Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder affecting women, and it’s one of the main causes of female infertility. Up to 15% of women of reproductive age around the globe have PCOS, so you’re not alone!

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PCOS causes an imbalance of the reproductive hormones FSH (follicle stimulating hormone) and LH (luteinizing hormone), which prevents eggs from maturing and getting released from the ovaries through ovulation. Instead they get stuck to the ovaries. 

PCOS usually also causes the body to produce too many androgen hormones, which is another condition called hyperandrogenemia. Having an excess of these male sex hormones can make women experience hair loss or excess hair growth, a deeper voice, and increased muscle mass.

Impact of polycystic ovary syndrome on fertility

PCOS can interfere with the menstrual cycle and ovulation. If there’s no egg available to be fertilized by sperm, it’s not possible to get pregnant. PCOS is the leading cause of anovulatory infertility. However, it’s important to note that this condition is very diverse and impacts women differently, so not everyone with PCOS experiences difficulty conceiving.

Potential causes of polycystic ovary syndrome

Doctors are unsure why someone develops PCOS, but believe it could be caused by a mix of genetics, inflammation in the body, and environmental factors. It may also happen as a consequence of insulin resistance, which can develop as a result of eating an unhealthy, unbalanced diet and not being physically active.

Symptoms of polycystic ovary syndrome

PCOS can vary a lot from woman to woman and there are different levels of severity. Some may have no physical symptoms and don’t realize that they have PCOS, while others have them all.

The most common signs of PCOS include:

About half of women with PCOS are overweight and have insulin resistance, which is a precursor to type 2 diabetes. Obesity may act as a trigger for PCOS in some. But there are also plenty of women who are slim or almost underweight with PCOS.

Diagnosis of polycystic ovary syndrome

In order to be diagnosed with PCOS, you must have 2 of the following 3 criteria:

• Irregular menstrual cycle or no cycle at all (amenorrhea)
• Physical signs of Hyperandrogenemia or excess androgens found in a blood test
• Polycystic ovaries (shown on an ultrasound)

Treatment to improve fertility

While there’s currently no official cure for PCOS, many treatments are available to alleviate symptoms and help women conceive. 

Women with PCOS are often prescribed the birth control pill to stabilize the menstrual cycle and reduce symptoms including hair loss, acne, etc. After stopping the pill, the cycle usually becomes irregular again and symptoms can return. 

Research has found that for women who are overweight, losing 5 to 10% of their body weight helps regulate the cycle and lessen some PCOS symptoms. But if you’re not overweight, weight loss unfortunately won’t help manage symptoms. 

Adopting a PCOS diet and minimizing processed sugars and saturated fats can reduce inflammation while improving symptoms and fertility. Check out our article on foods to help with PCOS to learn more. With expert nutritional coaching, many women are able to successfully conceive.

If you have insulin resistance, therapy with an insulin sensitizer called metformin can improve the body’s metabolization of sugar as well as cycle problems and other PCOS symptoms. Supplements such as myo-inositol can also help with insulin resistance and cycle irregularities.

Beyond that, there are medicinal plants scientifically proven to boost fertility. One well-known example is Agnus castus, AKA monk’s pepper. This plant directly impacts the pituitary gland, normalizing hormone production and stabilizing the cycle. 

If necessary, medication is available to stimulate the ovaries to ovulate, such as letrozole and clomiphene. One study found that 80% of women with PCOS who took clomiphene ovulated successfully, and half got pregnant naturally within six cycles. If that’s unsuccessful, treatment with a low-dose of FSH is another option to make the ovaries release a mature egg with ovulation.

In cases where the ovaries don’t respond to hormonal medication, a minimally invasive surgical procedure called ovarian drilling can help lower testosterone. This can normalize the menstrual cycle and help the ovaries release an egg each month. Research shows that 70% of women who didn’t respond to hormonal medication were able to get pregnant within 6 months of the surgery. Because of the treatment’s success and reduced risk of multiple pregnancies (which can happen with medication to stimulate the ovaries), it may become the first choice for treatment in the future.
Finally, assisted reproduction treatments (IVF or ICSI) can help you conceive if other treatments don’t work.   

• Ovarian Drilling for Infertility. ReproductiveFacts.org from the American Society for Reproductive Medicine. Accessed 05 September 2022.
• Teede HJ et al.: Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fert Stert, ASRM Pages. 2018. 10;3:364-379.
• Mercorio A et al.: Ovarian Drilling: Back to the Future. Medicina. 2022. 58;1002.