Understanding Polycystic Ovary Syndrome (PCOS) and fertility

On this page:

What is PCOS?

What causes PCOS?

Symptoms and signs of PCOS

PCOS diagnosis and testing

How does PCOS affect fertility?

Can you get pregnant with PCOS?

Treating PCOS to improve fertility

Fertility treatments for PCOS

PCOS and pregnancy: what are the risks?

Long-term health and PCOS

FAQs about PCOS

Final thoughts

What is PCOS?

PCOS is a common condition that affects how the ovaries work. It can cause problems with your periods, hormone levels, and how your ovaries look on an ultrasound.

The three main features of PCOS are:

• Irregular periods – meaning your ovaries do not release an egg regularly (this is called ovulation)
• High androgen levels – these are sometimes called “male hormones” and can lead to symptoms like excess facial or body hair
• Polycystic ovaries – your ovaries may be slightly larger and have many small fluid-filled sacs (follicles) around the eggs. These are not true cysts, even though the name suggests otherwise

You do not need to have all three features to be diagnosed. Most people are diagnosed when they have at least two.

PCOS is not just about your periods or fertility. According to Dr Guimarães:

 “It affects more than just the ovaries. It can also impact your metabolism, your mental health, and your skin.”

Caption: This illustration compares normal ovary function (left), where ovulation occurs, with polycystic ovary syndrome (PCOS) on the right, where multiple cysts and lack of ovulation (anovulation) can make it harder to conceive.

What causes PCOS?

Short answer: there isn’t one single cause. PCOS is multifactorial—a mix of inherited susceptibility and biological factors that interact over time:

• Family history: PCOS often runs in families, so genes may be part of it
• Insulin resistance: common even in people who aren’t overweight; this means the body makes insulin but cannot use it properly. To make up for this, the body produces even more insulin, which can lead to higher levels of androgens (male hormones) and affect ovulation
• Inflammation: Some research suggests low-level inflammation in the body may raise androgen levels
• Hormonal (neuroendocrine) dysregulation: altered GnRH/LH pulsatility and ovarian theca-cell androgen excess help sustain the condition.
• Weight and lifestyle: PCOS can affect people of all body types, but being overweight can make symptoms worse. Excess visceral fat can worsen insulin resistance and androgen production, amplifying symptoms (but doesn’t explain all cases; lean PCOS exists)

According to Dr Guimarães:

“Insulin resistance is one of the key features of PCOS. When we manage it, symptoms often improve, and so does fertility.”

Symptoms and signs of PCOS

PCOS can look different for everyone. Some people have only a few signs, while others have many. Symptoms can also change over time.

Common signs include:

• Irregular or missed periods – this is often a result of not ovulating regularly
• Trouble getting pregnant – due to irregular or absent ovulation
• Unwanted hair growth – especially on the face, chest, or back (called hirsutism)
• Oily skin or acne – often linked to higher androgen levels
• Thinning hair or hair loss from the head
• Weight gain – especially around the belly area
• Low energy or feeling very tired
• Mood changes – such as anxiety, low mood, or depression
• Patches of darker skin – often around the neck, underarms, or under the breasts
• Trouble sleeping – including poor sleep quality or symptoms like sleep apnoea

PCOS diagnosis and testing

There is no single test for PCOS. Doctors look at your symptoms, medical history, and run a few checks to get a clearer picture.

Tests may include:

• Hormone blood tests – to check your levels of androgens (male hormones), and other hormones like LH, FSH, oestradiol, and prolactin
• Blood sugar and insulin tests – to see how your body is handling insulin and check for signs of insulin resistance or prediabetes
• Ultrasound scan – to look at your ovaries and check for small fluid-filled follicles (often called “polycystic ovaries”)

Just having polycystic-looking ovaries on a scan is not enough for a diagnosis – especially in teenagers, where this can be normal. A full assessment is always needed.

How does PCOS affect fertility?

PCOS is one of the most common reasons people struggle to get pregnant. This is mainly because ovulation (when your ovaries release an egg) does not happen regularly, or sometimes not at all.

If no egg is released, fertilisation cannot happen. For some, ovulation is unpredictable or happens only a few times a year. PCOS can also raise the risk of certain pregnancy problems, like miscarriage, gestational diabetes, or high blood pressure.

But the good news is that most people with PCOS can get pregnant, either naturally or with the right support.

Can you get pregnant with PCOS?

Yes, many women  with PCOS go on to have healthy pregnancies. It might take more time or support, but it is very possible.

