Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder affecting up to 10% of women of reproductive age, and one of its most debilitating symptoms is reduced fertility. Many women with PCOS struggle to conceive, and those who do often face complications during pregnancy. The science behind PCOS influencing fertility lies in its impact on levels of many hormones and ovarian function, leading to high androgens, irregular menstrual cycles, anovulation, and follicular abnormalities.

PCOS is a complex hormonal disorder that affects the body on various levels, including the ovaries - reproductive organs responsible for producing and releasing eggs. In women with PCOS, the ovaries produce excess male sex hormones (potentially due to high insulin in the blood) that are normally present in small amounts in women. This hormonal imbalance can lead to the formation of multiple small cysts on the ovaries, which can interfere with ovulation and reduce fertility.

The exact mechanism by which PCOS affects fertility is still not fully understood, but it is thought to be related to a number of factors. One of the key factors is the disruption of the normal menstrual cycle, which can make it difficult for women with PCOS to ovulate regularly. In addition, the excess androgens produced by the ovaries can interfere with the maturation of eggs and their release from the ovaries.

PCOS can also increase the risk of insulin resistance and obesity, both of which can further exacerbate hormonal imbalances and interfere with ovulation. Women with PCOS are also at an increased risk of developing other health conditions such as diabetes, obesity, high blood pressure, and cardiovascular disease, which have a negative impact on fertility on their own.

In the UK only, PCOS affects approximately 1 in 5 women, making it one of the most prevalent endocrine disorders among women. It is estimated that up to 70% of women with PCOS experience infertility, compared to just 10% of women without the condition. Women with PCOS are also more likely to require fertility treatment, such as ovulation induction or in vitro fertilization (IVF), to conceive.

The impact of PCOS on fertility can have a significant social and psychological impact on women. Infertility can be a highly emotional and distressing experience for women, and the uncertainty and unpredictability of PCOS can add to this stress. Women with PCOS may feel isolated or alone in their struggles to conceive, and may also face stigma or discrimination related to their condition.

PCOS is a complex and multifaceted condition that requires ongoing education and research to better understand its underlying mechanisms and to develop effective treatments. Education and awareness campaigns can help to reduce the stigma and misinformation surrounding PCOS, and can also encourage women to seek early diagnosis and treatment.

Research into the underlying causes of PCOS and its impact on fertility is also critical for developing effective treatments and improving outcomes for women with the condition.

Advances in reproductive medicine, including assisted reproductive technologies such as IVF, have already made it possible for many women with PCOS to conceive and have healthy pregnancies. However, we think it's even more important to emphasise that a PCOS diagnosis does not mean you won’t be able to have children. Reduced fertility is just one of the symptoms of the larger problem that requires holistic care. By addressing the key root causes of the disease, focusing on glucose management, a varied and nutrient-dense diet, moving your body regularly, supplementing and managing stress you will be able to create a tremendously positive impact on your hormonal health and revert PCOS. Education and awareness campaigns can also reduce the stigma and misinformation surrounding PCOS and encourage women to seek early diagnosis and look out for various treatment options.

References:

1. Azziz R,  Woods KS, Reyna R, et al. Prevalence and Features of the Polycystic Ovary Syndrome in Women of Reproductive Age Group From the United States. The Journal of Clinical Endocrinology & Metabolism.2016. 91(6): 2128-2133.
2. Ehrmann DA. Polycystic ovary syndrome. New England Journal of Medicine. 2018. 356(4): 380-382.
3. March WA, Moore VA, Willson KJ, et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction. 2010. 25(2): 544-551.
4. National Institute for Health and Care Excellence (NICE). Polycystic ovary syndrome: Diagnosis and management. 2018. Available online: https://www.nice.org.uk/guidance/ng133
5. Teede HJ, Misso ML,  Costello  M, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility. 2018: 110(3), 364-379.