fbpx PCOS and Fertility: What to Know When Planning a Family
A pregnancy test with an icon of the female reproductive system is against a red and purple background.
A pregnancy test with an icon of the female reproductive system is against a red and purple background.

PCOS and Fertility: What to Know When Planning a Family

Polycystic ovary syndrome is a cause of infertility, but steps can be taken to mitigate effects.
Kelly Kling
Written by

Kelly Kling

September is Polycystic Ovary Syndrome (PCOS) Awareness Month, and aware we should be. This is a hormonal disorder that may affect someone you know.

"It's estimated that between 6 and 15 percent of women in the U.S. suffer from PCOS," said Kecia Gaither, M.D., a board-certified OB-GYN and director of perinatal services/maternal-fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx in New York City.

PCOS presents a number of symptoms that can vary from person to person. Common symptoms include cysts on the ovaries, missing or irregular periods, acne, insulin resistance, weight gain and infertility.

For people who want to become parents, PCOS can be a concern. The condition affects a sufferer's ability to get pregnant and may lead to various complications during pregnancy.

"Patients with a history of PCOS may be prone to having large babies and increased risk of preeclampsia/gestational hypertension, gestational diabetes, miscarriage and premature birth," Gaither said.

It's certainly not impossible to become pregnant and deliver a healthy baby while living with PCOS. However, if pregnancy is part of your plan, it's important to be aware of PCOS's effects on fertility and what you can do about them.

PCOS and fertility

In order to get pregnant, a female must ovulate, which is when a mature egg is released from an ovary and moves down to the fallopian tube, where it can be fertilized. If you have a regular menstrual cycle, ovulation is likely to occur once per month. However, that's not always the case for women with PCOS.

"PCOS causes an increase in androgens throughout the body in uterine persons," said Renee Trewella, B.S.N., a registered nurse in Louisiana who has PCOS herself. "This can result in anovulation, which leads to amenorrhea or absence of a period. On a personal note, I've gone as long as four months without a period and needed medication to trigger it."

Getting pregnant doesn't just require ovulation, however. The path to pregnancy includes a delicate dance between various hormone levels. PCOS can interfere with that hormonal balance, which can affect conception and pregnancy in a number of ways.

"Many people with PCOS experience insulin resistance, which throws off hormonal balances," said Jesse Petke, a former doula and agency owner of Birth and Beyond Wisconsin. "Usually, there is excess testosterone and prolactin levels with lower estrogen and progesterone levels.

"However, sometimes the excess testosterone will make the body create extreme levels of estrogen trying to find balance," Petke continued. "The extra prolactin can trick the body into not ovulating, just like in a nursing parent. And the low progesterone levels make miscarriages very common if a pregnancy does occur."

What you can do about it

Though there is no known cure for PCOS, there are ways to mitigate its effects on the hormone levels in the body. Addressing hormonal imbalances gets to the root of the potential problems.

"Generally, the first hurdle is to balance hormones," Petke said.

Diet and exercise aren't a magic cure-all, and regardless of how healthily you eat, weight gain is a very common PCOS side effect. It's more difficult for people with PCOS to control their weight, which may create the illusion that no progress is being made with diet and exercise.

However, even if weight isn't being actively lost, good diet and exercise routines can help people with PCOS maintain healthier hormone levels. Diets low on carbs and sugar, like those that people with diabetes follow, are a good option for some.

"Diabetic diets to control blood sugar and, therefore, insulin resistance can reduce symptoms," Petke said. "Exercise also helps reduce insulin resistance and, therefore, hormonal imbalances."

There are also medications available to treat infertility. These medications work by inducing ovulation in individuals who have an abnormal, irregular or missing cycle.

"For persons requiring assisted reproductive technology to build a family, this can be a linear progression of treatment, starting with drugs like clomiphene or letrozole," Trewella said.

Treatment for PCOS and infertility is personal

It's important to reiterate that PCOS does not make it impossible to conceive and carry a healthy baby to term.

"Not all persons having PCOS necessarily need assisted reproductive technology," Trewella said.

As always, your doctor knows best. The ideal route to the right infertility treatment plan for your needs starts with a conversation with a reproductive health professional.

"Infertility issues should result in a visit to a physician with resultant physical, sonographic and laboratory evaluation," Gaither said.

If you have PCOS and are trying to start a family, don't get discouraged if you can't conceive right away. You may just need a bit of help, and help is available, so schedule an appointment with your doctor to discuss your family planning goals.