For many who have begun searching for alternatives to start their family, they may already be aware of PCOS; it is one of the most common causes of infertility in women of childbearing age (15 to 44 years old). In fact, as many as 5% to 10% of women will be diagnosed with PCOS. If this number seems high, it can get even higher– in one study, up to 70% who had PCOS had not been diagnosed.

Whether you have been diagnosed with PCOS, or have a suspicion it may be affecting you, you can read on for answers to the most pressing questions about PCOS and its effects on your fertility.

What is PCOS?

Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle, but with PCOS, the egg may not develop as it should or it may not be released during ovulation.

PCOS can cause missed or irregular menstrual periods. Irregular periods can lead to infertility (inability to get pregnant) or the development of cysts (small fluid-filled sacs) in the ovaries.

What causes PCOS?

Unfortunately, we have yet to pinpoint the exact cause of PCOS, although doctors do have a few ideas. Many believe that genetics are a big factor, which may be why you are more likely to have PCOS if you have a mother, sister, or aunt that has it.

Another factor doctors are examining is high levels of androgens. Androgens are sometimes called “male hormones,” although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness and the development of male sex organs. Women with PCOS have more androgens than normal– higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne (two tell-tale signs of PCOS).

Health habits may contribute as well, as many with PCOS have high levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance (especially those who are overweight or obese) and may have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can also lead to type 2 diabetes.

What are the symptoms of PCOS? How do I know if I have it?

Some of the symptoms of PCOS include:

• An irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Alternatively, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods.
• Too much hair on the face, chin, or parts of the body where men usually have hair. This is called “hirsutism.” Hirsutism affects up to 70% of women with PCOS.
• Acne on the face, chest, and upper back
• Thinning hair or hair loss on the scalp; male-pattern baldness
• Weight gain or difficulty losing weight
• Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
• Skin tags, which are small excess flaps of skin in the armpits or neck area

The only way to be certain is to receive a diagnosis from a doctor. There is no single test to diagnose PCOS, but to help rule out other causes of your symptoms, your doctor may talk to you about your medical history and do a physical exam and different tests, such as a combination of the following:

• Physical exam. Your doctor will measure your blood pressure, body mass index (BMI), and waist size. They will also look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions, such as an enlarged thyroid gland.
• Pelvic exam. Your doctor may do a pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.
• Pelvic ultrasound (sonogram). This test uses sound waves to examine your ovaries for cysts and check the endometrium (lining of the uterus or womb).
• Blood tests. Blood tests check your androgen hormone levels. Your doctor will also check for other hormones related to other common health problems that can be mistaken for PCOS, such as thyroid disease. Your doctor may also test your cholesterol levels and test you for diabetes.

Once other conditions are ruled out, you may be diagnosed with PCOS if you have at least two of the following symptoms:

• Irregular periods, including periods that come too often, not often enough, or not at all
• Signs that you have high levels of androgens:
  • Extra hair growth on your face, chin, and body (hirsutism)
  • Acne
  • Thinning of scalp hair
• Higher than normal blood levels of androgens
• Multiple cysts on one or both ovaries

Can PCOS lead to other health problems?

Unfortunately, yes. Other issues can include diabetes, high blood pressure, unhealthy cholesterol, sleep apnea, endometrial cancer, and depression and anxiety. At this time, researchers do not know if PCOS causes some of these problems, if these problems cause PCOS, or if there are other conditions that cause PCOS and other health problems.

How is PCOS cured or treated?

There is no cure for PCOS; for many, its complications can last several years, or be lifelong. However, you can manage the symptoms of PCOS. Once diagnosed, you and your doctor will work on a treatment plan based on your symptoms, your plans for having children, and your risk of long-term health problems such as diabetes and heart disease. Many will need a combination of treatments, including both lifestyle changes and medicine.

You can take steps at home to help your PCOS symptoms, including:

• Losing weight. Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10% loss in body weight (for example, a 150-pound woman losing 15 pounds) can help make your menstrual cycle more regular and improve your chances of getting pregnant. 
• Removing hair. You can try facial hair removal creams, laser hair removal, or electrolysis to remove excess hair. You can find hair removal creams and products at drugstores. Procedures like laser hair removal or electrolysis must be done by a doctor and may not be covered by health insurance.
• Slowing hair growth. A prescription skin treatment (eflornithine HCl cream) can help slow down the growth rate of new hair in unwanted places.

Can I still get pregnant with PCOS?

Yes! Although common, having PCOS does not mean you can’t get pregnant with treatment. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). If you don’t ovulate, you can’t get pregnant. However, there are still plenty of options to explore to assist with ovulation; you can speak with a doctor to find the best course of action for you. 

In short, it is not impossible to conceive with PCOS, but people with PCOS may wish to speak to a fertility specialist to assist with the complications that can include higher rates of miscarriage, gestational diabetes, preeclampsia, c-section births, and macrosomia in the baby.

You can lower your risk of problems during pregnancy by:

• Reaching a healthy weight before you get pregnant. 
• Reaching healthy blood sugar levels before you get pregnant. You can do this through a combination of healthy eating habits, regular physical activity, weight loss, and medicines such as metformin.
• Taking folic acid. Talk to your doctor about how much folic acid you need.