PCOS: how does it affect fertility and pregnancy?
Polycystic ovary syndrome (PCOS) is a condition where you may have irregular periods, unwanted facial and body hair, and acne. It can also make it more difficult for you to get pregnant because it affects ovulation. In this article, I’ll talk about PCOS and fertility and the available treatments that can help with getting pregnant.
What causes polycystic ovary syndrome (PCOS)?
It’s not known what exactly causes PCOS. It might be due to both genetics and environmental factors. PCOS involves changes in your hormones. This includes insulin resistance, where your cells don’t respond well to insulin, causing your cells to make too much insulin. This raises the amount of the sex hormone testosterone in your blood.
Weight gain can also increase insulin resistance. Some people with PCOS produce too much luteinising hormone (LH). Raised insulin or LH levels make your ovaries produce testosterone instead of oestrogen. You may also have raised oestrogen levels.
Hormonal changes and issues with follicles developing in the ovaries to release eggs cause you to not ovulate as well as other PCOS symptoms.
What are symptoms of polycystic ovary syndrome?
PCOS symptoms usually start around puberty, but can be as late as your early 20s.
The main symptoms include:
- irregular periods or no periods at all
- difficulty getting pregnant (infertility)
- being overweight or finding it hard to lose weight
- having more body or facial hair than usual (hirsutism)
- thinning hair and losing hair on your head
- acne
- patches of dark thick skin in your armpit or around your groin or neck
PCOS is also linked with anxiety, depression, mood swings and low self-esteem. PCOS can also increase risk of developing:
If you have any of these symptoms, see your GP.
Can polycystic ovary syndrome cause infertility?
PCOS is a leading cause of infertility. This is because of its effect on ovulation. Ovulation is when an egg is released from your ovaries each month. But if ovulation does not happen, this makes you unable to get pregnant because no egg is released.
Can you get pregnant with polycystic ovaries?
There are a few treatments you can have to help you get pregnant if you have PCOS. The treatments aim to make your periods more regular so that you ovulate normally.
Lifestyle changes
If you are overweight or obese, you might be advised to lose weight as this may improve fertility. You may start ovulating again and having more regular periods if you lose even a small amount of weight. Exercise and a healthy balanced diet can help you maintain a healthy weight.
Medication
Metformin is a drug that is used treat PCOS, whether you’re planning to get pregnant or not. Metformin treats insulin resistance, and may regulate your periods and help you to start ovulating again. Your GP or a specialist may suggest this if losing weight hasn’t helped.
Another drug called clomifene can also help with ovulation. You can have it with or instead of metformin.
Or you can have injections of female sex hormones (gonadotrophins). Gonadotrophins may make you produce too many eggs. This might result in having twins or more (multiple pregnancy).
Assisted reproduction
If medicines for PCOS don’t work, your doctor may suggest fertility treatment. One type of fertility treatment is IVF (in vitro fertilisation). In IVF, you have hormones to stimulate your ovaries to make eggs. Your eggs are then collected and fertilised with sperm to create embryos. An embryo is transferred to your womb, and this should hopefully result in pregnancy.
The HFEA website has lots of helpful information about how and where to get fertility treatment.
Surgery
If medicines don’t work, your doctor may suggest you have an operation to improve your fertility. They will usually only suggest surgery if other treatments haven’t helped, and will refer you to a fertility specialist.
If you’re trying for a baby, one option is keyhole surgery. This procedure is called laparoscopic ovarian drilling. The surgeon makes a small cut in your abdomen. They then put a heated probe or laser through the cut and into the ovary. They use this to make small holes in the ovarian tissue to reduce the amount of testosterone produced. This changes the balance of hormones in your body, and can cause your ovaries to release eggs again.
Are there risks to getting pregnant with polycystic ovary syndrome?
Having PCOS may make it more likely to develop pregnancy complications. These can include gestational diabetes which is a type of diabetes you get while pregnant. Another complication is high blood pressure. Your baby is also more likely to be born early. Your antenatal team will take extra care by giving you regular health checks.
If you have PCOS it can affect your fertility and make it harder to get pregnant. However, it’s not impossible. Talk to your GP if you have PCOS and want to try and get pregnant.
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Sources Sources
- Polycystic ovary syndrome. NICE Clinical Knowledge Summaries. nice.org.uk, last revised April 2024
- Polycystic ovary syndrome (PCOS): what it means for your long-term health. Royal College of Obstetricians and Gynaecologists. rcog.org.uk, updated February 2022
- Polycystic ovary syndrome. BMJ Best Practice bestpractice.bmj.com, last reviewed July 2024
- Polycystic Ovary Syndrome (PCOS). MSD Manuals. msdmanuals.com, reviewed January 2023
- Polycystic ovary syndrome. World Health Organisation. who.int, published June 2023
- Polycystic ovary syndrome. Patient. patient.info, last updated March 2021
- Helena Teede et al. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University. doi.org/10.26180/24003834.v1
- Ovulation and fertility. Tommys. tommys.org, reviewed March 2024
- Anovulation. Medscape. emedicine.medscape.com, updated January 2023
- Polycystic ovary syndrome. British National Formulary. bnf.nice.org.uk, accessed August 2024
- Infertility. Management. NICE Clinical Knowledge Summaries. nice.org.uk, last revised July 2023
- In vitro fertilisation. HFEA. hfea.gov.uk, accessed August 2024
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