Treatment options include:

• Tracking ovulation to find out if and when you are ovulating
• Managing weight and insulin resistance – even small changes can help restart ovulation
• Using medicines to help with ovulation, such as letrozole or clomiphene
• Fertility treatments like IVF, if other options are not successful

According to Dr Guimarães:

“Our goal is to find out what is making it harder for you to conceive and build a plan around that. Having PCOS does not mean you cannot get pregnant, it just means you might need a bit more help.”

Treating PCOS to improve fertility

There is no one-size-fits-all treatment for PCOS. What works best depends on your symptoms, your hormone levels, and whether you are trying to get pregnant. Many people benefit from a mix of lifestyle changes and medication.

• Lifestyle changes can make a big difference, especially if you are not ovulating regularly:
• Eating a balanced, low-glycaemic diet can help manage insulin levels and support healthy weight loss
• Regular exercise can improve how your body uses insulin and may help your periods become more regular
• Even a small amount of weight loss – around 5 to 10% of your body weight – can help bring back ovulation

Doctors may also suggest medication to support ovulation and balance your hormones:

• Metformin helps your body respond better to insulin and may restart ovulation
• Letrozole is often the first medicine used to help you ovulate
• Clomiphene citrate is another option to help with ovulation
• Gonadotropins are injectable hormones used when tablets are not enough
• Inositol is a supplement that may help with insulin and hormone balance
• Berberine is a plant-based supplement being studied for its effects on insulin resistance

“We combine lifestyle changes with the right medications to target the underlying hormone issues in PCOS. This gives each person the best chance of getting pregnant,” says Dr Guimarães.

However, it is very important that patients are aware that these medications can be dangerous if not taken under the supervision of an experienced doctor, as PCOS patients are very unique and have huge inter-individual variations in the way they respond to medication.

This is why you must not take any of these medications without proper advice from a fertility specialist.

Fertility treatments for PCOS

If lifestyle changes and medication do not lead to pregnancy, assisted fertility treatments may be the next step. These treatments can help you conceive if ovulation is not happening on its own or if natural conception is not working.

Here are some of the most common options:

Intrauterine insemination (IUI)

This is a simple fertility treatment where sperm is placed directly into the uterus around the time of ovulation.

It gives the sperm a head start by helping it get closer to the egg. IUI is often used when ovulation can be triggered with medication, but natural conception has not happened. IUI can be used with donor sperm or sperm from your partner.

Learn more about IUI from our treatment page. 

In vitro fertilisation (IVF)

IVF is a more advanced treatment. First, medication is used to stimulate your ovaries to produce multiple eggs.

These eggs are collected during a short procedure and fertilised with sperm in a lab. If embryos form, one or more can be placed back into your uterus in the hopes of starting a pregnancy. IVF can be especially helpful when other treatments have not worked or if there are other fertility issues as well.

Learn more about IVF from our treatment page.

Your doctor will talk to you about which treatment might be best for your body and your fertility goals.

PCOS and pregnancy: what are the risks?

Many people with PCOS go on to have healthy pregnancies, but there can be a slightly higher chance of certain complications. Knowing what to expect means you and your healthcare team can take steps to manage these risks early.

Here are some of the most common pregnancy risks linked to PCOS:

Higher chance of miscarriage
People with PCOS may have a slightly increased risk of early miscarriage, especially if ovulation and hormone levels are not well balanced at the time of conception.

Gestational diabetes
This is a type of diabetes that develops during pregnancy. PCOS increases the risk because of the way it affects how your body uses insulin. Gestational diabetes usually goes away after birth but needs close monitoring during pregnancy to keep you and your baby safe.

High blood pressure and preeclampsia
PCOS may raise your risk of high blood pressure and a condition called preeclampsia, which affects your blood pressure and can be serious if not caught early.

Preterm birth
Some people with PCOS may go into labour early, before 37 weeks. Regular checkups and monitoring can help reduce this risk.

Caesarean section (C-section)
There is a slightly higher chance of needing a C-section, especially if other complications arise during pregnancy or labour.

The good news is that with early support, regular checkups, and a personalised care plan, most of these risks can be well managed.

Your doctor or midwife will help you stay on track and look after both your health and your baby’s.

Long-term health and PCOS

PCOS does not only affect your fertility. It is a long-term condition that can increase the risk of other health issues later in life, even after pregnancy or menopause.

Some of the long-term risks linked to PCOS include:

Type 2 diabetes
Because PCOS often affects how your body uses insulin, there is a higher risk of developing type 2 diabetes over time.

Heart disease
People with PCOS may be more likely to develop high blood pressure or unhealthy cholesterol levels, which can increase the risk of heart problems.

Endometrial cancer
If your periods are very irregular or stop completely, the lining of your womb (endometrium) may not shed regularly. Over time, this can increase the risk of endometrial cancer.

