PCOS and Fertility: What You Need to Know in 2025

Did you know that millions of women live with a hormonal condition they may not even know they have? Polycystic Ovary Syndrome, or PCOS, is a hidden disruptor of hormones, cycles, and fertility – yet it often goes undiagnosed. Let’s uncover what PCOS really is and why early awareness matters.

Explore the information below to learn about PCOS – its causes, symptoms, diagnosis, and treatment options to take control of your health.

What is PCOS and its causes

Polycystic Ovary Syndrome, also called PCOS, is a common type of hormonal imbalance that often occurs among women of reproductive age, usually starting during adolescence, which is characterized by excess androgen levels, irregular periods, and/or polycystic ovaries.

If the woman has PCOS, her ovaries produce unusually high levels of androgen hormones, causing an imbalance in the body. Estimates of how many women it affects vary widely, from 2 to 26 in every 100 women.

Each menstrual cycle in women develops follicles and forms eggs, one of which is released during ovulation. Once this process is completed, the follicles are meant to break down and disappear. 

However, in PCOS conditions, these follicles stop growing in the middle to mature; hence, ovulation also does not happen. These follicles become cysts, which are usually less than 1 cm and are arranged around the ovary, just below the surface. These cysts result from a hormonal imbalance due to an increased amount of testosterone.

The exact cause of this condition is still not understood well. However, multiple factors are believed to play a role in causing PCOS:

• Insulin resistance: Many patients with PCOS have been found to have insulin resistance, leading to increased insulin production, which in turn can stimulate the ovaries to produce more androgens.
• Genetics: As per many studies, it is concluded that certain genetic variants might be linked to PCOS, running in families.
• Obesity: As per many studies, girls and women who are obese are more likely to have PCOS.
• Excess male hormones: Women with PCOS often have increased levels of androgens (male hormones) than usual, which can disrupt ovulation and lead to other symptoms like acne and excess hair growth.
• Environmental factors: Some researchers suggest a link between exposure to specific environmental pollutants and a raised risk for this syndrome.

Symptoms of PCOS

PCOS is referred to as a syndrome because it encompasses multiple symptoms experienced simultaneously, symptoms including as follows:

• Irregular periods: They can range from amenorrhea (no periods) or oligomenorrhea (infrequent) to irregular or heavy periods. Some women may experience few or absent periods and may build a thick lining in the uterus, and this may, rarely, cause endometrial (uterine) cancer.
• Excessive hair growth: Excess male hormones (androgens) cause acne or excess or unwanted hair on the face, back, thighs, nipples, and tummy.
• Scalp hair loss: Alopecia (losing hair from the head) is another symptom that can occur due to too much testosterone.
• Acne: It is also caused by increased levels of androgens and can appear on the face, back, and elsewhere on the body.
• Insulin resistance: Approximately 80% of women with PCOS have insulin resistance. When there are high levels of insulin hormone present in the bloodstream, the body produces more androgens, leading to other symptoms such as
  • Weight gain and increase in fat deposition around the abdomen
  • Hairiness, acne, and difficulty ovulating
  • Patches of darkened skin on the back of the neck, in the groin area, and under the arms
• Other symptoms:
  • Poor sleep 
  • Skin tags
  • Depression or anxiety

PCOS can affect A woman’s

• Hormones
• Menstrual cycle
• Fertility
• Blood vessels
• Heart Appearance
• Risk for cancer
• Mental health
• Metabolic syndrome

Complications of PCOS

If the PCOS left untreated, it may be at risk of developing the long-term effects, including:

• Infertility

• Metabolic syndrome
• Miscarriage or premature birth
• Gestational diabetes
• Pregnancy-induced high blood pressure
• Depression, anxiety and eating disorders
• Prediabetes or type 2 diabetes
• Endometrial cancer

Diagnostic criteria and tests

Diagnosis criteria

A diagnosis of PCOS is typically made after ruling out other rare causes of similar symptoms, provided that at least two of the following three criteria are met:

1. Irregular periods or infrequent periods—indicate that the ovaries are not ovulating regularly (do not regularly release eggs).
2. Increased male hormones (androgens) such as testosterone as shown by acne, excess hair growth or increase blood testosterone levels.
3. A characteristic appearance of the ovaries (polycystic ovaries) on ultrasound scans 

Since only two of the diagnostic criteria are required to confirm PCOS, an ultrasound scan may not be necessary for diagnosis.

Diagnosis tests of PCOS

There is no particular test for PCOS, but your doctor will consider the symptoms and usually perform the following tests:

• Physical examination: A physical examination can be performed to check for any hair loss, facial hair, discoloured skin, and skin tags, which are suggestive of PCOS.

• Pelvic examination: A pelvic examination can be performed to look for other causes of abnormal bleeding.

• Blood tests: Blood tests are performed to check testosterone and cholesterol levels, blood sugar levels (e.g., insulin resistance), and for changes in LH (luteinizing hormone) or FSH (follicle-stimulating hormone).
• Ultrasound: Ultrasound is performed to examine the ovaries and to detect any thickness of uterine lining and look for other causes of abnormal bleeding.

