How does PCOS affect your fertility?

What is PCOS?

PCOS is an endocrine disorder that affects your ovaries — your endocrine system is responsible for producing hormones. It’s a common condition that’s thought to affect as much as 1 out of 10 women.

It has 3 main features, but you only need 2 out of 3 to be diagnosed with PCOS. The 3 main features are:

• irregular or missing periods — because ovulation is irregular or not happening
• high levels of “male hormones” — like testosterone
• polycystic ovaries — where fluid-filled sacs (follicles), containing immature eggs, grow in your ovaries

Signs you might have PCOS

The symptoms you experience and how severe they are can vary greatly from person to person. But the most common PCOS symptoms include:

• absent or irregular periods 
• difficulty getting pregnant 
• excessive hair growth (hirsutism) — commonly on your face, back, buttocks, or nipples
• hair loss on your head or thinning hair
• weight gain
• oily skin and acne
• headaches

If you haven’t been diagnosed with PCOS but suspect you might have it, it’s a good idea to speak to your GP. Diagnosing it will usually involve questions about your menstrual cycle, a PCOS blood test, and sometimes an ultrasound scan.

How PCOS affects your fertility

PCOS is one of the most common reasons you might have difficulty getting pregnant. But importantly, most people can still get pregnant.

You can get insights into your fertility and egg count using a fertility insights blood test.

Ovulation and PCOS

The main reason you might have difficulty getting pregnant is because of how PCOS affects ovulation. Ovulation is when one of your ovaries releases a mature egg — which can then be fertilised by sperm.

In a typical cycle, a follicle in your ovary develops and releases a mature egg (due to stimulation from hormones like follicle-stimulating hormone). But if you have PCOS, a hormonal imbalance might prevent the development and release of a mature egg. In this case, you don’t ovulate, and fertilisation can’t happen. 

If ovulation does occur and a mature egg becomes fertilised, imbalanced hormone levels might also mean the lining of your womb doesn’t build up properly, and a fertilised egg can’t implant.

Irregular periods and PCOS

A higher level of “male” hormones, like testosterone, can also disrupt your menstrual cycle as you might:

• get fewer periods than usual 
• not get any periods at all (amenorrhea)

An irregular cycle can make it harder to predict when your chances of becoming pregnant are high.

How PCOS affects your hormones

As mentioned, PCOS can cause a range of hormones to become imbalanced. These hormones include:

• testosterone — important for ovulation
• oestrogen — key hormone for regulating your cycle, ovulation, and building up the lining of your womb
• progesterone — its main role is to build up the lining of your womb  
• follicle-stimulating hormone (FSH) — stimulates follicles to produce mature eggs for ovulation 
• luteinising hormone (LH) — helps to mature and release eggs for ovulation 
• insulin — its main role is to help regulate blood sugar levels but high levels (common in PCOS) can affect fertility

If any of these hormones are imbalanced, it can affect various aspects of your reproductive health.

Fertility treatments for PCOS

PCOS can’t be cured, but there are a range of lifestyle changes and medications that can help both your fertility and overall symptoms. 

Lifestyle changes

If you’re carrying excess weight, losing some weight can be very effective at reducing your symptoms and improving your fertility. Weight loss on its own is sometimes enough to trigger ovulation.

It can be harder to lose weight with PCOS due to high insulin levels — which promotes fat storage. To help overcome this, you can try:

• following a low glycaemic diet — rich in fruits, vegetables, and whole grains
• doing three 30-minute high-intensity exercise sessions a week — helps to improve your insulin levels

If you’re still struggling, you might find it helpful to have support from a health professional, like a dietitian.

First-line treatment: oral medication

Clomifene, a medication that stimulates ovulation, is the main treatment recommended for people with PCOS who are trying to get pregnant.

Your doctor will usually prescribe clomifene for a maximum of 6 cycles — but most people get pregnant within 3 cycles. A similar medication called letrozole might sometimes be prescribed instead of clomifene. 

If you don’t get pregnant using clomifene, another medication called metformin might be recommended. Metformin can help:

• stimulate ovulation
• regulate your cycle
• reduce the risk of miscarriage 

Sometimes a combination of clomifene and metformin might be used. 

Second-line treatment: injections

If oral medications don’t work, you might be recommended gonadotrophin injections. These injections contain the hormone FSH — stimulates ovulation. This treatment can increase your chances of having a multiple pregnancy (like twins).

Third-line treatment: IVF

If the first and second-line treatments don’t work, IVF might be offered. This involves removing eggs from your ovaries and fertilising them with sperm in a laboratory. The fertilised eggs are then returned to your womb. IVF also increases your chances of having a multiple pregnancy.

Sometimes a surgical procedure called laparoscopic ovarian drilling (LOD) can help if you’re having fertility issues. Heat or a laser is used to destroy tissue in your ovaries to correct your hormone imbalances — allowing your ovaries to function normally. 

When to seek fertility help for PCOS

If you know you have PCOS, you might like to get advice from your GP when you start trying for a baby. But not everyone with PCOS will need treatment to get pregnant — most people will become pregnant and give birth without treatment at least once in their life.

If you’ve been having unprotected penile-vaginal sex 2-3 times a week for 6 months and aren’t pregnant, it's a good idea to seek support from your doctor or a fertility specialist.