PCOS Infertility: Causes, Symptoms, And Management

Infertility rates in America are rising. According to the Centers for Disease Control and Prevention (CDC), one in five women who are trying to get pregnant, and have not previously been pregnant, do not get pregnant after a year of being sexually active.¹

One common reason for infertility among women is polycystic ovary syndrome (PCOS). The condition is responsible for 80% of cases where a woman can’t get pregnant because her body doesn’t ovulate.²

Fortunately, this problem can often be treated through medication and lifestyle changes. In this post, we look at the impact of PCOS infertility, including its causes, symptoms, and treatment.

What is PCOS?

Polycystic ovary syndrome (sometimes called polycystic ovarian syndrome), or PCOS, is a health condition caused by a hormonal imbalance in the body. This imbalance causes irregular menstrual cycles and also impacts ovulation and egg development in the ovary.

Women can be diagnosed with PCOS anytime after puberty. This condition can affect women of any ethnicity or race.

Causes and symptoms of PCOS

Research is still ongoing on the exact cause(s) of PCOS. So far, scientists have been unable to pinpoint any one specific factor as the main cause of PCOS in women. However, we do have some scientific insight into what causes the symptoms of PCOS. Some important factors include the following:

High insulin levels

Many women with PCOS, especially those who are overweight or obese, have insulin resistance. Insulin is a hormone that helps your body to deal with high blood sugar. In people who have insulin resistance, the body is not as responsive to insulin.

People with insulin resistance often have high insulin levels, as the body secretes extra insulin to try and get a response. It also makes it more difficult for the body to respond when your blood sugar rises, leading to high blood sugar levels. When insulin resistance is severe, it leads to type 2 diabetes.

High androgen levels

Androgens are predominantly male hormones, but women’s bodies also produce them in small amounts. The most common androgen is testosterone. These hormones are responsible for producing male characteristics, such as facial hair. 

When a woman has higher androgen levels than normal, these hormones may prevent her from ovulating or releasing an egg from the ovary. Increased androgens can also cause symptoms like increased hair growth and acne.

Common signs that someone with PCOS might experience include the following:

• Increased facial and body hair: Also called hirsutism, this problem affects about 70% of women with PCOS.³

• Acne: Skin becomes oily, causing breakouts to appear, most commonly on the face, upper back, and chest.

• Thinning hair: Many women begin to experience hair loss on the head, often resembling male-pattern baldness.

• Weight gain: Increased weight is often a result of high insulin levels. Many women with PCOS also have difficulty losing weight.

• Skin tags: These are small flaps of excess skin that often appear in the armpits or the neck.

• Darkened skin: Patches of darker skin may appear, usually around the groin, on the neck, or underneath the breasts. This is known as hyperpigmentation.

• Irregular menstrual cycle: You may have fewer periods (less than eight in a year) or even stop menstruating altogether. Periods may also come after 21 days more in women with PCOS.

These symptoms often appear in women during late adolescence or early adulthood. Seek an evaluation by a medical professional if you notice any of them.

What is infertility?

Infertility is usually defined as being unable to get pregnant after a year or more of having unprotected sex regularly. However, for women over 35, it’s recommended that they get evaluated for infertility after six months rather than waiting for a year. This is because, in this age group, it may become more and more difficult for a woman to get pregnant as she ages.

When a woman is diagnosed with infertility, this may be due to a problem with any of the following:

• Ovulation (releasing an egg from the ovary)

• Fertilization (the egg joining with the male sperm)

• Movement of the fertilized egg through the fallopian tube

• Implantation of the embryo into the uterus

Infertility due to PCOS is caused by an issue with ovulation. The high levels of testosterone and other androgens suppress the process of releasing an egg from the ovary. 

Normally, several follicles (sacs containing an egg) each month will begin developing and getting ready for ovulation. Still, just one egg usually finishes this process and is released. In women with PCOS, there may be more follicles than usual that begin the development process, but none of them actually finish the process and are released from the ovary. 

