If you’ve been diagnosed with polycystic ovary syndrome, or PCOS, it’s likely that you have some questions about how this impacts your fertility, either now or in the future. First off, you should know that you aren’t alone — PCOS affects at least 1 in 20 women, possibly as many as 1 in 6 by some estimates.
You should also know that while there are certainly some fertility challenges associated with PCOS, it’s also one of the most easily treated and managed causes of infertility. Many women with PCOS go on to have healthy pregnancies either naturally or with the assistance of fertility treatments.
If you want to know more about PCOS, how it might affect your chances of getting pregnant, and what your next steps might be, read on!
You may want to know how PCOS can affect your hormones and your ability to get pregnant!
What is PCOS?
The name “polycystic ovary syndrome” is a bit misleading, since PCOS is a condition that affects the entire body and imbalances in multiple hormones. PCOS is diagnosed based on having two of the three following criteria: signs of hyperandrogenism, irregular periods, and polycystic ovaries.
Let’s explore those a little further:
Hyperandrogenism: The overproduction of certain hormones called androgens (including testosterone) by the adrenals and ovaries. It can also lead to excess luteinizing hormone production. Hyperandrogenism can be diagnosed by blood test, but symptoms include facial or body hair and acne.
Irregular periods: Due to hormone imbalances (like hyperandrogenism), many women with PCOS may experience irregular periods or super long cycles. Those with PCOS may only experience a period every 60 days, for example.
Polycystic ovaries: This is probably what you most commonly think of when you think of PCOS. If you have polycystic ovaries, your ovaries will look like they have a bunch of little fluid-filled sacs on them via an ultrasound.
In fact, PCOS is one of the most common causes of anovulatory infertility, with women with PCOS representing around 80% of cases. Fortunately, if you have anovulatory PCOS, you still have options when it comes to fertility. We’ll discuss those a little later on.
In addition to the symptoms discussed above, PCOS can also come with symptoms including insulin resistance, increased risk of type II diabetes, recurrent miscarriage, weight gain, and skin abnormalities.
How does PCOS impact fertility?
As you may already guess, since PCOS largely affects hormones and the ovaries, it is common to experience some additional fertility challenges with PCOS. Unfortunately, 70-80% of women with PCOS are diagnosed with infertility at some point, but this doesn’t mean getting pregnant is impossible.
With PCOS, it’s very common to experience long cycles before ovulation finally occurs, with several repeated estrogen rises and even steadily high LH levels. Excess androgen production means that hormone levels aren’t what they would typically be before ovulation, so it can take a while for the ovaries to receive the correct signals to actually release an egg.
Because hormone levels aren’t necessarily falling within standard ranges on the expected days, relying on ovulation predictor kits or period trackers alone doesn’t usually provide enough information for someone with PCOS to know when they’re ovulating. This can lead to mistiming intercourse and missing the actual fertile days.
In cases of anovulatory PCOS, the imbalance of hormone levels means that ovulation never actually happens at all. In this case, subfertility is simply due to the fact that there’s no egg for sperm to fertilize, and conception can’t occur.
How do I detect ovulation with PCOS?
So, how do you figure out if you’re ovulating, and when? Since PCOS often comes with elevated LH levels, some people may find that LH tests (ovulation predictor kits) don’t work as well for them since they have positive tests throughout their cycle.
Or, even if they don’t have positive tests all the time, since cycles can be long and irregular it can be difficult to figure out when to take LH tests at all. For this reason, it’s wise to include two other hormones in your tracking: estrogen and progesterone.
A healthy estrogen rise will precede a successful LH surge and ovulation. You can detect an estrogen rise via estrogen’s metabolite found in urine, E1G. Proov Complete can detect an E1G rise, helping you find the full fertile window and navigating irregular cycles.
Cervical mucus tracking can also be effective. Cervical mucus becomes more fluid, watery, and slippery, like raw egg whites, when ovulation is approaching and estrogen is high. If you notice egg white-quality cervical mucus, that’s a good time to try and likely means estrogen is high enough for ovulation.
You can also track cervical mucus with kegg, which gives information on potential fertility based on electrolytes present in cervical mucus.
Detecting ovulation is just the first step, though. While an estrogen rise and an LH surge typically result in ovulation, they don’t always, and with PCOS there’s a greater likelihood of failed ovulation. This might mean that either you don’t ovulate at all, or you do ovulate, but your progesterone levels weren’t high enough during the implantation window to sustain a pregnancy.
That’s why it’s important to also confirm ovulation with PdG, a metabolite of progesterone, and make sure you’re ovulating successfully. While timing intercourse properly is a great start, studies have found that it’s most important to know that ovulation was successful.
What if I’m not ovulating regularly or successfully?
Many of the fertility challenges of PCOS are due to anovulation, and the good news is that anovulation is relatively treatable! If you determine that you aren’t ovulating you’ll likely need to work with your physician to induce ovulation. Letrozole is considered the first-line treatment for anovulation with PCOS.
Your doctor may want to consider incorporating other fertility treatments as well. For instance, One study found intrauterine insemination to be more effective for PCOS patients using ovulation induction medication than timed intercourse.
If you are ovulating, but have low PdG levels, you can also consider ways to support your progesterone levels naturally. This can include herbal supplements, nutrition for fertility, or seed cycling. You can also talk to your doctor about progesterone supplementation.
PCOS may introduce some wrinkles in your TTC journey, but now you know that it’s relatively common, it’s treatable, and you have options!