Estimated reading time: 8 minutes
If you're trying to conceive, polycystic ovary syndrome (PCOS) can feel like a roadblock on your journey to parenthood. As one of the most common causes of infertility, affecting 8-13% of reproductive-age women, PCOS interferes with the normal process of ovulation - the key step needed for pregnancy.
While a PCOS diagnosis can be overwhelming, understanding how it affects your fertility is the first step toward taking control of your reproductive health and exploring your treatment options.
How Does PCOS Affect Fertility?
PCOS can affect fertility in three main ways: through irregular or absent periods that disrupt ovulation, elevated androgen (male hormone) levels that can interfere with reproductive function, and polycystic ovaries that may not release eggs regularly. Understanding these factors helps explain why PCOS can make getting pregnant more challenging and what treatment options might help.
Irregular Periods and PCOS
In a typical menstrual cycle, periods occur every 21-35 days. However, with PCOS, this predictable pattern is often disrupted. With PCOS, your body's hormonal balance is disrupted by insulin resistance and high androgen levels. Normally, your brain releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in a specific pattern to trigger egg development and ovulation. But in PCOS, high insulin levels cause your ovaries to produce excess testosterone, which interferes with these signals.
This hormonal imbalance prevents eggs from maturing properly, leading to irregular or absent ovulation and unpredictable periods.
PCOS disrupts your fertility cycle because:
- Hormonal imbalances prevent regular ovulation
- Only 15-40% of women with PCOS ovulate naturally
- Irregular periods mean fewer opportunities to conceive
- Unpredictable ovulation makes timing conception difficult
High Androgen Levels and PCOS
Elevated androgens (male hormones) are a hallmark of PCOS, affecting up to 70% of women with the condition. While everyone produces some androgens, PCOS can cause levels to be significantly higher than normal, leading to visible changes in your body. Common Signs of High Androgens:
- Hirsutism (excess hair growth)
- 57% of PatientsLikeMe Members living with PCOS reported severe/excessive hair growth
- Unwanted facial hair, especially on the chin and upper lip
- Thick hair growth on chest, back, and abdomen
- Acne, particularly on the face, chest, and upper back
- 76% of PatientsLikeMe members living with PCOS reported severe to moderate acne
- Skin changes like darkening or skin tags
Polycystic Ovaries
The term "polycystic" can be misleading - these aren't actually cysts, but rather small, immature follicles that contain eggs that haven't fully developed. In a typical ovary, one follicle matures and releases an egg each month.
But in PCOS, these follicles stall in their development, collecting in the ovaries and forming a pearl-like pattern visible on ultrasound. While normal ovaries typically have 4-8 developing follicles, PCOS ovaries often contain 12 or more small follicles measuring about 2-9mm in size. These underdeveloped follicles create a distinctive "string of pearls" appearance on ultrasound, and the ovaries themselves may be larger than normal due to this accumulation of follicles.
So, how do polycystic ovaries impact your fertility?
- Follicles start to develop but don't reach the size needed for ovulation
- Multiple immature follicles mean fewer mature eggs
- Even when eggs mature, they may not be released properly
- This leads to inconsistent or absent ovulation -- Without ovulation, pregnancy can't occur naturally
How Do I Know If I Have PCOS?
Understanding how PCOS affects fertility is an important first step in taking control of your reproductive health. But how do you know if these fertility challenges are related to PCOS? Recognizing the signs and symptoms of PCOS can help you get the right diagnosis and treatment sooner, improving both your overall health and your fertility outcomes.
My cycle was never super-regular before, and there were a few times when I wouldn't have my period for 2-3 months in a row. I didn't think that was a problem previously (just a little strange!), but I also had skin problems (persistent acne) since I was a teenager, and then I became more concerned when I started noticing facial hair. That's when I had to talk to my GYN to get the PCOS diagnosis. I am trying different treatments now, but it is good to know what is going on."
