Impact of PCOS on Fertility and Its Management

PCOS is a common hormonal condition, affecting 8-13% of women in their reproductive age. It can show up in different ways for each person—whether that's irregular periods, hormonal imbalances, or challenges with fertility. If you're navigating these symptoms, it's important to remember that your journey is unique, and there are ways to manage PCOS that support both your body and your well-being.

While PCOS can bring physical, emotional, and mental challenges, small, compassionate lifestyle changes can make a world of difference. Many women with PCOS find ways to thrive, focusing on nourishing their bodies and making adjustments that feel right for them.

Let's briefly take a look at what PCOS is, how it can affect fertility, and some practical, supportive strategies to help manage its symptoms in a way that feels empowering.
 

PCOS is an endocrine disorder that affects women of reproductive age, caused by the imbalance of several reproductive hormones, including androgens, insulin, LH, FSH, estrogen, and progesterone. The most common symptoms of PCOS include irregular periods, insulin resistance, high androgen levels, weight gain, skin tags, acne, and more.

If you’re dealing with absent or irregular menstrual cycles and struggling with hormonal imbalances, please know that you’re not alone. Many women with PCOS face similar challenges.

In PCOS, the body produces higher levels of androgens, which can make it tough for your menstrual cycle to stay on track. This can be frustrating, especially when trying to conceive. But remember, there’s hope—understanding your body is the first step, and there are ways to manage PCOS effectively.

There are three types of PCOS:

PCOS can sometimes be tricky to diagnose because it presents as a wide range of symptoms that often overlap with other conditions, making it easy to miss. But don't be discouraged!

Diagnosis is usually based on a mix of your medical history, a physical exam, and a few specific tests. While there isn’t one single test to confirm PCOS, doctors have many tools to help identify it and guide you toward the right care.

The diagnosis typically follows the Rotterdam Criteria, which requires the presence of at least two of the following three factors:

1. A history of irregular menstrual cycles, which includes oligo or anovulation for long periods
2. Excess levels of androgens, detected through physical signs such as male-pattern baldness, excess facial and body hair, acne, and blood tests.
3. Polycystic ovaries that are enlarged with multiple cysts or follicles (at least 12 follicles each measuring 2-9mm or ovarian volume more than 10ml at least in one ovary).

In addition to these systems, there are a few less common, yet useful signs to look out for when diagnosing PCOS: 

• Darkening of the skin (especially on the neck, groin and underarms)
• Sudden weight gain (noticeably) in the abdominal area
• Difficulty in losing weight
• Oily skin
• Anxiety and depression
• Fatigue and low energy levels

Everyone’s experience with PCOS is unique—some may notice certain symptoms, while others might not. If you do recognise any of these signs, seeking professional guidance can be really helpful. While PCOS is a chronic condition that might not be fully “cured,” it can absolutely be managed with the right care and treatments.

Even though PCOS can affect fertility, there’s good news: there are many effective treatments that can greatly boost your chances of conception and a healthy pregnancy. 

Wondering if PCOS affects pregnancy? It can, yes. PCOS may make it a bit harder to conceive because it can interfere with regular ovulation. Sometimes, ovulation may be irregular or even absent, which can make natural conception feel more challenging. But don't lose hope! Many women with PCOS go on to have successful pregnancies, often with a little extra support and the right treatment.

Another way in which PCOS affects fertility is through the elevated levels of male hormones (androgens) that can interfere with the ovulation process. Insulin resistance, on the other hand, contributes to hormonal imbalances and weight gain. Both of these negatively affect fertility.

However, this does not mean that natural conception is impossible for women with PCOS. With lifestyle changes, medications to stimulate ovulation, and fertility treatments such as IVF, many women with PCOS can conceive successfully, and lead healthy lives. Apart from infertility treatment, IVF-supporting procedures like laparoscopic ovarian drilling will also help improve fertility.
 

Many women with PCOS do not ovulate regularly, thus hindering their natural menstrual cycle, and making it difficult to conceive naturally. These are a few ovulation issues you need to keep in mind if you have been diagnosed with PCOS:

Anovulation:

In a healthy reproductive system, ovaries release healthy and matured eggs which are necessary for conception. When this process is disturbed due to hormonal imbalances, egg production will not occur regularly. Additionally, excessive production of androgen (male hormones), insufficient levels of luteinizing hormone (LH), and follicle-stimulating hormone (FSH) hormones lead to irregular or absence of ovulation which is called anovulation. Similarly, when ovulation takes place once every 5 or 6 months, it is usually referred to as oligo ovulation.