• Transvaginal Ultrasound: A long, slender probe is inserted into the vagina to identify the presence of ovarian cysts or enlarged ovaries and also to examine any irregularities in the reproductive organs.

Treatment approaches: medication, lifestyle, IVF

The treatment approach for PCOS is individualized and tailored to manage specific symptoms, taking into account several factors, including age, symptom severity, and overall health. The type of treatment may also depend on the plan of pregnancy.

• Lifestyle changes
• Medications
• PCOS Treatment Options for Women Trying to Conceive

Lifestyle changes: 

Maintaining a healthy lifestyle can show a positive effect on insulin levels.

• Weight loss: In overweight women, the PCOS symptoms and overall risk of developing long-term health issues can be greatly improved by losing excess weight. Just 5% weight loss also makes a significant improvement in PCOS women. Regularly exercising and eating a healthy, balanced diet can help you lose weight.
• Exercise: Engaging in both aerobic and resistance training exercises to improve insulin sensitivity, boost mood, and manage weight. Incorporating activities like brisk walking, swimming, cycling, jogging, and weightlifting can help manage weight.
• Healthy diet: Diet should include plenty of vegetables and fruit (at least 5 portions a day), whole foods such as whole-grain cereals, wholemeal bread, and brown rice, lean meats, fish, and chicken. Inducing foods like spinach, fatty fish (salmon), tomatoes, and kale can help reduce inflammation, which is often associated with PCOS. Limiting the foods that are high in refined carbohydrates, sugary drinks, and processed foods cannot worsen insulin resistance. Opting for foods with a low glycaemic index (GI), which release glucose slowly, helps to regulate blood sugar and insulin levels.
• Stress management: Managing stress through meditation, yoga, or spending time in nature can reduce the exacerbation of PCOS symptoms.
• Prioritize sleep: Poor sleep disrupts the delicate hormonal balance in the body and is linked with an increased risk of insulin resistance and obesity. Aiming for 7-9 hours of quality sleep per night can help manage hormonal imbalance.

Medications:

Medications are recommended to manage the various symptoms of PCOS and reduce the risk of long-term complications.

• Hormonal birth control: Options like birth control pills, shots, vaginal rings, patches, or intrauterine devices are recommended to regulate the menstrual cycle.
• Insulin-sensitizing medicine: Metformin (biguanides) helps to regulate the sugar (glucose) levels in the blood, helping to control diabetes. It is often recommended in PCOS patients to improve insulin sensitivity, reduce serum androgen levels, and restore the menstrual irregularities.
• Medications to block androgens: Anti-androgens and combined oral contraceptive pills (COCPs) are given to PCOS patients to inhibit the effects of male sex hormones, reducing symptoms.

PCOS Treatment Options for Women Trying to Conceive

If the women want to become pregnant now or in the future, treatment for PCOS includes:

• Drugs to induce ovulation (releasing an egg): A successful natural pregnancy starts with ovulation. Certain medications have been proven to induce ovulation in women with PCOS, but they have some side effects.
• Surgery: A surgical procedure is rarely recommended to restore ovulation by removing tissue in the ovaries that produces androgen hormones.
• In vitro fertilization (IVF): This is an option for women with PCOS when medication doesn’t help with ovulation.

Link between PCOS and fertility

PCOS is one of the leading causes of infertility. PCOS can affect a woman’s fertility in different ways. Ovulation problems are usually the main cause of infertility in women with PCOS, where ovulation may not occur in PCOS patients due to an increase in testosterone production or follicles on the ovaries that do not mature.

Even if ovulation occurs, an imbalance in hormones may prevent the development of the uterine lining to allow for the implantation of the mature egg.

Due to unbalanced hormones, menstruation and ovulation can be irregular. Unpredictable menstrual cycles can also make it difficult to get pregnant.

Fertility preservation tips

It is highly recommended for women with PCOS to maintain a healthy lifestyle for fertility preservation through exercise, a healthy diet, and reducing stress. If these lifestyle changes are not enough, assisted reproductive technologies like IVF or fertility medications can be considered.

There is a consensus among experts regarding the treatment of infertility related to PCOS. Lifestyle adjustments are now widely accepted as a crucial component in managing PCOS and have been recommended by various guidelines. Research indicates that if overweight and obese PCOS patients lose 5–10% of their weight, their fertility, metabolic indicators, and psychological well-being significantly improve.

Conclusion:

PCOS is a complex hormonal disorder that affects many aspects of a woman’s health, especially fertility. While its exact cause remains unclear, early diagnosis and a combination of lifestyle changes, medications, and fertility treatments can significantly improve symptoms and increase the chances of conception. Managing weight, maintaining a balanced diet, regular exercise, and reducing stress are key to long-term health and fertility in women with PCOS. With proper care and support, many women with PCOS can successfully manage the condition and achieve their reproductive goals.