Polycystic ovary syndrome (PCOS) is a condition involving hormonal imbalances and metabolism problems.
This condition affects the ovaries, but doesn’t necessarily lead to infertility. You can get pregnant. However, PCOS is a common cause of infertility.
Research estimates that PCOS affect 5–13 percent of women of reproductive age — but it’s treatable. Here’s how the condition can influence fertility and what you can do about it.
People with PCOS have a hormonal imbalance that can lead to:
. High levels of hormones called androgens
. The formation of small, painless, fluid-filled sacs in the ovaries
. Thickening of the outer shell of the ovaries
. High levels of insulin in your blood
These are all things that can interfere with ovulation. One sign that this is happening is irregular or missed periods.
The prevalence of infertility in people with PCOS is thought to be between 70 and 80 percent.
Signs and symptoms of PCOS usually show up in late adolescence or early adulthood. They can include:
. Excess hair growth on the face or other places where males are typically more likely to have hair
. Thinning hair on the scalp
. Oily skin or severe acne
. Skin tags on the neck or armpits
. Patches of thick, darkened skin (acanthosis nigricans), particularly on the neck, groin, or underneath the breasts
. Weight gain or difficulty losing weight
You might also have insulin resistance, which leads to high levels of insulin in your blood. Untreated, this can lead to type 2 diabetes.
Symptoms that may suggest you have fertility problems include irregular or absent menstrual periods. You may not be ovulating regularly or at all.
There’s currently no cure for PCOS, so treatment and management depends on the goal.
For infertility caused by PCOS, treatment involves correcting any ovulation issues and tackling metabolic problems, such as insulin resistance.
Hormonal birth control pills can be helpful for those who don’t wish to get pregnant. And there are treatments to help you ovulate and conceive. It can also be used to help regulate menstrual cycles and provide protection from endometriosis in women with irregular periods associated with PCOS.
Your doctor will probably recommend some basic health measures first.
Maintaining a healthy weight for your body can help regulate menstruation and keep blood glucose levels under control. So a healthy, balanced diet and regular exercise are vital.
If you don’t already, it’s a good time to start tracking your periods. There are many calendars and fertility apps designed to help you figure out which days you’re most likely ovulating.
Clomiphene citrate is an ovulatory stimulant. It works by blocking estrogen feedback to the brain.
This oral medication is taken once a day for 5 days at the beginning of your menstrual cycle. You’ll start with the lowest possible dose. Your doctor can increase it as needed.
Clomiphene citrate (Clomid) is quite effective in helping women with PCOS to ovulate. However, about 15 percent of women with PCOS don’t respond to the maximum dose.
Letrozole (Femara) is an aromatase inhibitor. It’s used to treat breast cancer and for jump-starting ovulation in people with PCOS.
This medication blocks estrogen production and increases the release of follicle-stimulating hormone (FSH) to stimulate ovulation.
Metformin is used to treat type 2 diabetes. It boosts the body’s ability to effectively use insulin.
This isn’t a first-line treatment for PCOS, but can be used to encourage regular periods and ovulation. Metformin is not usually recommended for women with PCOS who have difficulty becoming pregnant, because it’s not as effective as letrozole and clomipheme. But, it can encourage ovulation, so women taking metformin who do not want to become pregnant should use birth control, as they may start ovulating.
Gonadotropins are injectable hormones that can help you ovulate. This treatment may require frequent doctor’s visits to see how your body is responding.
If you haven’t responded to medication, a type of surgery called laparoscopic ovarian drilling may be an option, though this is rarely done in practice.
PCOS can thicken the outer shell of the ovaries and block ovulation. In this procedure, the surgeon will make several tiny incisions.
Through one incision, a laparoscope will be used to view your internal organs. Then, a laser or fine needle will be inserted to make a few holes on the surface of the ovary. This generally restores ovulation for 6 to 8 months.
It’s usually performed under general anesthesia as an outpatient procedure. Results aren’t permanent.
A healthy diet is important to overall health for anyone. But a low calorie, low carb diet that provides all essential nutrients is said to significantly improve insulin sensitivity and fertility in people with PCOS.
Aiming for at least 30 minutes of moderate exercise 3 times per week is also beneficial.
