Polycystic ovarian syndrome (PCOS) is a hormonal imbalance that affects female reproductive health and fertility. Common symptoms include weight gain, unwanted hair growth, acne, and difficulty getting pregnant. PCOS affects 5–10% of individuals between ages 15 and 44, and often leads to ovarian cysts, irregular menstrual cycles, and anovulation (absence of ovulation).
Although PCOS is one of the leading causes of infertility, it is also among the most treatable. About 70–80% of individuals with PCOS experience fertility challenges, but many treatment options exist. Treatments often focus on regulating ovulation and menstrual cycles, with success depending on factors like age, treatment type, and underlying conditions. Ovulation induction with medications such as clomiphene (Clomid) and gonadotropins is around 70% effective. Ovarian drilling has a 50% success rate.
Lifestyle Approaches
Lifestyle changes are commonly the first step in managing PCOS-related infertility. These approaches may also complement medical treatments.
Maintaining a healthy weight is important, as even modest weight loss through diet and exercise can improve symptoms and increase ovulation by regulating blood sugar and insulin resistance.
Regular physical activity enhances ovulation and menstrual regularity. Experts recommend at least 150 minutes of physical activity per week, including 90 minutes of moderate-intensity aerobic exercise.
Diet plays a critical role. A balanced diet rich in protein, fiber, whole grains, and low glycemic index foods helps regulate glucose levels, improving symptoms and ovulatory function.
Medical Treatments for Fertility
Several medical therapies can help manage PCOS and promote fertility.
First-line medication typically includes clomiphene (Clomid), which induces ovulation. If this is unsuccessful, letrozole (Femara) is an alternative. Gonadotropins, such as FSH and LH, are hormone injections used if first-line medications are ineffective.
Metformin, though not FDA-approved for PCOS, is often prescribed off-label to improve insulin sensitivity and can support ovulation in people with insulin resistance.
Surgical options, such as ovarian drilling, may be considered if medications fail. This procedure helps the ovaries release eggs more regularly by reducing thickened ovarian tissue.
Assisted reproductive technologies like in vitro fertilization (IVF) may be necessary when other treatments are unsuccessful. IVF involves stimulating ovulation, retrieving eggs, fertilizing them with sperm in a lab, and transferring embryos to the uterus. Some may choose to freeze unused eggs or embryos for future use.
Alternative and Complementary Therapies
Certain supplements and therapies may support fertility. Inositol (myo- and d-chiro forms) can enhance insulin sensitivity and promote ovulation. Melatonin may improve sleep and hormone balance. Vitamin D, B12, and calcium can help regulate hormones.
Complementary treatments like acupuncture have shown promise in managing PCOS by improving insulin sensitivity, hormone balance, and ovulation.
Coping with Infertility and Stress
Infertility related to PCOS can be emotionally challenging. Individuals may experience heightened stress, anxiety, or depression. Coping strategies include allowing yourself to process emotions, seeking support from loved ones or groups like RESOLVE, and setting boundaries with social events that may be emotionally difficult.
Healthcare providers can help address emotional concerns and connect you with mental health resources or support networks.
Summary
PCOS is a common but manageable cause of infertility. Treatments range from lifestyle modifications to medications and reproductive technologies. Because each individual is different, working with a healthcare provider to develop a personalized plan is essential. Fertility treatment can take time and persistence, but many individuals with PCOS go on to have successful pregnancies.
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