Polycystic Ovary Syndrome (PCOS) is the most common cause of ovulatory infertility - and one of the most treatable. If you've been diagnosed with PCOS or suspect you might have it, this guide will help you understand the condition, how it affects your fertility, and the paths forward to building your family.

Understanding PCOS: What's Really Happening

PCOS affects an estimated 8-13% of women of reproductive age worldwide. In the UAE and Middle East region, prevalence is significantly higher-studies suggest 25-30% of women may be affected. That means roughly 1 in 4 women in this region has PCOS.

What PCOS Is (and Isn't)

The name "Polycystic Ovary Syndrome" is actually misleading. The "cysts" on ultrasound aren't true cysts-they're immature follicles. And you can have PCOS without polycystic-appearing ovaries on ultrasound.

PCOS is fundamentally a hormonal and metabolic condition. It affects:

How your ovaries function
Your hormone balance
Often, how your body processes insulin

The Diagnostic Criteria

Most doctors use the Rotterdam Criteria to diagnose PCOS. You need two of these three features:

1. Irregular or absent ovulation: Cycles longer than 35 days, cycles that vary significantly, or no periods at all.

2. Signs of excess androgens (male hormones): This can be clinical (acne, excess hair growth) or biochemical (elevated testosterone on blood tests).

3. Polycystic-appearing ovaries on ultrasound: Multiple small follicles arranged around the ovary's edge.

You don't need all three features to be diagnosed with PCOS. Other conditions that mimic PCOS must be ruled out first.

The Different "Types" of PCOS

Classic PCOS: Irregular periods, high androgens, and polycystic ovaries. Often associated with insulin resistance.

Non-hyperandrogenic PCOS: Irregular periods and polycystic ovaries, but normal androgen levels.

Ovulatory PCOS: Regular periods, but high androgens and polycystic ovaries.

Lean PCOS: PCOS in women with normal body weight. About 20% of women with PCOS are not overweight.

How PCOS Affects Fertility

The primary way PCOS impacts fertility is through disrupted ovulation. If you're not releasing eggs regularly, pregnancy opportunities are limited.

The Ovulation Problem

In a typical cycle, several follicles begin developing, but one becomes dominant and releases an egg. In PCOS, hormonal imbalances often prevent this normal selection process. Multiple follicles start developing but none reaches maturity.

It's Not Just About Ovulation

Even when ovulation does occur, PCOS may affect fertility in other ways:

Egg quality: Some research suggests hormonal imbalances may affect egg quality.

Endometrial health: Irregular cycles can affect the uterine lining's receptivity.

Miscarriage risk: Some studies show higher miscarriage rates in women with PCOS.

Despite all this, PCOS is highly treatable. The vast majority of women with PCOS can conceive with appropriate intervention.

PCOS Symptoms: Beyond Fertility

Common Symptoms

Menstrual irregularities: Cycles longer than 35 days, unpredictable cycles, or absent periods
Acne: Often along the jawline, chin, and chest
Hirsutism: Excess hair growth in male-pattern areas (affects about 70% of women with PCOS)
Hair thinning: Male-pattern hair loss
Weight and metabolism: Many women struggle with weight management
Skin changes: Darkened skin patches can indicate insulin resistance
Mood: Higher rates of anxiety and depression

PCOS and Your Long-Term Health

PCOS isn't just a reproductive issue-it has implications for lifelong health.

Metabolic Concerns

Insulin resistance: About 50-70% of women with PCOS have insulin resistance, regardless of weight.

Type 2 diabetes risk: Women with PCOS are 4-7 times more likely to develop type 2 diabetes.

Cardiovascular risk: Higher rates of high blood pressure and elevated cholesterol are associated with PCOS.

Lifestyle Modifications: The Foundation

For many women with PCOS, lifestyle changes are the first-and sometimes most effective-treatment step.

