If you’ve been dealing with infertility for some time, I suspect you’ve heard PCOS and infertility mentioned in the same sentence. PCOS has been identified as one of the leading causes of infertility in women. By the way, PCOS stands for polycystic ovary syndrome. This can occur in about 10% of women. A large number of women with PCOS do not know they have it, and it is believed that less than 25% of those with it have been diagnosed.

Researchers are inclined to believe that certain women produce unusually high levels of insulin, and that this abundance is counteracted by the body producing higher levels of male androgen hormones. In fact, the relationship between PCOS and infertility is not completely understood. But, in any case, the issue is complicated because women with PCOS are resistant to insulin, which leads to diabetes problems.

This is what is known. When a woman experiences menstruation, there are several follicles that develop in the ovaries. Each of the follicles has an ovum, which is the high-dollar term for “egg.” During the menstruation process, only one of the follicles will persist and produce an egg that will be available for ovulation. Specifically, the egg matures and LH levels rise, forcing the egg out of the follicle. This is the essence of ovulation.

However, when a woman has PCOS, things are a little different. Usually she won’t make enough female hormones for this to fully take place. The bottom line is that the follicles do not generate mature eggs. Alternatively, some follicles may develop into cysts. When this happens, it can be seen on ultrasound. It resembles a string of pearls in the ovary, with the “pearls” being the follicles that have not developed. Each of the ovaries usually has a series of cysts on the outside. However, when ovulation does not occur, the progesterone necessary to thicken the uterine wall is not produced. Therefore, it is easy to see the relationship between PCOS and infertility, as the uterus is not ready to receive a fertilized egg, even if one is available.

It is believed that certain aspects of PCOS and infertility may worsen over time. For example, irregular menstrual cycles could cause a complete absence of menstruation. PCOS and infertility can even branch out into other seemingly strange symptoms. You may see an increase in acne or experience pelvic pain. Some women have to deal with hair growth on their chest, face, and even back. In addition to having hair where you don’t want it, the hair on your head can also thin out. Other women with PCOS and infertility gain weight, and as noted, others deal with high insulin levels that lead to type II diabetes.

There are some recommended interventions for women with PCOS and infertility. Some women can see an improvement with just a little regular weight loss. Sometimes this is enough to adjust hormonal balances. When insulin plays a role, some doctors will recommend drugs like metformin. This is designed to improve the way a woman’s body absorbs insulin. Such a drug does not work so much on blood sugar levels, but affects insulin levels itself.

I know that not everyone is crazy about pharmaceuticals, but there is another class of drugs that I will mention for women suffering from PCOS and infertility. Clomid is used to block estrogen in the brain and tricks the body into thinking estrogen levels are unduly low. As a result, the body will respond by creating more FSH and LH. These will trigger ovulation. However, full disclosure requires me to point out that still around 35% of women who use it get pregnant, so there are clearly other issues at play.

A final intervention for PCOS and infertility that I will mention is in vitro fertilization (IVF) and in vitro maturation (IVM). With in vitro fertilization, as you may know, the mature eggs are fertilized and placed in the woman’s uterus. Less well known is IVM, in which immature eggs are retrieved from a woman at an early stage of menstruation. The eggs are then matured in a laboratory so they can be fertilized right then.