What to Know (and Do) About PCOS and Infertility

Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects the ovaries. PCOS causes hormonal imbalances and metabolism problems. Severe cases may lead to infertility, but it is possible to become pregnant naturally. 

There is no cure for PCOS, but it can be managed, and several treatment options are available.

This article will provide an overview of how PCOS affects fertility and the steps you can take to treat the symptoms and improve your chances of becoming pregnant.  

A woman holding a home pregnancy test

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Polycystic Ovary Syndrome

How PCOS Affects Fertility

PCOS may affect your ability to become pregnant and have a healthy pregnancy. PCOS causes an imbalance in reproductive hormones, which prevents the ovaries from functioning correctly.

The ovaries are responsible for making and releasing an egg each month. When the egg is fertilized by sperm, it travels to the uterus to implant, and pregnancy occurs. When the egg is not fertilized, your body sheds the uterine lining, causing your menstrual period

The ovaries need the right amount of hormones present to function normally. People with PCOS usually have high levels of luteinizing hormone (LH) and low follicle stimulating hormone (FSH) levels. They also tend to have high levels of insulin and testosterone.

When the ovaries cannot release an egg each month, ovulation does not occur. This means that you cannot become pregnant that month. 

Once you become pregnant, PCOS may increase the risk of complications. Having PCOS raises the risk of miscarriage, gestational diabetes, preeclampsia, and cesarean section (C-section). To lower your risk, talk with a healthcare provider about maintaining a healthy weight and blood sugar level before becoming pregnant. 

PCOS Symptoms

PCOS causes an increased level of androgens, a group of reproductive hormones that are naturally more abundant in males than in females. In people with PCOS, the levels of androgens like testosterone are too high. 

Common symptoms of PCOS include:

How Common Is Infertility With PCOS?

Infertility is a common problem for people with PCOS. About 70% to 80% of people who seek fertility treatments due to ovulation problems have PCOS.

PCOS Treatment

While there is no cure for PCOS, there are treatment options to help manage symptoms and improve fertility. Your healthcare provider will likely discuss lifestyle changes with you and medications to improve your PCOS symptoms.

Common medicines to manage PCOS include hormonal birth control and anti-androgen medications. Hormonal birth control pills can be used for long-term treatment in people with PCOS who do not wish to get pregnant. These birth control pills regulate the menstrual cycle, and reduce hirsutism and acne often seen in PCOS. Anti-androgen drugs block the effects of testosterone and other androgens to improve PCOS symptoms. 

Fertility Treatments for PCOS

Infertility is a common problem for people with PCOS, and there are several available treatments to try. 

Clomiphene Citrate (Clomid)

Clomid is a drug used to induce ovulation in people not ovulating regularly. It works by increasing the luteinizing and follicle stimulating hormones in the body.

Healthcare providers usually prescribe Clomid for five days starting the second day of the menstrual cycle. It may take three to six cycles of Clomid before your body starts to ovulate regularly. As many as 75% to 80% of people with PCOS begin to ovulate after taking Clomid. 

Letrozole

Femara (letrozole) is a breast cancer drug that may be more effective at helping people become pregnant than Clomid. While both drugs cause your body to ovulate, letrozole has higher rates of pregnancies and live births. This means more people taking letrozole can carry a healthy pregnancy to term.

Metformin

Glucophage (metformin) is an insulin-sensitizing agent usually prescribed to people with type 2 diabetes. It improves the cells’ response to insulin, resulting in lower insulin and blood sugar levels. When insulin levels are lower, the body can produce reproductive hormones properly, increasing the chances of ovulation. 

Gonadotropins

When first-line treatments like Clomid and letrozole are ineffective, your provider may recommend gonadotropins. These injectable drugs contain FSH and LH. The body needs these hormones to ovulate.

Surgery

If medication options have not been successful, the next step may be surgery. Surgery to improve fertility in people with PCOS is known as ovarian drilling. The surgeon makes small (laparoscopic) cuts in the abdomen and uses a needle with an electric current to drill tiny holes into the ovaries. The procedure aims to lower androgen levels in the body and increase the odds of ovulation. 

