What is PCOS?
Polycystic ovary syndrome (PCOS) is a very common endocrine condition in
reproductive-aged women. It affects approximately 5-10 percent of young women and
often leads to difficulty conceiving. Women with this condition can experience irregular
periods, abnormal hair growth, acne, and can have ovaries containing multiple small
cysts.
PCOS and Infertility
PCOS negatively impacts fertility because women with the condition do not ovulate
(release an egg) each month due to an overproduction of estrogen by the ovaries.
Because ovulation does not occur regularly, periods become irregular and increased
levels of hormones such as testosterone can affect egg quality, inhibit ovulation, lead to
insulin resistance, and increase the risk disorders such as gestational diabetes.
Is it Possible to Get Pregnant with PCOS?
While it’s not impossible for a woman with PCOS to get pregnant on her own, many
women do need to seek care from a fertility specialist.
PCOS and Fertility Treatment
For those women trying to conceive a pregnancy, the first step in treatment of PCOS is
lifestyle modification, including a healthy diet and exercise. Diets shown to be most
successful in PCOS patients include those with lower carbohydrates and a reduced
glycemic load. Recommended exercise in PCOS patients is at least 30 minutes of
moderate exercise three times per week, with daily exercise being the ultimate goal.
Women who still have infrequent ovulation despite lifestyle modifications may require
fertility medications to assist with the release of an egg from the ovary. Typical initial
therapy for patients with PCOS who do not ovulate and are trying to conceive includes
administration of certain fertility medications. These agents are selective estrogen
receptor modulators.
For some women with PCOS, fertility tablets do not result in ovulation or pregnancy,
and they require fertility injections to release an egg. Fertility injections (Follistim®,
Gonal-F®, Bravelle®, and Menopur®) contain the same hormone the brain releases to
signal the ovary to produce eggs. Rather than producing one egg in a month, most
women on fertility injections will produce two or more eggs. This treatment requires
closer monitoring with transvaginal ultrasounds and several blood draws to determine

the woman’s estradiol level, which is a hormone produced in the ovary. Fertility
injections are also associated with an increased risk of multiple births.
In some instances, women with PCOS require in vitro fertilization (IVF) to achieve a
healthy pregnancy. In this scenario, daily fertility injections are used to stimulate the
ovaries to produce multiple eggs, which are harvested in a minor procedure. The eggs
are fertilized in the lab, and then a resulting embryo (fertilized egg) is transferred into
the woman’s uterus. Additional embryos can be frozen (cryopreserved) for future use.
What are PCOS Health Risks?
As previously mentioned, insulin resistance can occur in women with PCOS. A simple
blood test can determine if a person is insulin resistant. If the test indicates insulin
resistance exists, women with PCOS may be treated with a medication called metformin
(trade name Glucophage).
Hyperlipidemia, or elevated cholesterol and/or triglycerides, can occur in PCOS women
as well. Women can be screened for this condition with a fasting blood sample.
Screening for hyperlipidemia is very important since this condition can lead to
cardiovascular disease later in life.
Women with PCOS appear to be at increased risk for endometrial (uterine) cancer later
in life due to persistently higher levels of circulating estrogens. Since menstrual periods
do not occur regularly, overgrowth of the uterine lining can occur and in some cases can
lead to a malignancy.
Women with PCOS also have an elevated risk of ovarian torsion (twisted ovary).