Anxiety and depression
The emotional effects of PCOS, including its impact on mood, self-image, and fertility, can raise the risk of anxiety or low mood.

Sleep apnoea
This is a condition where your breathing briefly stops during sleep. It is more common in people with PCOS, especially if they carry extra weight.

For all these reasons, it is important to keep managing PCOS long term, not just when you are trying to get pregnant. Regular checkups, a healthy lifestyle, and emotional support can all make a big difference to your overall well being.

FAQs

What does PCOS mean?
Polycystic ovary syndrome is a hormone-related condition that affects ovulation, your hormone levels, and how your body uses energy (metabolism).

Can you have PCOS and endometriosis?
Yes. They are different conditions, but it is possible to have both at the same time.

Can PCOS be cured?
No, there is no permanent cure – but the symptoms can be managed, and many people go on to conceive with the right treatment.

Is PCOS genetic?
Yes. It often runs in families, so your risk may be higher if a close relative has it. However, it is multifactorial—a mix of inherited susceptibility and biological factors that interact over time.

What does metformin do for PCOS?
Metformin helps your body use insulin better. This can lower androgen levels and sometimes help restart ovulation.

How do I know if I have PCOS?
If you have irregular periods, acne, facial hair, or your doctor sees polycystic ovaries on a scan, it is worth getting checked.

Can I get pregnant naturally with PCOS?
Yes. Many people with PCOS conceive naturally, especially by tracking ovulation and making small lifestyle changes.

Is PCOS dangerous?
PCOS is not life-threatening, but if left unmanaged, it can raise the risk of other health issues over time.

Does PCOS cause weight gain?
Yes. Hormone imbalances and insulin resistance can make it easier to gain weight, especially around the belly.

What is the difference between PCOS and PCOD?
PCOD (polycystic ovarian disease) is an older term sometimes used interchangeably with PCOS. PCOS (polycystic ovary syndrome) is now the more widely used and medically recognised term.

What triggers PCOS?
The exact cause is unknown, but PCOS is linked to a mix of genetics, insulin resistance, and hormone imbalances. Stress, diet, and lifestyle may also play a role in how symptoms show up.

Can PCOS go away?
PCOS is a lifelong condition, but many symptoms can improve with treatment and lifestyle changes. Some people find that symptoms ease with age or after pregnancy, but the underlying hormone imbalance usually remains.

Can you develop PCOS later in life?
Yes. Some people do not show symptoms until their 20s or 30s, especially if they gain weight or their hormone levels change.

Can you have PCOS and regular periods?
Yes. Not everyone with PCOS has irregular cycles. You can have regular periods and still have other signs of PCOS, such as high androgen levels or polycystic ovaries on a scan.

Does PCOS cause pain?
PCOS does not usually cause pelvic pain, but some people report discomfort around ovulation or with larger follicles. If you have frequent pain, it is worth checking for other conditions like endometriosis.

Can PCOS cause hair loss or acne?
Yes. Higher levels of androgens can lead to hair thinning on the scalp and acne, especially on the face, chest, or back.

Why is it hard to lose weight with PCOS?
Insulin resistance and hormone imbalances can make it easier to gain weight and harder to lose it – especially around the stomach.

Can PCOS cause miscarriage?
Yes. PCOS is linked to a higher risk of early miscarriage, but with the right care and treatment, many people go on to have healthy pregnancies.

Is PCOS a disability?
PCOS is not usually classed as a disability, but it can have a big impact on day-to-day life. In some cases, people may qualify for support depending on how severe their symptoms are.

Is PCOS a chronic condition?
Yes. PCOS is considered a chronic (long-term) condition that needs ongoing management to prevent complications.

Can PCOS cause tiredness or fatigue?
Yes. Hormone imbalances, insulin resistance, poor sleep, or mood changes linked to PCOS can all contribute to feeling low on energy.

How is PCOS diagnosed?
Most people are diagnosed using the Rotterdam Criteria – this includes checking for irregular periods, signs of high androgens, and polycystic ovaries on a scan. Your doctor may refer you to a specialist or request blood tests and an ultrasound.

Final thoughts

PCOS can be a frustrating and emotionally taxing condition, especially when you are trying to get pregnant. However, with the right guidance, support, and personalised treatment, most women with PCOS can achieve a healthy pregnancy.

“At Procriar, we combine medical expertise, evidence-based treatment, and compassionate care to support each patient through their unique fertility journey,” concludes Dr Guimarães.

If you think you may have PCOS or are struggling to conceive, contact Procriar Fertility Clinic to schedule a consultation with our experienced team. We are here to help you find clarity, control, and confidence in your fertility journey.