PCOS and Infertility: Signs, Symptoms, and Trying to Conceive

Caroline is 20 years old, a normal weight, and has mild acne. She experiences mood disruption on occasion and has light periods. Her body shows no signs of excess hair growth. Her friend Kayla is 35 years old, is slightly overweight, and experiences moderate acne. She has some excess hair on her face, chest, and abdomen. Her periods are heavy, irregular, and usually accompanied by painful cramps. Though the two women have vastly differing symptoms, they both share a diagnosis of Polycystic ovary syndrome, also known as PCOS.

What is PCOS, and how does it affect fertility?

PCOS is an endocrine disorder that is associated with an imbalance of sex hormones. According to the U.S. Department of Health and Human Services, this condition affects about one in ten women of childbearing age. Though the precise cause of PCOS is not known, it presents with high levels of androgens (such as testosterone), as well as elevated levels of insulin in the blood. Women with PCOS may have insulin resistance, which puts them at risk for type 2 diabetes. Though PCOS develops anywhere from early adolescence to middle age, many women do not realize that they have it until they are having difficulty conceiving.

Some common physical symptoms of PCOS include:

  • Weight gain— The PCOS Awareness Association states that about 50% of women with PCOS undergo weight gain and obesity that is hard to manage.

  • Acne—changes in hormones often lead to chronic acne and even skin darkness/ spots.

  • Thinning hair—especially in middle age, women with PCOS may notice thinning manes.

  • Hirsutism— excess hair on the face, chin, thumbs, and other regions that men would typically grow hair.

Although Polycystic ovarian syndrome has “cyst” in its name, a woman does not have to have cysts on her ovaries to have PCOS. The Endocrine Society recommends diagnosing PCOS based on whether a patient has two of these three symptoms:

  1. Hyperandrogenism (elevated levels of male hormones)

  2. Ovulatory Dysfunction (irregular or absent periods)

  3. Polycystic Ovaries

Women with PCOS represent 80% of anovulatory infertility incidences. This is because high levels of androgens affect ovulation by disrupting the development and release of eggs. As a result, women who have PCOS may have trouble getting pregnant.

PCOS has traditionally been regarded as a gynecological disorder that mainly affects infertility, but researchers have indicated that untreated PCOS is correlated with cardiovascular and cancer-related risks later in life. A 2011 study published in The Journal of Clinical Endocrinology & Metabolism followed 25 women with PCOS and 68 women without the condition and found that women with PCOS showed higher rats of hypertension and triglyceride levels. PCOS doesn’t just have physical consequences—a Cambridge University study that came out this year linked the condition with higher rates of depression, perceived stress, and anxiety. These types of studies show that even if you’re not trying to conceive, treating PCOS and starting to ovulate regularly is very important!

Tips for Trying to Conceive With PCOS:

Although having a diagnosis of PCOS may feel discouraging, plenty of women still get pregnant with the condition. Some lifestyle changes such as an increase in moderate to intense exercise, as well as decreasing caloric intake, may help to control weight gain and insulin resistance. A study conducted in 2015 randomly assigned 149 women with PCOS to three conditions: lifestyle modification (a combination of diet and exercise), oral contraceptive (OCP), and combined (lifestyle and OCP). Ovulation was induced in participants after four months, and the women subsequently had timed intercourse to conceive. The ovulation rate for women who were in the combined group was 67%, and the ovulation rate for the lifestyle group was 60%. These rates were much higher than the ovulation rate of the OCP group, which was 46%.

Hormone interventions such as birth control aids in getting regular periods. Though you cannot get pregnant on birth control, your physician may prescribe medications to help resume ovulation. Clomid is a common choice, as it increases levels of GnRH, which is responsible for the release of follicle-stimulating hormone (FSH) to promote ovulation. More choices include Letrozole, which blocks estrogen production and increases FSH, and Metformin, which helps control insulin resistance.

Finding Perspective:

PCOS is one of the most common hormonal disorders. Though it may feel scary, there are increasing numbers of therapies and treatments coming out for it each year.

Many women successfully conceive with PCOS. If you want support or have questions, there are incredible groups of people to connect with such as PCOS Challenge (run by The National Polycystic Ovary Syndrome Association), or local groups in your community.

Click below to read about a true story about one woman’s journey on how she discovered and healing her body from PCOS.