If you have infertility, it’s a good idea to visit a fertility clinic for a complete evaluation. PCOS infertility is often treatable, and many couples can conceive with the right treatment.

How to improve fertility for a person with PCOS

When you visit your doctor about infertility, they will run several tests to determine if PCOS is the main cause of your problem. In addition to asking about your medical history, your doctor may order some of the following tests:

• Ultrasound — using sound waves to create an image of your ovary to see whether there are cysts or uterus thickness

• Blood tests — taking blood samples to check hormone levels, blood sugar, and other factors

• Pelvic exam — examining the pelvic region both visually and by pressing in various areas to check for abnormalities of the ovaries, uterus, clitoris, or other structures

There are a variety of possible treatments that can be used to help women with PCOS conceive. Some involve medications, while others do not. Note that there is no cure for PCOS. However, there are measures to help treat and manage PCOS infertility.

Non-pharmacological measures

Following a diagnosis of PCOS, your doctor may recommend a set of lifestyle changes to help manage your weight. According to research, losing as little as 5% of body weight can improve PCOS symptoms significantly.⁴

Here are some ways to help you lose excess body weight:

Diet changes

Eating a diet lower in calories can help you lose weight. Many people benefit from eating foods with a higher glycemic index, which measures how quickly a food spikes your blood sugar. Sugary and starchy foods cause a quick spike in blood sugar, while those with more fiber and protein lead to more stable blood sugar levels. This may improve fertility and insulin sensitivity in people with PCOS. 

Examples of foods with a lower glycemic index are fruits and vegetables (try to eat a minimum of five servings daily), lean meats, chicken, fish, and whole foods like whole grain cereals, brown rice, and whole grain bread.

Exercise

Regular exercise is another way to help manage PCOS symptoms. A combination of moderate exercise every week and a healthy diet has been shown to improve menstrual cycle regularity in women. At the very least, aim to do some brisk walking thrice a week for about 30 minutes to an hour. Walk quickly enough that you’re slightly out of breath. A good rule of thumb is to walk at a pace where you can still talk, but it would be hard to sing.

Acupuncture

Although research on the impact of acupuncture on PCOS is still in its early stages, some studies show that acupuncture could be an effective treatment for the condition. Much of the present evidence suggests that acupuncture can help treat PCOS by:⁵

• Boosting blood flow to the ovaries

• Minimizing ovarian cyst and volume

• Reducing weight

• Managing hyperglycemia

Again, much research still needs to be done to determine how effective acupuncture is at treating PCOS infertility. However, this is a safe treatment with very few known side effects, so some women with PCOS may want to try it to see if it works.

Behavioral therapy

Many aspects of life with PCOS can be challenging — from weight gain to acne to infertility. The added stress caused by the condition may make it even harder to conceive. In some cases, women with PCOS may suffer from depression or anxiety due to the stress of their condition. Therapy and/or medications can help deal with these issues. Some women with PCOS also choose to use other methods of addressing anxiety, such as meditation, yoga, or biofeedback.

Herbs and supplements

A 2017 study showed that certain natural herbs and supplements could benefit women with PCOS. The evidence suggested that consuming omega-3 fish supplements and inositol might help with PCOS-related infertility. However, these studies were considered to be of scientifically low quality, and it’s not yet clear whether these supplements are really helpful.⁶

Always talk to your doctor before taking any supplements because some have side effects and can interact with certain medications.

Pharmacological measures

Medically recommended measures for dealing with PCOS infertility may include medications and/or surgical procedures. The specific treatment method recommended for you depends on your medical circumstances.