Lifestyle Changes

Lifestyle changes can help relieve PCOS symptoms and improve fertility. If your weight falls into the overweight or obese categories, research shows, losing 5% to 10% of your body weight (if advised) can reduce your insulin and androgen levels, lower your lipid levels (a type of fat in the blood), normalize your menstrual cycle, and induce ovulation. 

Diet and Exercise

A healthy diet can improve your hormonal balance and lower insulin levels. A healthy PCOS diet should include fruits and vegetables, low-fat dairy products, lean proteins, healthy fats, and whole grains.

Avoid foods that can spike blood sugar levels and contribute to insulin insensitivity. These include sweets, fried foods, saturated fats, refined carbohydrates, and processed foods. 

There is a link between daily physical activity and regular ovulation in people with PCOS. Regular exercise has been proven to improve insulin sensitivity as well. Research shows that 150 minutes of moderate or 75 minutes of vigorous activity per week can improve PCOS symptoms and hormonal imbalances. 

Manage Stress

Both PCOS and infertility have been linked with an increased risk of stress, anxiety, and depression. Managing stress can have a beneficial effect on your ability to become pregnant. Stress-management practices to help improve symptoms include tai chi, yoga, and meditation. Meeting with a therapist or support group may also be helpful.

Acupuncture

Research found that acupuncture is an effective treatment for PCOS. It has been found to reduce PCOS symptoms and regulate the menstrual cycle. Acupuncture may also induce ovulation in people with PCOS.

Herbs and Supplements

Certain herbs and supplements may improve fertility, but more research is needed. Vitamins A, B, D, and E have been found to regulate the menstrual cycle and improve fertility. Always talk with a healthcare provider before adding natural herbs and supplements to your medication regimen.   

In Vitro Fertilization (IVF)

IVF may be the next step if PCOS has been ineffective. IVF is a type of assisted reproductive technology (ART) considered a third-line treatment for PCOS-related infertility. 

During the IVF process, a healthcare provider will retrieve eggs and sperm from you and your partner, then combine them in a lab setting. The provider then implants the embryos into your uterus. This process may sound simple, but it takes months. 

Still Struggling? Other Factors That Affect Fertility

If you’re still struggling with infertility after finding treatments to manage PCOS, there may be another reason why you’re unable to become pregnant. Other conditions that affect fertility include:

  • Endometriosis: A chronic condition where the uterine lining grows outside the uterus
  • Uterine fibroids: Noncancerous growths that develop within the walls of the uterus
  • Structural problems: Physical problems or blockages in the uterus or fallopian tubes

PCOS, Infertility, and Mental Health

Both PCOS and infertility can affect your mental health and well-being. Infertility has been linked with an increased incidence of depression, anxiety, and high levels of distress throughout their treatments. 

PCOS is also linked with an increased risk of anxiety and depression. Depression may affect one’s ability to engage in treatment and positive lifestyle changes. People with PCOS are also at an increased risk of sleep disturbances, which can affect mood. 

However, treating depression is linked with improved quality of life and decreased PCOS symptoms. Research has found that a combined approach of both cognitive behavioral therapy and antidepressant medications was effective at treating depression associated with PCOS. 

Summary 

Polycystic ovary syndrome (PCOS) is a hormonal disorder that can significantly impact your ability to become pregnant. PCOS causes metabolic problems and hormonal imbalances that affect fertility. Fortunately, it is possible to become pregnant with PCOS. 

First-line treatments often include lifestyle changes, Clomid, letrozole, and metformin. When these treatments are unsuccessful, your provider may recommend gonadotropins or surgery. Some people with PCOS might require IVF treatment to become pregnant. 

11 Sources
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Carrie Madormo

By Carrie Madormo, RN, MPH
Carrie Madormo, RN, MPH, is a health writer with over a decade of experience working as a registered nurse. She has practiced in a variety of settings including pediatrics, oncology, chronic pain, and public health.