ANSWER: The effect of polycystic ovary syndrome, or PCOS, on fertility can vary quite a bit from one woman to another. In some women, PCOS can make getting pregnant more difficult than usual. But that’s not always the case. When PCOS does have an impact on fertility, there often are treatments available that can help.
There’s no single test that shows you have PCOS. Instead, a diagnosis is made when you have two out of three signs of PCOS. The first sign, irregular or less-frequent periods, suggests that you are not ovulating every month. Ovulation is the process where the ovaries develop a mature egg that is then released into the uterus and can be fertilized by sperm. Women with PCOS usually have less than nine periods per year, or there is other evidence that they are not ovulating every month.
The second sign of PCOS is an excess of the male hormone, testosterone, or other hormones that have a similar effect on the body. This can be detected through blood tests or by symptoms of extra or unwanted hair growth, severe acne or hair loss.
The third PCOS sign is a finding of multiple follicles in the ovary on an ultrasound test. The term “polycystic” can be misleading. PCOS actually is not related to abnormal ovarian cysts. Instead, the ultrasound detects small, undeveloped follicles that are not getting signals to mature and release an egg.
Based on your diagnosis and the signs of PCOS you have, your health care provider can decide what therapies may work best for you, as well as assess you for other medical conditions associated with PCOS. Treatment often can help control problems that may arise as a result of PCOS, including infertility.
Not all women who have PCOS have difficulty with fertility. Even if you are not ovulating every month, you can still get pregnant. So you shouldn’t assume you will have fertility issues or that you can’t get pregnant because you have PCOS. Fortunately, even if you do have trouble getting pregnant, medical therapies often can help increase your chances of ovulation and pregnancy without the need for more advanced fertility technologies.
In some cases, PCOS is associated with insulin resistance. With this condition, the insulin your body makes does not work as well as it should. That can increase your risk for developing prediabetes or diabetes, as well as interfere with ovulation. Medications like metformin that improve how insulin works in your body can also improve your chances for ovulation.
Your weight also may be a factor in your fertility when you have PCOS. Women with PCOS who are overweight can see an improvement in fertility with exercise and weight loss. If you are not overweight now, maintaining a healthy weight will help you increase your chances of normal fertility.
If you have PCOS and you want to have children — especially if you have irregular periods or have been told that you are not ovulating monthly — consider trying to get pregnant sooner rather than later, if possible. If you do have difficulty becoming pregnant, the ideal time to start therapies to help you get pregnant is before the age of 30. Fertility rates and success rates of fertility treatments start to decline after that.
Take time to review your diagnosis with your health care provider to see how much PCOS may be affecting your fertility and overall health. You might also decide to consult with an endocrinologist, gynecologist or reproductive endocrinologist depending on your concerns, symptoms or risk factors. You can then decide on the best treatment plan for you, based on your individual needs. — Alice Y. Chang, M.D., M.Sc., Endocrinology, Mayo Clinic, Rochester, Minn.