Weight Management

For women who are overweight, losing even 5-10% of body weight can:

Restore regular ovulation in some women
Improve insulin sensitivity
Reduce androgen levels
Improve response to fertility treatments

Diet Approaches

Evidence supports approaches that address insulin resistance:

Lower glycemic index foods
Balanced macronutrients
Mediterranean-style eating
Regular meal timing

Exercise

Regular physical activity improves insulin sensitivity-often quickly, even before weight changes occur.

Aim for: At least 150 minutes per week of moderate activity, plus strength training.

Medical Treatment for PCOS Fertility

Ovulation Induction: The First Step

Letrozole (Femara): Now considered the first-line treatment for PCOS-related anovulation.

Why letrozole for PCOS?

Higher ovulation rates compared to clomiphene
Higher live birth rates in some studies
Lower risk of multiple pregnancies

Clomiphene citrate (Clomid/Serophene): The traditional first-line treatment, still commonly used.

When First-Line Treatment Doesn't Work

Metformin: An insulin-sensitizing medication that can:

Help restore ovulation in some women
Enhance the effectiveness of letrozole or clomiphene
Reduce miscarriage risk (some evidence)

Gonadotropins (injectable FSH): If oral medications don't produce ovulation, injectable FSH directly stimulates the ovaries. This requires closer monitoring because PCOS ovaries are very sensitive to stimulation.

IUI for PCOS

Intrauterine insemination (IUI) is often combined with ovulation induction for women with PCOS.

Combined with ovulation induction, IUI success rates for women with PCOS are generally good-often 15-20% per cycle, with cumulative pregnancy rates of 50-60% over several cycles.

Most doctors recommend 3-6 IUI cycles before considering IVF.

IVF for PCOS

When simpler treatments don't work, IVF is highly effective for PCOS.

Why IVF Works Well for PCOS

High responders: Women with PCOS typically have many antral follicles and respond well to stimulation.

Bypasses ovulation issues: Eggs are retrieved directly, so natural ovulation doesn't need to happen.

PCOS-Specific IVF Considerations

Risk of OHSS: The same high response that produces many eggs also increases the risk of ovarian hyperstimulation syndrome. To minimize this:

Lower medication doses may be used
GnRH agonist trigger instead of hCG
Freeze-all cycles allow the body to recover

IVF success rates for women with PCOS are generally comparable to or better than women without PCOS.

Managing PCOS During Pregnancy

Women with PCOS need additional monitoring during pregnancy.

Increased Risks

Gestational diabetes: About 2-3 times higher risk
Pregnancy-induced hypertension and preeclampsia: About 2-4 times higher risk
Preterm birth: Somewhat elevated risk

What Helps

Preconception weight management
Early glucose screening
Close prenatal care

Frequently Asked Questions

Can I get pregnant naturally with PCOS?

Yes, many women with PCOS conceive naturally-it may just take longer, especially if ovulation is irregular. If you've been trying for 12 months (or 6 months if over 35) without success, see a specialist.

Is PCOS hereditary?

PCOS tends to run in families. If your mother or sister has PCOS, your risk is higher. However, genetics isn't the whole story-environmental factors also play a role.

Will losing weight cure my PCOS?

Weight loss won't "cure" PCOS, but it can significantly improve symptoms and fertility. Some women begin ovulating regularly after losing just 5-10% of body weight.

Do I need IVF if I have PCOS?

Not necessarily. Many women with PCOS conceive with simpler interventions like letrozole or clomiphene. IVF is typically considered if first-line treatments don't work.

Your Next Steps

If you have PCOS and are trying to conceive:

Get a clear diagnosis: Make sure other conditions have been ruled out
Understand your specific pattern: Which criteria do you meet? Do you have insulin resistance?
Optimize lifestyle factors: Even small improvements can help
Work with a specialist: A reproductive endocrinologist understands PCOS fertility treatment
Be patient but proactive: Treatment often works, but it may take several cycles

This content is for educational purposes only and should not replace professional medical advice. If you have PCOS and fertility concerns, please consult with a qualified healthcare provider for personalized guidance.

PCOS and Fertility: Everything You Need to Know