Mayo Clinic: Effect of PCOS on fertility can vary from one woman to another
DEAR MAYO CLINIC: I’m 24 and was recently diagnosed with polycystic ovary syndrome. How will this affect my fertility?
ANSWER: The effect of polycystic ovary syndrome, or PCOS, on fertility can vary quite a bit from one woman to another. In some women, the syndrome can make getting pregnant more difficult than usual. But that’s not always the case. When PCOS does have an impact on fertility, treatments can help.
No single test indicates the presence of the syndrome. Instead, a diagnosis is made when a patient has two out of three signs of PCOS. The first sign, irregular or less-frequent periods, suggests that the woman is not ovulating every month. Ovulation is the process whereby the ovaries develop a mature egg that’s then released into the uterus and can be fertilized by sperm. Women with the syndrome usually have less than nine periods per year or other evidence that they’re not ovulating every month.
The second sign of PCOS is an excess of the male hormone, testosterone, or other hormones that have a similar effect on the body. This can be detected through blood tests or by symptoms of extra or unwanted hair growth, severe acne or hair loss.
The third PCOS sign is a finding of multiple follicles in the ovary through an ultrasound test. The term “polycystic” can be misleading. The condition actually is not related to abnormal ovarian cysts. Instead, small, undeveloped follicles are not getting signals to mature and release an egg.
Based on your diagnosis and the signs of the syndrome that you have, your healthcare provider can decide what therapies may work best, as well as assess you for other medical conditions associated with PCOS. Treatment often can help control problems that may arise as a result of PCOS, including infertility.
Not all women with the condition have difficulty with fertility. Even if you’re not ovulating every month, you can still get pregnant. So you shouldn’t assume you’ll have fertility issues or that you can’t get pregnant because you have PCOS. Fortunately, even if you do have trouble getting pregnant, medical therapies often can help increase your chances of ovulation and pregnancy without the need for more advanced fertility technologies.
In some cases, the syndrome is associated with insulin resistance. With this condition, the insulin the body makes does not work as well as it should. That can increase the risk for developing pre-diabetes or diabetes, as well as interfere with ovulation. Medications like metformin that improve how insulin works in the body can also improve chances for ovulation.
Weight also may be a factor in fertility when a person has PCOS. Women with the condition who are overweight can see an improvement in fertility with exercise and weight loss. If you’re not overweight now, maintaining a healthy weight will help you increase your chances of normal fertility.
If you have PCOS and want to have children — especially if you have irregular periods or have been told that you’re not ovulating monthly — consider trying to get pregnant sooner rather than later, if possible. If you do have difficulty becoming pregnant, the ideal time to start therapies to help you get pregnant is before the age of 30. Fertility rates and success rates of fertility treatments start to decline after that.
Take time to review your diagnosis with your healthcare provider to see how much PCOS may be affecting your fertility and overall health. You might also decide to consult with an endocrinologist, gynecologist or reproductive endocrinologist depending on your concerns, symptoms or risk factors. You can then decide on the best treatment plan, based on your individual needs. — Dr. Alice Y. Chang, endocrinology, Mayo Clinic, Rochester, Minn.
The MAYO CLINIC Q&A is an educational resource and doesn’t replace regular medical care. Email questions to MayoClinicQ&A@mayo.edu. For more information, visit mayoclinic.org.