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Infertility is one of the most common and devastating impacts of polycystic ovary syndrome. Why does PCOS cause infertility, and what are your treatment options? Here are 8 things every woman with PCOS should know.

Though polycystic ovary syndrome can be accompanied by some pretty invasive symptoms — things like excessive hair growth on the face and thinning hair on the head, irregular periods, weight gain, anc acne — not every woman with PCOS is symptomatic. Having no obvious symptoms doesn't mean PCOS doesn't affect you, however, and many women are initially diagnosed with the condition after they find they're unable to conceive

Infertility is one of the most common complications of PCOS — so much so that around 50 percent of women struggling to get pregnant are thought to have polycystic ovary syndrome. Why does PCOS sometimes cause infertility, and what are your treatment options?

1. Don't suffer in silence: See your doctor if you have PCOS symptoms!

The tell-tale symptoms of PCOS may be your normal if you've had them since adolescence (as is common), but they absolutely signal that something is wrong, so please seek medical attention if you have noticed several of the following signs of polycystic ovary syndrome:

  • Irregular periods — or absent menstrual periods
  • Hirsutism — the growth of excessive amounts of hair in places typically associated with men, such as the face, chest, back, and thighs
  • Thinning hair on your scalp
  • Acne or oily skin
  • Weight gain not fully explained by your lifestyle
  • Mood swings
  • Pelvic pain
  • Headaches
  • Trouble sleeping
  • Not getting pregnant after trying for a while
It is important to make an appointment with your healthcare provider even if you aren't struggling to get pregnant, as PCOS leads to an elevated risk of certain health conditions. Among them are high cholesterol levels, hypertension, diabetes, certain cancers, and cardiovascular disease. Not all women with PCOS have trouble conceiving, and should you be one of them, it's still important to be diagnosed. This is because PCOS sufferers are more likely to develop pregnancy complications like gestational diabetes and preterm labor, too, so you will need extra monitoring.

Of course, see your doctor if you haven't been able to conceive after trying for six months to a year even if you don't have any PCOS symptoms; infertility can result from many different conditions, many of which can be treated, either by managing the underlying condition or with assisted reproductive techniques.

2. How does PCOS affect your fertility?

The ways in which PCOS can impact your ability to get pregnant are complex. Higher levels of androgens, typically "male" hormones such as testosterone, can interfere with ovulation, the release of eggs. Your follicles may not mature to the point they can be viable eggs, but they do grow, and can become cysts instead. 

This process also disrupts the production of hormones that normally regulate the menstrual cycle, progesterone being an important one. Hence many women with PCOS experience irregular, unpredictable menstrual cycles while some go for long periods without having a period at all. This, of course, further interferes with fertility. Women with PCOS who do ovulate may still face difficulties in getting pregnant due to this hormonal imbalance.

3. Is there any chance I can get pregnant naturally with PCOS?

Some women who PCOS absolutely get pregnant naturally without any kind of medical assistance. If you are not one of them and you have been trying to conceive without a positive pregnancy test for a while now, that still doesn't mean you cannot have a baby, however. In addition to fertility treatments such as the medications Clomid and gonadotropins and IVF, lifestyle changes can also boost your odds of getting pregnant. More about those later.

4. Pharmacological approaches to treating PCOS-related infertility

The following medications are commonly prescribed to women with polycystic ovary syndrome who have been unable to get pregnant naturally:

  • Clomid (clomiphene citrate) is a fertility drug that induces ovulation, allowing many women with PCOS to get pregnant
  • Metformin is a diabetes drug, often offered to women who live with PCOS because of the associated insulin resistance. It can help women lose weight, something that has been found to significantly increase your odds of getting pregnant if you have polycystic ovary syndrome.
  • Letrozole (Femara) is a medication used in women with hormone-dependent breast cancer, but it is also prescribed to help you start ovulating. This drug will most likely be offered to you if Clomid and metformin, first-line treatments, didn't have the desired effect. 
  • Gonadotropins like Gonal-F, Follistim, Bravelle, Ovidrel, and Menopur are injectable hormomonal medications, often used in conjunction with IVF or intrauterine insemination. They do have the risk of leading to ovarian hyperstimulation syndrome, a dangerous complication that PCOS patients have a higher likelihood of developing.
  • IVF is the last-resort treatment. Expensive and invasive, it does give you a very good chance of getting pregnant.

5. Weight loss can improve your fertility

Numerous PCOS sufferers are overweight or obese, because insulin resistance is also common in women with this condition. If you are one of them, losing even a small percentage of your body weight, five to 10 percent, can boost your odds of conceiving a baby — being overweight makes you more likely to have irregular menstrual cycles during which you do not ovulate.

Even if losing weight doesn't help you get pregnant naturally, you will be interested to know that having a healthy weight also makes your chances of conceiving with fertility treatments higher.

6. Does diet help you improve your fertility?

Maybe — everyone benefits from eating a healthy and varied diet, and for women who have insulin resistance, it is also important to keep blood sugar levels steady. You may find that a low-carb diet and foods that have a low glycemic index will help you lose weight, thereby indirectly improving your fertility. This generally means avoiding highly processed, carby, fatty, sugary foods. 

7. PCOS and infertility: What role does exercise play?

A steady exercise routine is, again, good for just about anyone. In women who live with PCOS, research has shown, regular workouts can alleviate symptoms, promote weight loss, and make for a more regular menstrual cycle. In some cases, a combination of exercise and a good diet will be enough to help a woman get pregnant. Your best bet is combining cardio with strength training and doing this at least a few times a week, but talk to your doctor before commencing a new exercise program.

8. Stress impacts infertility, too

This may sound like "pie in the sky" and even a little condescending ("think nice thoughts, and you'll get pregnant"), but there's actually some science behind it. People who are exposed to long-term stresses — and having a chronic illness definitely counts — produce higher levels of cortisol (a stress hormone) and insulin. This unfortunate combo is detrimental to your fertility, so making self-care and stress relief a priority in your life may indeed boost your fertility. Meditation, yoga, and exercise are among the typically-recommended ways to destress, but really, if binge-watching your favorite show or attending a debate club does it for you, that's good, too.

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