PCOS and fertility: everything you need to know

PCOS, short for polycystic ovarian syndrome, is a common condition related to hormones, in which the ovaries don’t always release an egg every month. It can lead to difficulty getting pregnant.

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS, short for polycystic ovarian syndrome, is a common condition related to hormones in which the ovaries don’t always release an egg at the end of the menstrual cycle (the start of a period to the start of the next one). It can lead to difficulty getting pregnant. 

It is thought to be very common, affecting about 1 in every 5 women in the UK.

If you have polycystic ovaries (PCO):

  • Your ovaries are slightly larger than normal
  • you have many more follicles (the fluid-filled pockets on the ovaries that release the eggs when you ovulate)

Having polycystic ovaries does not mean that you have PCOS. PCO is a variation of normal ovaries, while PCOS is disorder linked to unbalanced hormone levels.

Symptoms of PCOS

Having polycystic ovaries does not mean that you have PCOS. To be diagnosed as having PCOS you would have PCO and some of the following symptoms:

  • irregular periods or none
  • more facial or body hair
  • less hair on the head
  • difficulty losing weight or rapid weight gain
  • acne or oily skin
  • difficulty becoming pregnant

Periods are ‘irregular’ if the length of your cycle (the gap between your periods starting) keeps changing. The average menstrual cycle lasts 28 days, although it's normal for it to be a bit shorter or longer than this.

You may have some of these symptoms of PCOS but they vary from woman to woman, with some women having milder symptoms and others more severe.

What are the causes of PCOS?

The exact cause of PCOS is not known but it may be genetic as you are more likely to have it if any of your relatives (mother, aunts, sisters) have it.

The symptoms are linked to hormones:

  • Women with PCOS have slightly higher than normal levels of testosterone - this is associated with many of the symptoms of the condition, such as more facial hair.
  • If you have PCOS, your body may not respond to insulin (this is known as insulin resistance), so the level of glucose is higher in your body. High levels of insulin can lead to weight gain and fertility problems. This means that if you are diagnosed with PCOS, you are at increased risk of developing diabetes in later life

Do I have PCOS?

Women who have mild symptoms often only realise they have PCOS when they start trying for a baby, particularly if their weight goes up and down.

Use of the combined oral contraceptive (‘the pill’) can ‘hide’ PCOS as:

  • many varieties have a pill-free 7-days causing a withdrawal bleed, which can be mistaken for a period (It is not a true period as it is unrelated to egg production or thickening of the lining of the womb). Even if they are aware, women do not know whether their period is regular or not.
  • the pill has hormones that can help the symptoms of PCOS. It can improve acne and lessen excess hair growth. It is a standard treatment for PCOS when women are not seeking to get pregnant.

A diagnosis of PCOS is made when you have any two of the following:

  • irregular periods or none
  • a transvaginal scan (in which a wand is put inside your vagina) showing polycystic ovaries
  • an increase in facial or body hair or test results show you have excess levels of testosterone.

If you think you have PCOS visit a GP to get a referral to a gynaecologist.

How does normal ovulation work?

In a normal menstrual cycle with ovulation a number of eggs mature in follicles in your ovaries. The ripest egg is released into one of your fallopian tubes, where it meets the sperm if there is any.

If you have PCOS although the polycystic ovaries contain follicles with eggs in them, the follicles do not develop and mature properly - so there is no ovulation or release of eggs. This is called anovulation.

Many women do not find out they have PCOS until they try to conceive, particularly if they were using contraception that uses hormones, which masks irregular or no periods, because it allows for a monthly bleed.

“Since my diagnosis and journey to conceive began, I have found out so many other women I know have it and have also had problems conceiving. I think a lot of us had the symptoms when we were teenagers but went on the pill which masked the condition for years.”

PCOS sufferer

What is the treatment for PCOS if you are trying to conceive?

There is no treatment for PCOS in itself but the symptoms can be treated. If you have a BMI of over 30, you will be advised to lose weight with healthy eating and exercise. This alone may restore ovulation. Even if it does not do this, it will allow your medication to work better, and will cut down on risks during pregnancy.

There are a number of different medicines that may be offered to help with conceiving with PCOS

  • clomifene citrate (the best known brand in the UK is Clomid) – this stimulates your ovaries to release eggs
  • metformin is used to correct insulin resistance, which may also be present with PCOS
  • a combination of the above.

If you are taking clomifene citrate tablets:

  • you will have a transvaginal scan in the first cycle of treatment to check whether it is the correct dose for you. The scan will look at your follicles to see how they are developing.
  • you will not be given it for more than six months as it increases your risk of ovarian cancer.

If clomifene citrate doesn't work then you may be offered:

  • gonadotrophins (a fertility drug that is based on the gonadotrophin hormones, which stimulate your ovaries to produce and ripen eggs). These are more likely to overstimulate your ovaries and cause a multiple pregnancy but you will have regular scans to check on developing follicles.
  • surgery using a technique called laparoscopic ovarian drilling (LOD). This kills the tissue on the ovaries that is produces the testosterone.
  • IVF – in which the egg is retrieved, fertilised outside the body and transferred into the uterus.

Read more about treatment for infertility.

What are my chances of conceiving with PCOS?

Although it is difficult to give statistics as cases vary so much and different treatments have different success rates, the majority of women with PCOS will be able to have a baby with fertility treatment. For women who are under 35, this is even more the case.

Finding out that you are having fertility issues can be a real shock, and feelings of guilt and failure are not uncommon. However, if you are able to, think of it as a medical problem that is treatable alongside most other conditions, and not a reflection on you as a woman. Many, many couples use fertility treatment to conceive and the inconvenient start is long forgotten in later years.

For some couples, working through different treatments works is a long, complicated and anxious process, especially if it is combined with having to take time off from an unsympathetic workplace. Try to support each other as much as you can through the consultations, treatments  and appointments.

“When I got diagnosed I had to accept conceiving a baby was going to take time, I needed to be kind to and patient with my body but I would never give up hope that I would become pregnant. I invested time into getting my diet right, started a couch to 5k programme and de-stressed my life.” PCOS sufferer

PCOS and pregnancy

PCOS in pregnancy can increase the risk of pregnancy-induced hypertension, pre-eclampsia and preterm birth. All women should be screened for gestational diabetes by 20 weeks and review any medication they are taking.

More support

A charity called Veriity runs a special website with resources and support for women suffering with PCOS. 

The Fertility Network UK has forums and support for those who are affected by infertility.

Sources

NHS Choices [accessed 31/05/2018] Polycystic Ovary Syndrome, Page last reviewed: 18/03/2016 
Next review due: 01/03/2019. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/

RCOG (2015) Polycystic ovary syndrome: what it means for your long-term health. Information for you. Royal College of Obstetricians and Gynaecologists, London, England.

NICE (2013) Fertility problems – assessment and treatment. National Institute of Health and Clinical Excellence, London, England.

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Last reviewed on May 31st, 2018. Next review date May 31st, 2021.

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