PCOS and Infertility: Breaking Down the Myths & Misconceptions
Polycystic ovary syndrome (PCOS) and infertility from excess androgens in PCOS are common hormonal disorders. PCOS affects reproductive-aged women, causing a range of symptoms, including irregular periods, excessive body hair growth, acne, and fertility problems. According to the U.S. Office on Women’s Health, PCOS is a common and treatable cause of infertility.
Despite the challenges that PCOS presents, it is important to understand that it can be managed with appropriate medical care and that treatment options are available to address PCOS symptoms and improve fertility.
Table of Contents
Understanding PCOS and Infertility
PCOS is characterized by hormonal imbalances that lead to a variety of symptoms. The exact cause of PCOS is not fully understood, but it is believed to involve a combination of genetic and environmental factors. Women with PCOS often have elevated levels of androgens (male hormones) and insulin, which can disrupt the normal ovulation process and result in the formation of small cysts on the ovaries.
The symptoms of PCOS can vary from woman to woman, but common manifestations include:1
- Irregular or absent periods
- Excessive facial and bodily hair growth (hirsutism)
- Unexplained weight gain
- Severe acne
- Hair loss
- Thickened, velvety patches on the neck or other skin folds
- Impaired carbohydrate and lipid metabolism
PCOS affects 5-10% of women of reproductive age. Early detection is essential for successful management and treatment. 2
How PCOS Affects Fertility
Ovulation, or the release of an ovum (egg) that can be fertilized by sperm, is controlled by hormones released by the hypothalamus in the brain.
The hypothalamus releases gonadotropin-releasing hormone (GnRH), stimulating the pituitary gland to release follicle-stimulating hormone (FSH). FSH promotes the growth of follicles in the ovaries. One follicle becomes dominant and prepares to release an egg. Estrogen levels rise as the follicles grow and mature. Low levels of progesterone are also released.
High estrogen levels trigger a surge in luteinizing hormone (LH) release around the middle of the cycle. The dominant follicle releases an egg. The egg has the potential to be fertilized and implanted in the uterine wall as a pregnancy.
PCOS is the most common cause of infertility due to failure to ovulate (anovulatory infertility). People with PCOS tend to have high LH and low FSH levels, along with increased insulin and testosterone levels. This causes underproduction of estrogens and overproduction of androgens.3
Insulin resistance is common in people with PCOS. The pancreas produces insulin, but body cells develop resistance to its effects. As long as possible, the pancreas responds by increasing insulin production.
Insulin resistance may reduce the production of sex hormone-binding globulin, which increases free testosterone levels. Increased testosterone levels may further impair fertility.
Anovulatory infertility is a common consequence of PCOS. PCOS is the underlying cause of approximately 70 to 80 percent of cases of anovulatory infertility.4
Diagnosing PCOS and Infertility
Diagnosing PCOS can be challenging, as there is no single definitive test for the condition. However, early diagnosis is essential to improve or restore fertility, reduce symptoms, and prevent complications.
There are several competing diagnostic criteria used to diagnose PCOS. A common one is the Rotterdam criteria, which states that a diagnosis can be made if two of the following three criteria are met and other health conditions have been ruled out.3
- Decreased or lack of ovulation
- Clinical or biochemical signs of increased androgens
- Polycystic ovaries visible by ultrasound
Some criteria do not include polycystic ovaries as a requirement for diagnosis. PCOS is a complex medical condition that can cause a range of underlying hormonal imbalances and related symptoms.
Treatment Options for PCOS and Infertility
While PCOS cannot be cured, its symptoms can be effectively managed through a combination of lifestyle changes, medication, and targeted interventions. The goal of treatment is to restore hormonal balance, regulate menstrual cycles, and improve fertility outcomes. Treatment plans typically focus on addressing specific symptoms.3
Lifestyle changes are a first-line treatment for managing PCOS-associated infertility and metabolic complications. Lifestyle modifications can also reduce the risk of PCOS complications and chronic disease.
Exercise and appropriate weight-reduction plans can reduce circulating insulin and androgen levels. Losing weight can also improve lipid profiles and increase FSH levels. Normalizing these hormones can improve PCOS symptoms, normalize menstrual cycles, induce ovulation, and improve overall health.
For women with overweight or obesity, a 5% to 10% weight loss can significantly improve overall health and fertility.3,4
No specific diet is endorsed to improve PCOS. A low-glycemic diet may be beneficial, but more research is needed. Vitamin D deficiency is common in women with PCOS. Consume a diet rich in fruits and vegetables, low-fat dairy products, lean proteins, healthy fats, and whole grains. Avoid sweets, saturated fats, refined carbohydrates, and highly processed foods.5 Supplementation with vitamin D may improve fertility and insulin sensitivity.3
When researchers reviewed studies that tested the impact of exercise on PCOS symptoms, they found that regular and consistent exercise led to improved menstrual regularity and ovulation.
