Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age, yet it’s also one of the least understood. If you’ve been diagnosed with PCOS, or you suspect you might have it, you may already know that it can make getting pregnant much more difficult. But why does PCOS affect fertility, and what can be done about it? I’ll break it down for you.

What is it?

The ovaries don’t function in quite the typical way when someone has PCOS. The process of ovulation is usually a monthly cycle of developing several follicles, one of which usually becomes the dominant/biggest one, and that releases an egg during ovulation.

With PCOS however, the ovaries often lose sync. This can cause the follicles to develop at different times and rates, which prohibits any one dominant follicle from becoming an egg. Because eggs are released infrequently or not at all, sometimes the ovaries develop a bunch of tiny, underdeveloped follicles.

This is often due to a combination of hormonal imbalances, including:

● Higher levels of androgens (sometimes called “male hormones”)

● Disrupted signally between pituitary in the brain and the follicles in ovaries (particularly involving LH and FSH)

● Insulin resistance, which can make the ovaries produce more androgens and interfere with ovulation

These imbalances can then result in long or absent periods (known as amenorrhea), late ovulation or skipping ovulation (known as anovulation), and infertility or difficulty getting pregnant. Secondarily it can also manifest as body or facial hair growth, acne and/or oily skin, weight gain and difficulty losing weight, or in some cases weight loss and difficulty gaining weight.

What causes it?

While it would make things much simpler if PCOS had one clear cause, as with most hormonal imbalances it is typically the result of a few different contributing factors, the first of which is genetics. Especially if you see similar patterns that run in your family, you may be predisposed to developing PCOS.

Due to its close link to insulin resistance, we know diet and exercise can also have a big effect. Diets made up of highly processed, starchy, or sugary foods, especially when in combination with lack of exercise or sedentary lifestyle can contribute to the progression of PCOS, or difficulty managing it.

High stress levels can also trigger PCOS symptoms. This is due to stress’ ability to increase inflammation in the body and disrupt hormones because it down-regulates the parasympathetic nervous system (our relaxation response.)

Exposure to toxins or artificial hormones may also contribute to the hormonal imbalances involved with PCOS, especially because many of the beauty and cleaning products we use can be culprits.

How does it affect fertility?

The most common reason PCOS affects fertility is because it can cause irregular or absent ovulation. If you don’t know when, or if, you are ovulating that can make it much more difficult to

know when conception is even possible. And even if ovulation does occur, the imbalanced hormonal environment can negatively influence egg quality and endometrial receptivity.

The Good News

Having PCOS does not mean you can’t get pregnant. Many people with PCOS go on to conceive naturally or with support. Treatment depends on your unique presentation, but may include:

● Lifestyle changes: nutrition, exercise, and stress management can improve insulin sensitivity and restore ovulation.

● Medications: options like letrozole, clomiphene, or metformin may help regulate cycles and support ovulation, these are typically prescribed by gynecologists or fertility specialists. ● Acupuncture and integrative care: research suggests acupuncture may help regulate cycles, reduce stress, and support fertility outcomes.

● Assisted reproductive technologies (ART): IVF and other treatments can be effective for those who need more advanced support.

PCOS is a common but highly individual condition. While it can create challenges when trying to conceive, there are many tools available to help you reach your family-building goals. If you’ve been diagnosed with PCOS and are considering pregnancy, working with a provider who understands both the hormonal and fertility aspects of this condition can make a world of difference.

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