PCOS and Fertility: Everything You Need to Know

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Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age — and one of the leading causes of female infertility. But here is the encouraging truth: PCOS is also one of the most treatable causes of infertility. With the right approach, the vast majority of women with PCOS can and do achieve successful pregnancies.

What Is PCOS?

PCOS is a hormonal disorder characterised by an imbalance in reproductive hormones. The ovaries may develop many small follicles (fluid-filled sacs containing eggs) but fail to regularly release an egg — a process called anovulation. Without ovulation, pregnancy cannot occur naturally.

PCOS affects approximately 1 in 10 women of childbearing age in India and globally.

How Is PCOS Diagnosed?

We use the Rotterdam criteria — a diagnosis of PCOS requires at least two of the following three features:

• Irregular or absent periods (indicating infrequent or absent ovulation)
• Elevated androgen levels (testosterone) — evidenced by blood tests or symptoms such as acne, excess facial/body hair (hirsutism), or hair thinning
• Polycystic ovaries on ultrasound — 12 or more small follicles in one or both ovaries

We also check your AMH level (usually elevated in PCOS), fasting insulin and glucose (to assess insulin resistance), thyroid function, and prolactin levels.

PCOS and Fertility — The Connection

The primary fertility challenge with PCOS is irregular ovulation. If you are not ovulating regularly, the timing of intercourse becomes unpredictable and conception difficult. Additionally, the hormonal environment in PCOS can affect egg quality and uterine lining preparation.

Treatment Options for PCOS-Related Infertility

Lifestyle Modification — The First Step

Even modest weight loss (5–10% of body weight) in women with PCOS who are overweight can restore regular ovulation in many cases. A low-glycaemic diet (reducing refined carbohydrates and sugar), regular exercise, and stress management are foundational to PCOS management.

Ovulation Induction

Medications such as Letrozole or Clomiphene Citrate are used to stimulate the ovaries to release an egg. These are taken as tablets in the first half of your cycle and are effective in a large percentage of women with PCOS. We monitor your response with ultrasound to confirm ovulation and time intercourse or IUI appropriately.

IUI (Intrauterine Insemination)

When ovulation induction alone is not sufficient, combining it with IUI — placing prepared sperm directly into the uterus — increases the chances of conception by maximising the proximity of sperm to egg.

IVF (In Vitro Fertilisation)

For women with PCOS who do not respond to simpler treatments, or those with additional fertility factors, IVF is highly effective. We use carefully calibrated protocols to stimulate the ovaries gently, minimising the risk of ovarian hyperstimulation syndrome (OHSS) — a concern with PCOS due to the large number of follicles present.

PCOS During Pregnancy

Women with PCOS have a slightly higher risk of gestational diabetes and pregnancy-induced hypertension. We monitor these carefully with additional blood glucose tests and blood pressure checks throughout your pregnancy.