Incomplete Follicle Development:

In women with PCOS, the ovaries develop multiple small follicles (often referred to as cysts) that fail to mature and release eggs. For ovulation to occur, a mature follicle must release an egg, but in PCOS, this process is disrupted, making conception more challenging.

Irregular Menstrual Cycles:

Irregular or absent ovulation often leads to irregular periods. It ranges from an abnormal gap between the periods (shorter than 21 days or longer than 45 days) to an absence of one's period entirely. 

Hormonal imbalances are at the heart of understanding PCOS and its symptoms. These imbalances can affect everything from your menstrual cycle to ovulation and even your overall well-being. But don’t worry— this is something that can be managed with the right approach. To give you a clearer picture, here are some of the key ways hormonal imbalances show up in women with PCOS:

• Elevated Androgens

Male hormones such as testosterone are present in small amounts in the female body. However, in women with PCOS, the ovaries produce higher-than-normal levels of androgens, leading to symptoms such as excess facial hair growth, male-pattern baldness, and acne.

• Imbalanced LH and FSH Levels

Sufficient levels of LH and FSH help the ovaries to produce eggs regularly. The disturbances in LH and TSH levels disrupt the maturation and release of eggs.

• Insulin Resistance:

Insulin is well known for its role in regulating blood sugar levels. However, women with PCOS often develop insulin resistance, meaning their cells do not respond effectively to insulin. As a result, the body compensates by producing more insulin, which can eventually lead to higher blood sugar levels.

• Progesterone Deficiency

Due to absent or irregular ovulation, women with PCOS may also develop a progesterone deficiency. Low progesterone levels are often associated with irregular periods and difficulty in maintaining a pregnancy. 
 

Yes, getting pregnant with PCOS is absolutely possible! Treatments, lifestyle changes, and medications can help manage symptoms and enhance fertility. A balanced diet, reducing refined sugars and carbs, and regular exercise can help with insulin resistance.

Additionally, medications that stimulate ovulation—along with assisted reproductive technologies—can further increase the chances of conceiving. Let’s take a closer look at these options.

Medications to Induce Ovulation

Following medications helps in stimulating the ovulation process.

1. Clomiphene Citrate: It works by inducing the release of eggs from ovaries. This can help women get pregnant.
2. Letrozole: This medication was initially used to treat breast cancer. Today, it is usually prescribed to women who do not respond well to Clomiphene. It helps in regulating ovulation disrupted by PCOS.
3. Metformin: It is primarily used to treat insulin resistance and type-2 diabetes. Metformin also plays an important role in regulating the menstrual cycle and improves ovulation.
4. Gonadotropins: These are injectable fertility medicines that contain FSH and LH, usually prescribed to boost and aid fertility. 

Assisted Reproductive Technologies (ART) can offer hope for women with PCOS who may be struggling to conceive. If other treatments haven't worked out as expected, ART provides several options that can help you along your fertility journey.

You might have heard of procedures like IVF or IUI—both are commonly used and have helped many women with PCOS achieve successful pregnancies. IUI, or Intrauterine Insemination, is a procedure where sperm is gently placed directly into the uterus during ovulation to increase the chances of conception. For some, this is a simple next step with a little medical support to boost ovulation.

IVF, or In Vitro Fertilisation, is another option often considered when other methods haven’t been successful. It involves collecting eggs, fertilising them in a lab, and then placing the embryo back into the uterus. Though it may sound complex, many women have found this approach to be a positive and hopeful experience. 

Making some lifestyle changes can really make a difference when it comes to managing PCOS and boosting your chances of conception. While medications are helpful, adopting healthier habits can truly enhance the process and often lead to even better results.

It’s all about taking small, manageable steps toward improving your overall well-being. A few important things to focus on, especially for tackling PCOS symptoms like insulin resistance and hormonal imbalances, include:

Weight management: It is crucial in managing PCOS symptoms. Even a small percentage of weight loss can show major changes in hormonal imbalance.

Nutrition: Eating a balanced diet that is high in protein and low in carbs and fats can help too. Include lean meats, whole grains, vegetables, and vitamin sources or supplements in your daily food routine.

Exercise: Regular physical activity helps to improve mental health, balance hormones, and promote weight loss.

Stress management: Lowering your stress levels can improve cortisol levels. 

PCOS is a common cause of infertility, but the good news is that it’s something that can be managed effectively. With a mix of lifestyle changes, medical treatments, and fertility options like IVF and IUI, many women with PCOS go on to have healthy pregnancies. Taking small steps toward healthier choices and seeking guidance from healthcare professionals can make a world of difference. Don't lose hope because with the right support and approach, managing PCOS and achieving pregnancy is entirely within reach.