hormone imbalances typical of condition may make losing weight difficult, for instance), it's also recommended that all factors be considered for infertility. If the person who wishes to get pregnant is on the older side, for example, it may be best to focus on reproductive assistance techniques first instead of weight loss.
Weight loss can be achieved through a variety of lifestyle modifications with PCOS, but incorporating exercise into your daily routine is associated with improved fertility, per the Clinical Medicine Insights Reproductive Health article.
Aim to get 150 minutes every week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity activity, combined with two non-consecutive days of muscle strengthening activities, per guidelines published in July 2018 in Fertility and Sterility.
If you want to lose weight, try to get 250 minutes per week of moderate-intensity exercise or 150 minutes of vigorous exercise, along with strength training, per the guidelines.
Because weight loss can be difficult for people with PCOS, some individuals may be a candidate for weight-loss surgery. Bariatric surgery can help people with PCOS both manage their symptoms and improve their fertility and chances of getting pregnant, per an October 2016 overview in the European Journal of Obstetrics and Gynecology and Reproductive Biology.
However, there are risks involved with surgery, including a possible chance of babies who are small for their gestational age, so you should consider the procedure carefully with your doctor.
Medications for PCOS aim to regulate your hormones to increase your chances of ovulating on your own or help your body maintain your blood sugar levels. They can help both manage symptoms and increase your chances of conceiving.
For instance, insulin-sensitizing drugs like Metformin can help your body use insulin more effectively and help restore ovulation, per the UK's National Health Service.
Doctors may use clomiphene to induce ovulation, letrozole, which can help balance estrogen levels (which can also help your body naturally ovulate) and if necessary, thyroxine may be prescribed for hormone regulation, Dr. Diaz says.
Some people may also have hyperplasia, which is excessive tissue in the uterus that can often be treated with progestin. This hormone can be given in a variety of ways, including oral medications and creams, according to ACOG.
Hyperplasia can occur with PCOS because as your body prepares to ovulate, the lining of the uterus thickens in preparation for a possible pregnancy. If pregnancy isn't achieved, the lining is shed. If ovulation does not occur or if the hormones necessary to complete the process are not at adequate levels, the lining is not shed. Overtime, this process may cause the uterine lining to build up.
There is a potential link between stress and PCOS, so managing your stress levels may be helpful in minimizing symptoms and improving fertility, per a January 2018 study in the Journal of Human Reproductive Sciences.
Reproductive Assistance Technologies
Dr. Diaz points out that if there are other barriers to getting pregnant, such as a partner's low sperm count, blocked fallopian tubes or recurrent miscarriages, in-vitro fertilization (IVF) may also be an option.
If you are having trouble getting pregnant, visit your doctor or a fertility specialist who will screen you for possible reasons, including PCOS. Getting a diagnosis enables you and your doctor to work on a treatment plan that can help you conceive.
- Office on Women's Health: Polycystic Ovary Syndrome
- Centers for Disease Control and Prevention: "PCOS and Diabetes"
- Obstetrics & Gynecology: “Metabolic Syndrome in Women with Polycystic Ovary Syndrome”
- Journal of Clinical Endocrinology & Metabolism: "Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome "
- American College of Obstetricians and Gynecologists: Polycystic Ovary Syndrome"
- Endocrine Society: "What is Thyroxine?"
- National Health Society: "Metformin"
- University of Michigan Medicine: "Clomiphene"
- Medicine: “Letrozole for Patients with Polycystic Ovary Syndrome”
- The Journal of Human Reproductive Sciences: “Possible Link Between Stress-related Factors and Altered Body Composition in Women with Polycystic Ovarian Syndrome”
- International Journal of Women’s Health and Reproduction Sciences: "Metabolic Syndrome and Infertility"
- European Journal of Obstetrics & Gynecology and Reproductive Biology: “Polycystic Ovary Syndrome and Endometrial Hyperplasia: an Overview of the Role of Bariatric Surgery in Female Fertility”
- Clinical Medicine Insights Reproductive Health: “Fertility Treatment Options for Women With Polycystic Ovary Syndrome”
- Fertility & Sterility: "Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome"
- ACOG: "Endometrial Hyperplasia"