PatientsLikeMe member since 2011
While only a doctor can diagnose PCOS, there are several symptoms to watch for:
- Fewer than 8 periods per year
- Cycles longer than 35 days
- Unpredictable menstrual cycles
- Pain during periods and leading up to
- Missing periods for 3+ months
- Excess facial or body hair growth
- Acne, especially on face, chest, or upper back
- Blood tests showing high androgen levels
Other Common Symptoms
- Difficulty losing weight
- Weight gain around the middle
- Skin tags
- Darkening of skin in body folds
- Fertility challenges
When to See a Doctor for PCOS
In addition to the above symptoms, if you're experiencing irregular cycles that are becoming a pattern rather than a one-time occurrence, don't wait to get help. Make an appointment if you've noticed:
- Your periods are unpredictable for more than 3 months
- You're having severe pain that interferes with daily activities
- You've been trying to conceive for 6 months without success if you're over 35, or one year if you're under 35
- You're experiencing unusual symptoms between periods like spotting or severe cramping
- Your period symptoms are getting worse over time
- Over-the-counter treatments aren't helping manage your symptoms
The earlier PCOS is diagnosed, the sooner you can start treatments to manage symptoms and protect your fertility. Don't wait for symptoms to become severe - your doctor can help determine if PCOS might be affecting your health and create a plan to address your specific concerns.
Treatments for PCOS
While there's no cure for PCOS, various treatments can help manage symptoms and improve fertility. Your treatment plan will depend on your specific symptoms, whether you're trying to conceive, and your overall health goals.
Medications
Metformin is one of the most common pharmaceutical solutions for PCOS; in fact, 80% of PatientsLikeMe members with PCOS take this to help manage their symptoms. This diabetes medication has become a key treatment for many with PCOS because it:
- Improves insulin sensitivity
- Can help regulate menstrual cycles
- May aid in weight management
- Often prescribed alongside fertility treatments
- Can reduce the risk of gestational diabetes. Studies show Metformin helps restore regular periods in 50-70% of women with PCOS.
Other Common Medications:
PatientsLikeMe members with PCOS also report taking Spironolactone (37%) and Medroxyprogesterone Acetate to treat their PCOS
Other options recommended can include:
- Birth control pills to regulate periods and reduce androgens
- Anti-androgen medications to address excess hair growth
- Fertility medications like Clomid to help with ovulation
Lifestyle Changes
Often the first line of treatment, lifestyle modifications can significantly improve PCOS symptoms:
- Regular exercise helps improve insulin sensitivity
- A balanced diet focusing on steady blood sugar levels
- Maintaining a healthy weight can help regulate periods; Studies show that even modest weight loss of 5-10% can help improve PCOS symptoms.
- Stress management techniques
How to lose weight with PCOS
Losing weight with PCOS can be challenging due to insulin resistance and hormonal imbalances, but it's not impossible. Focus on eating patterns that help control insulin levels: choose high-fiber foods, lean proteins, and healthy fats while limiting refined carbohydrates that can spike blood sugar. Aim for 4-6 smaller meals throughout the day rather than 3 large ones to help maintain steady blood sugar.
When it comes to exercise, combine strength training (which helps improve insulin sensitivity) with moderate cardio activities. Be patient with your body - weight loss might be slower than for someone without PCOS, but consistent, sustainable changes are more effective than crash diets.
Support, Connection, and Solutions for PCOS
You don't have to navigate this journey alone. Join the PatientsLikeMe PCOS community where you can connect with others who understand exactly what you're going through. Track your symptoms, periods, and treatments to better understand your body's patterns and share insights with your healthcare team.
I felt so alone - dealing with endless periods, pain that kept me in bed, and doctors who just didn't seem to get it. I was at my lowest point after bleeding for 70 days straight (I know, yikes) when I joined the PCOS thread. Reading posts from other women going through the exact same thing, I literally cried with relief. Through the community, I heard about a treatment others were taking that I hadn't heard of, brought it up with my doctor, and it changed everything."
PatientsLikeMe Member since 2020
Learn from others' experiences with fertility treatments, weight management strategies, and medication side effects. Plus, access resources about managing PCOS symptoms, improving fertility, and maintaining your overall health. From comparing treatment experiences to finding emotional support, our community is here to help you take control of your PCOS and fertility journey.
