How Will PCOS Affect My Fertility? Exploring the Link
According to the NHS, around one in seven couples may have difficulty getting pregnant – that’s the equivalent of about 3.5 million people in the UK. Trying to conceive can be a quite distressing process. It is important that you have a clear understanding of what you can do to improve your chances of getting pregnant and also if there are any underlying problems that are getting in the way.
One of the most common causes of infertility in women is a lack of regular ovulation. If you don’t ovulate regularly you’ll have irregular and/or infrequent periods or no periods at all. A common cause of ovulation problems is polycystic ovary syndrome (PCOS).
PCOS and fertility
According to Patient, period problems such as irregular and infrequent cycles are thought to affect about seven in ten women with PCOS. Brazilian researchers also suggest that between 70 and 80 percent of women with PCOS are affected by infertility.i
Besides period problems the other main PCOS symptoms are excess facial and body hair, weight gain, thinning hair and hair loss from the head, oily skin and acne. However, not all women with PCOS have all of these symptoms, and some have milder symptoms while others are more severely affected.
If you’ve just been diagnosed with PCOS, questions about how the condition will affect your fertility may be uppermost in your mind. Meanwhile, you may only have discovered you have PCOS because you’ve been having problems getting pregnant. Within this piece, we will look into how PCOS can impact a woman’s fertility.
Cysts and hormones
How PCOS is thought to cause ovulation problems is down to two main things: cysts on your ovaries and an imbalance of certain hormones – though often in PCOS the two are connected.
Ovulation happens when your ovaries release an egg into one of your fallopian tubes. If your cycle is normal, this happens about once a month. Several follicles in one or the other of your ovaries start developing at a certain point in your cycle, but only one follicle produces an egg that’s mature enough to be released. Then about 14 days after the egg is released, you’d normally get your period if you’re not pregnant.
But with PCOS there can be twice as many follicles developing eggs with none of the eggs developing fully, meaning there’s no egg to be released. These undeveloped follicles are the cysts in polycystic ovary syndrome (though technically speaking they’re not cysts at all since they’re very small and don’t get bigger, as with other abnormal ovarian cysts). Find out more about how PCOS can impact your fertility here.
It’s very common to have polycystic ovaries, with some experts suggest 33 percent of women of reproductive age are affected by them.ii However, it doesn’t mean all of these have PCOS. That’s because PCOS can only be diagnosed if you have any two out of the following:
Polycystic ovaries as shown via an ultrasound scan
Irregular and/or infrequent ovulation or absence of ovulation
High levels of androgens or hyperandrogenemia (androgens are ‘male’ hormones such as testosterone)
Hormones in PCOS
Hyperandrogenemia causes PCOS symptoms such as excess or unwanted hair growth, acne and thinning scalp hair. Having high level of androgens can also affect the follicles and prevent them from developing mature eggs.
Some women with PCOS may produce high levels of oestrogen and luteinizing hormone, which stimulates ovulation, and low levels of follicle-stimulating hormone (also needed for ovulation) and progesterone. Like having too much testosterone, this imbalance of hormones is thought to prevent eggs developing fully in the follicles and being released, because the ovaries aren’t getting the hormones they need in the right amounts to work normally.
Insulin resistance and fertility
Another hormone that many believe plays a key role in PCOS is insulin. Up to 70 percent of women with PCOS are thought to be affected by insulin resistance, which is where your body doesn’t respond normally to insulin. When your cells don’t work properly with normal insulin levels, your pancreas produces more, making your insulin levels higher than they should be. This explains why type 2 diabetes can be a long-term effect of PCOS.
High insulin levels have been linked with irregular periods and fertility problems. Having too much insulin in your body may affect your ovaries and make them produce too much testosterone. High levels of both insulin and testosterone are thought to interfere with the development of follicles into eggs, making many follicles develop, but rarely to full maturity.
Weight gain and fertility
Meanwhile, your weight can affect your fertility too. According to the NHS being overweight or severely underweight can affect ovulation. It is common for women with PCOS to be affected by weight gain. This may be another factor that impacts overweight PCOS women when trying to get pregnant. Thankfully losing weight can help increase your chances of regulating your fertility - here are some tips on getting started.
What are the treatments?
If you have PCOS and have experienced difficulties getting pregnant, there are several medical treatments you may be offered:
This is a drug used to stimulate ovulation, but there are side effects associated with it, including a higher risk of having multiple pregnancies. It’s usually only prescribed for three to six cycles, as a prolonged use isn’t recommended.
Taking the contraceptive pill may also help correct hormonal balances and trigger a monthly bleed. But of course you won’t be able to get pregnant while you’re taking it, so it may only be suitable if you’re planning to conceive at some point in the future.
If you’ve tried clomifene but it was unsuccessful, you may be treated with an injected medicine to help your ovaries produce eggs. One example is a drug called letrozole, which may help boost your levels of follicle-stimulating hormone.
In vitro fertilisation is an option for women with PCOS who want to conceive and is often successful. However, it’s not usually suitable for women with PCOS who are also obese.
This may sound alarming but it’s a simple surgical procedure that involves making several small holes in each ovary, often with a laser. This can make the ovaries more sensitive to clomifene or make ovulation regular without clomifene – though experts aren’t really sure why it works.
There are also lots of other things you can do to boost your chances of getting pregnant with PCOS.
Not all women with PCOS have problems with fertility, and you can still get pregnant if you’re not ovulating every month and having unprotected sex. If you have PCOS and you’re not trying for a baby, it’s important to use contraception to avoid an unwanted pregnancy. Speak to your GP for more advice on suitable contraception methods.
To find out more about PCOS and understanding your symptoms, explore the rest of our resources centre.
Melo, A.S., Ferriani, R.A., Navarro, P.A. (2015 Nov). Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics (Sao Paulo). 2015 Nov; 70(11): 765–769. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642490//
Michelmore, K.F., Balen, A.H., Dunger, D.B. and Vessey, M.P. (1999 Dec). Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol (Oxf). 1999 Dec;51(6):779-8. Available online: https://www.ncbi.nlm.nih.gov/pubmed/10619984