If your BMI is high, symptoms of PCOS can be improved by losing excess weight. It’s also helpful to speak with a dietitian or nutritionist, who can provide input on healthy eating and offer motivation.
Research from 2010 suggests that acupuncture might be safe and effective in treating PCOS by:
. Increasing blood flow to the ovaries
. Reducing ovarian volume and ovarian cysts
. Managing hyperglycemia
. Reducing cortisol levels
. Assisting in weight loss
Keep in mind, while there’s little evidence of harm, it’s unclear if there are any possible benefits, either.
Acupuncture for PCOS hasn’t been well-studied. More research is needed to determine if it has any benefit for treating PCOS.
Essential oils are plant extracts that produce a variety of fragrances that may impact the way you feel.
Many people find inhaling essential oils relaxing or invigorating. Others use essential oils to ease symptoms of various health conditions.
Research into the effectiveness of essential oils is limited.
A study in rats that was published in 2017 evaluated the effects of essential oil on PCOS.
The researchers concluded that spearmint inhibits testosterone and restores follicular development in ovarian tissue. They also suggest that it has potential in treating PCOS. Whether that translates to humans remains to be seen.
There’s not enough research to make firm conclusions. Aromatherapy is generally considered safe, though side effects can occur.
Use it if it makes you feel good. But make sure you’re using essential oils correctly. Some can interfere with medications, so discuss all complementary remedies with your doctor.
Even natural herbs and supplements can interact with medications. If you’re taking medicine for PCOS-related infertility, speak with your doctor before taking supplements.
A 2017 review found some “low quality” evidence that women with PCOS may benefit from inositol and omega-3 fish oil supplements.
There aren’t enough high-quality studies addressing the safety and effectiveness of herbal and nutritional supplements for people with PCOS.
Talk with your doctor about your diet, whether you’re lacking in nutrients, and whether supplements are a good choice for you.
If you’re struggling with PCOS and infertility, and you’re not responding to treatment, your doctor may look for another cause.
Endometriosis is a condition in which the type of tissue that lines the uterus grows elsewhere in the pelvis. This abnormal tissue growth can block the fallopian tubes or damage the egg or sperm.
According to the American College of Obstetricians and Gynecologists, about 40 percent of women with infertility have endometriosis.
Symptoms of endometriosis can include:
. Heavy periods
. Pelvic pain around menstruation or during sexual intercourse
. Pain during bowel movements or urination
Not everyone with endometriosis has these symptoms.
A study in 2019 addressed the overlap of PCOS and endometriosis.
The research included women with PCOS who hadn’t responded to clomiphene citrate. After a procedure called laparoscopic ovarian drilling, 7.7 percent were found to have incidental endometriosis.
Experiencing difficulty conceiving can be frustrating. And going through fertility treatments can be an emotional roller coaster.
These are physical problems, but they can place added stress on relationships and on mental health.
Depression and anxiety are fairly common among people with PCOS, though it’s unclear how these conditions are related.
If you have depression or anxiety, or are just having trouble coping, rest assured that you’re not alone. Help is available. Your doctor can evaluate your symptoms and refer you to the appropriate specialist if needed.
Sometimes, lifestyle adjustments, medicines, and surgery don’t work. If that happens to you, IVF may be an option.
You’ll start by having fertility injections to stimulate your ovaries. You’ll probably produce multiple eggs at one time. Once the eggs are harvested, they’ll be fertilized with sperm.
Some fertilized eggs can be frozen for later use. Some will be transferred to your uterus to implant and develop. IVF may increase the likelihood of a multiple birth.
If you have symptoms of PCOS, see your doctor for diagnosis and treatment.
If you plan to get pregnant at any point, the sooner you start treatment for PCOS the better. Your doctor will guide you in how to proceed or refer you to a fertility specialist.
PCOS is a condition that involves a hormonal imbalance that can interfere with ovulation.
Some people with PCOS have difficulty getting pregnant. There are effective treatments, though.
With medical intervention, many people with fertility problems due to PCOS are able to conceive. It’s also important to note that PCOS doesn’t mean you can never get pregnant. Always use contraception if you don’t want to conceive, even if you have PCOS.