How PCOS Affects Fertility

Many women discover that they have PCOS when they have fertility issues (or have trouble conceiving.) About 70 to 80% of women with PCOS struggle with infertility. This is why it is important to understand how PCOS affects fertility. With this article, we hope to shed light on the connection between PCOS and fertility issues, equipping women with knowledge to help them overcome these hurdles. 

The Link between PCOS and the Female Reproductive System

To understand how PCOS affects fertility, you need to know how it disrupts the female reproductive system. Hormones like estrogen and progesterone regulate the release of eggs during ovulation and the menstrual cycle. In women with PCOS, there is a disruption in this hormonal balance. 

In the previous article on what PCOS is, we highlighted factors that contribute to PCOS and how it interferes with the normal functioning of the female reproductive system.

How PCOS Affects Fertility

Your ovaries contain multiple small follicles which release eggs into the fallopian tube. In a regular menstrual cycle, hormones like follicle-stimulating hormone (FSH) and luteinising hormone (LH) work together to stimulate the growth and release of mature eggs. In women who have PCOS, the LH and FSH levels are higher and lower than normal. The follicles do not grow or mature properly, leading to the build-up of cysts in your ovaries.

One of the most challenging aspects of PCOS for many women is its effect on fertility. Here are some other ways how PCOS affects fertility:

Anovulation (irregular ovulation)

PCOS is the most common cause of infertility due to anovulation. Anovulation is the medical term for when a woman doesn’t ovulate or has irregular ovulation. A study showed that about 90-95% of the women who seek treatment for infertility have PCOS. 

In the menstrual cycle, ovulation occurs when an egg is released from the ovaries. Due to the hormonal imbalance between LH and FSH in PCOS, the follicles do not grow or mature properly and cannot release eggs every month. While some women with PCOS have irregular ovulation, others may not ovulate at all. If a woman doesn’t ovulate regularly, her chances of getting pregnant are lesser. 

Irregular menstrual cycle or periods

About 14 days after ovulation, a woman should get her period if she is not pregnant. Since women with PCOS do not ovulate regularly, they have irregular menstrual periods (amenorrhea). Some women may go months without a period, while others may experience shorter or longer cycles. Irregular periods make it harder to track ovulation and conceive naturally. This is usually frustrating and stressful for women who are trying to conceive.

Quality of eggs

With PCOS, the ovaries produce excess androgens (male hormones). The hormonal imbalance and insulin resistance affect not only ovulation but also the quality of eggs produced. This produces immature eggs, making them less likely to fertilize and develop into healthy embryos.

Common Fertility Issues in Women with PCOS

PCOS contributes to other issues reduces your chances of getting pregnant and carrying a healthy pregnancy. Women with PCOS experience some fertility-related issues, such as:

Difficulty conceiving

The most common fertility issue for women with PCOS is difficulty conceiving. This experience can be frustrating and emotionally draining. Even if a woman may be fertile (can conceive within 12 months), the amount of time it will take for her to conceive increases if she has PCOS. In contrast, some women have never been pregnant (primary infertility), while some struggle to conceive after their previous pregnancy (secondary infertility). The irregular ovulation and hormonal imbalances associated with PCOS can make it harder for women to get pregnant naturally.

Implantation issues 

The implantation of eggs occurs in the uterus (uterine or endometrial lining). When the ovaries produce excess androgens, it affects the quality of the uterine lining. Special chemicals that aid the receptivity of the uterine lining are also lower in women with PCOS, especially during the first trimester. As a result, the lining is thicker and less responsive, leading to endometrial dysfunction. Since, the fertilized egg can not be implanted, and an embryo can not develop in the uterus. 

Increased risk of miscarriage

PCOS increases the risk of miscarriage. About 30-45% of women with PCOS have a higher risk of miscarriage compared to 10-15% of women without the condition. The cause of the miscarriage is unknown. However, hormonal imbalances, insulin resistance caused by obesity, and endometrial dysfunction can contribute to it. Because the hormonal levels in the uterus are not optimal for embryo development, it can lead to recurrent miscarriages (early pregnancy loss). 

Potentially leading to early pregnancy loss. Because the fertilized egg can not implant and develop in the uterus, 

Complications in pregnancy

Women with PCOS who get pregnant are at a higher risk of dealing with certain pregnancy complications. Some of these complications include gestational diabetes, preeclampsia, and premature birth. These complications make the pregnancy journey more challenging. In more critical cases, these women may undergo a cesarean section for a safe might be the safer delivery. These risks emphasize why regular checkups are required for a healthy pregnancy journey.

Learn more about seven health conditions that can affect a pregnancy 

Diagnosis of Infertility in PCOS

Before looking for ways to increase your chances of getting pregnant, you must visit your healthcare provider. Your doctor or gynaecologist can give an accurate diagnosis. 

Doctors will also order blood tests to check hormone levels and insulin sensitivity. Hormone-level tests help assess the balance of reproductive hormones. Your doctor may order an ultrasound scan to examine the ovaries for further testing. 

If you are trying to conceive, your doctor may also check:

• Ovarian reserve: Ovarian reserve tests will evaluate egg quantity and quality
• Ovulation tracking: With ovulation tracking, you can determine if and when ovulation occurs. Tracking ovulation also helps to plan intercourse and maximize windows where you are very fertile. You can use home ovulation tests or a calendar to monitor your cycle. Ovulation predictor kits, basal body temperature charting, and monitoring cervical mucus can increase your chances of conception. 

These assessments help healthcare providers tailor treatment plans to individual needs and optimize fertility potential.

Read more on the diagnosis of PCOS 

When to Seek Professional Help

If you have been trying to conceive for over a year without getting pregnant, you may need to seek professional help. If you notice any of the PCOS symptoms, kindly speak to your healthcare provider. Weight gain, irregular periods, and other symptoms of PCOS affect fertility in the long run. Even if you do not want to get pregnant, getting an early diagnosis helps to reduce the risk of complications.

There are other potential causes of infertility aside from PCOS, including fibroids, endometriosis, or even a problem with the structure of the fallopian tubes or other parts of the reproductive system. 

However, getting tested for PCOS can help target treatment and improve the chances of conceiving. A fertility specialist can evaluate you using in-depth assessments, identify potential underlying causes, and recommend appropriate treatment options. Some treatment options include but are not limited to ovulation induction, intrauterine insemination (IUI), or in vitro fertilization (IVF).