Regular exercise can lead to:4
- Improved insulin sensitivity
- Weight loss
- Decreased testosterone levels
- Decreased abdominal fat
- Reduced unwanted facial and body hair
The International Guideline for the Assessment and Management of PCOS recommends that adults from 18 to 64 years do a minimum of 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity exercise or an equivalent combination of both, including muscle-strengthening activities on two non-consecutive days of the week.
For modest weight loss, a minimum of 250 minutes per week of moderate-intensity activities or 150 minutes per week of vigorous-intensity activities is recommended.6
Medications can treat PCOS symptoms and infertility. For example, clomiphene or letrozole are commonly used to treat infertility. Metformin is a second-line treatment for infertility and the primary treatment option for insulin resistance. Hormonal contraceptives, with or without anti-androgen therapies, can treat hirsutism and acne.7
If medications have not successfully treated infertility, surgical options such as ovarian drilling are also available. In this procedure, an electric current is passed through a needle and used to drill tiny holes in the ovary. This procedure can decrease androgen levels and improve the chances of ovulation.
In cases where medication alone is not sufficient, assisted reproductive technologies (ART), such as in vitro fertilization (IVF), may be recommended. IVF involves retrieving eggs from the ovaries, fertilizing them with sperm in a laboratory, and transferring the resulting embryos into the uterus. This approach can significantly increase the chances of achieving a successful pregnancy for women with PCOS.
Emotional Support and Well-being
Living with PCOS can be emotionally challenging, as it can impact self-esteem, body image, and overall well-being. Seeking emotional support and connecting with others who are going through similar experiences with managing PCOS can help. Support groups, online communities, and counseling services can provide valuable resources for coping with the emotional aspects of PCOS.
When you are living with PCOS, prioritizing self-care is crucial. Engaging in stress-reducing activities such as mindfulness, meditation, and exercise can help alleviate anxiety and improve overall well-being.
PCOS is a complex hormonal disorder that affects many women of reproductive age. While it can present challenges, PCOS is a manageable condition with a range of treatment options available.
Weight management is an important lifestyle modification that can reduce PCOS symptoms and potentially improve fertility. Talk to a treatment specialist at Invigor Medical about weight management treatment plans.
Frequently Asked Questions
How does PCOS affect fertility?
PCOS can affect ovulation, or the release of an egg from the ovary. If an egg is not released, it cannot be fertilized. An imbalance of hormones, such as estrogen and testosterone, may interfere with ovulation.
Can PCOS be cured?
There is no cure for PCOS, but its symptoms can be managed. Treatment options focus on managing specific symptoms such as infertility, hirsutism, acne, or obesity.
What are the signs or symptoms of PCOS?
Common signs and symptoms associated with PCOS include irregular or absent periods, excessive unwanted facial or body hair, severe acne, infertility, weight gain, hair loss, and patches of thickened, velvety skin in skin folds.
Can I get pregnant if I have PCOS?
Yes, many women with PCOS can conceive. However, they may need treatments such as lifestyle modification or medications to improve hormonal balance and enhance fertility.
Is there a link between PCOS and other health problems?
Yes, PCOS is associated with an increased risk of developing health problems such as insulin resistance, type 2 diabetes, high cholesterol, cardiovascular disease, depression, obesity, sleep apnea, and uterine cancer.
- Sharma S, Mahajan N. Polycystic Ovarian Syndrome and Menopause in Forty Plus Women. J Midlife Health. 2021 Jan-Mar;12(1):3-7. doi: 10.4103/jmh.jmh_8_21. Epub 2021 Apr 17. PMID: 34188419; PMCID: PMC8189332.
- Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89:2745-2749.
- Dennett CC, Simon J; The Role of Polycystic Ovary Syndrome in Reproductive and Metabolic Health: Overview and Approaches for Treatment. Diabetes Spectr 1 May 2015; 28 (2): 116–120. https://doi.org/10.2337/diaspect.28.2.116
- Sawant S, Bhide P. Fertility Treatment Options for Women With Polycystic Ovary Syndrome. Clinical Medicine Insights: Reproductive Health. 2019;13. doi:10.1177/1179558119890867
- Xenou M, Gourounti K. Dietary patterns and polycystic ovary syndrome: a systematic review. Maedica (Bucur). 2021;16(3):516-521. doi:10.26574/maedica.2020.16.3.516
- Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., International PCOS Network, Andersen, M., Azziz, R., Balen, A., Baye, E., Boyle, J., Brennan, L., Broekmans, F., Dabadghao, P., Devoto, L., Dewailly, D., … Yildiz, B. O. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome†‡. Human Reproduction, 33(9), 1602–1618. https://doi.org/10.1093/humrep/dey256
- Williams T, Mortada R, Porter S. Diagnosis and Treatment of Polycystic Ovary Syndrome. Am Fam Physician. 2016 Jul 15;94(2):106-13. PMID: 27419327.