Medications

Several different medications can be helpful for PCOS infertility. Some of the options include:

Clomiphene citrate (Clomid)

Clomid is usually the first choice of treatment for PCOS. It stimulates ovulation by blocking the estrogen response in the brain. While the drug is often effective at treating PCOS infertility, about 15% of women don't respond to Clomid. These women are said to be "Clomid resistant" and may benefit from another treatment.²

Metformin

Metformin is a drug that’s used for people with insulin resistance. It enhances your body's ability to use insulin and reduces blood sugar levels. In women with PCOS, metformin is known to help stimulate ovulation. It’s believed that this is because it reduces the production of androgens in the ovaries, although the mechanisms of action are still being investigated.

Letrozole

Letrozole, sold under the brand name Femara, belongs to a group of drugs known as aromatase inhibitors. It is often used in treating breast cancer, but research shows it may effectively prompt ovulation in women with PCOS. The drug blocks estrogen production and boosts the release of follicle-stimulating hormone (FSH), a hormone that stimulates ovulation.

Gonadotropins

If Clomid, metformin, and letrozole are ineffective, then gonadotropins, which are injectable fertility drugs, may be tried. These medications stimulate ovulation. The couple can then engage in intercourse to achieve a pregnancy, or intrauterine insemination (IUI) may be performed. In an IUI, a tube is used to place sperm directly into the uterus to maximize the number of sperm that have the chance to encounter the egg.

Fertility procedures

Some procedures can help treat PCOS infertility if medications don't work. These include:

Laparoscopic ovarian drilling

Laparoscopic ovarian drilling is a surgical procedure intended to restore ovulation. In this procedure, a doctor makes incisions on the thick outer shell of the ovary. It’s believed that this decreases the ovary’s production of testosterone, gets rid of excess follicles that may be blocking ovulation, and improves blood flow to the ovary. 

Studies have found that ovarian drilling leads to ovulation in 74% of patients within 3 to 6 months.⁷

In vitro fertilization (IVF)

In vitro fertilization (IVF) is a procedure that involves gathering eggs from the woman’s body, combining them with sperm in the laboratory to cause fertilization, and then transferring one or more embryos into the woman’s uterus. First, fertility drugs are injected to stimulate the ovaries. This often results in the production of many eggs at one time, which are then harvested using a needle guided by ultrasound.

The eggs are placed together with sperm for fertilization in the laboratory. After the eggs have been fertilized, one or more of the resulting embryos are transferred back to the uterus, where it’s hoped that they will implant. If there are extra embryos remaining that have not been implanted, they can be frozen for later use.

When to see a doctor

You should talk to your doctor if you have any signs of PCOS, such as irregular periods, hair growth, acne, or weight gain. If you’re hoping to get pregnant, the sooner you seek treatment, the better.

If you’re already taking PCOS treatments and are still experiencing infertility, you should also seek medical evaluation. Adjusting your treatment plan may help you to get pregnant. You might also have other conditions that are causing your infertility.

The lowdown

PCOS is a common hormonal problem in women of childbearing age. It can prevent women from ovulating or releasing eggs from their ovaries. Common signs of PCOS include irregular menstrual cycles, acne, weight gain, and excessive hair growth on the face and body.

If you're diagnosed with PCOS-related infertility, there is treatment available that can help. Several different medications are often effective. If none of these medications work, a laparoscopic ovarian drilling procedure may help. In vitro fertilization, or IVF, can also help many couples to achieve pregnancy. 

Talk to your doctor about all the possible treatment options, and let them know if your treatments aren't working, so your treatment plan can be adjusted.

Frequently asked questions

What other complications are likely to occur in women with PCOS?

Women with PCOS are more likely to develop serious health problems, such as high blood pressure, type 2 diabetes, heart and blood vessel problems, and uterine cancer.

Can you become fertile again after being diagnosed with PCOS?

Yes, treatments can help many women with PCOS to conceive. The use of clomiphene citrate in women with PCOS helps about 80% of them to become pregnant.

Is PCOS the leading cause of infertility among women?

The leading cause of infertility in women is failure to ovulate. This can be a result of several different conditions, but PCOS is by far the most common. 90 to 95% of women who are infertile due to lack of ovulation have PCOS.⁸