How does PCOS affect fertility?

Written by: Mr Mahantesh Karoshi
Published: | Updated: 17/02/2020
Edited by: Laura Burgess

When a woman has polycystic ovary syndrome (PCOS) she can actually be asymptomatic and doesn’t know that she has it at all. PCOS has a spectrum of manifestations in the way that it presents, which ranges from no symptoms to those that are more severe. You could have PCOS and be completely fine without realising it until certain signs start flashing up, or if your intentions to conceive are not successful.

Mr Mahantesh Karoshi is one of our top consultant gynaecologists and here he explains the symptoms of PCOS, how it affects fertility and what to do if you’re living with the condition and are planning to have a baby.

What are the symptoms of PCOS?

Your friend might have everything working in their favour; they are not carrying any extra weight, do not have acne or period issues and then they get married and try for a baby and sadly, it’s not happening. Then we investigate and her blood results show PCOS, which has a spectrum of manifestations. The symptoms on the ‘middle’ end of the spectrum include:

  • Weight gain 
  • Irregular periods - suddenly periods are lasting longer
  • Hair starts to become missing - especially on the sides (temples)
  • Excessive body hair - on the chin, hair, neck
  • Acne

Some patients may have just one of these symptoms.

How can a woman regulate her period?

If weight is an issue in a woman with PCOS the common advice given by the specialist to regulate periods is to lose weight. We recommend having a BMI between 18-24.9 because weight has a direct correlation to periods. Due to the body lock mechanism, if you are either too thin or too big, you won’t be able to have your periods, so it is better to be in the middle range of the BMI at around 21. We recommend that you lose weight through healthy diet and exercise.

How can PCOS affect fertility?

PCOS affects fertility by anovulation (no ovulation), which is where a woman can have normal periods but they are not ovulating and miss their fertile days. Anovulatory cycles are menstrual cycles where no ovulation occurs.

Around 70% of anovulatory infertility is related to PCOS. During follicular arrest, no dominant follicle grows large enough to ovulate. The second way that PCOS affects fertility is because the woman could have associated issues such as endometrial-hostility where the lining of the womb is very thick which is very common if she is missing her periods.

What are other possible causes of female infertility?

We have to look at the female anatomy as a whole but the woman could have problems in their uterus, such as fibroids, polyps or scarring. There could be tubal blockage from an infection.

Sometimes the male partner could also be having fertility issues, such as low sperm count or excessive abnormal-looking forms.

Is there a link between PCOS and cancer?

If a woman with PCOS misses her periods or is not having more than three periods per year, they carry the risk of a medical condition called endometrial-hyperplasia (overgrowth of the lining of the womb). If this endometrial hyperplasia either goes undetected or untreated over many years, then there is increased risk of the lining of the womb cancer (endometrial cancer).

The contraceptive coil Mirena protects the lining of the women and can halt this progression. In simple words, PCOS-women with less frequent periods can consider Mirena for endometrial protection.

What fertility treatments are available for women with PCOS?

Firstly, I recommend optimising woman’s body weight through diet and exercise to be in a healthy BMI range. Secondly, in cases of PCOS and infertility, I suggest taking the supplement Inositol, which can be bought over-the-counter. Scientific theory recognises that if a woman with PCOS takes the Inositol supplement it unblocks the chemical pathway and everything gets corrected at the molecular level. It usually takes around three to six months to see the effects and the woman may need to have regular blood tests to monitor her progress and response.

The patient can also use modern gadgets at home, such as ovulation testing kits, if they are really serious about monitoring their fertility journey. The kits are pretty accurate with 95-99% accuracy.

Finally, the doctor can prescribe clomiphene, which is an ovulation-inducing drug. This is to be prescribed by a trained specialist and patients taking this will need monitoring; starting with a low dosage that may need to be increased.

If you are living with PCOS and are trying for a baby, do not hesitate to visit Mr Karoshi for his expert medical advice.

By Mr Mahantesh Karoshi
Obstetrics & gynaecology

Mr Mahantesh Karoshi is a London-based women’s health expert and consultant gynaecologist, with a special interest in ovarian cysts, heavy menstrual bleeding, infertility, fibroids, and adenomyosis. He is currently one of the most highly-rated gynaecologists in London with a very good reputation amongst his patients and peers.

Mr Karoshi's work is recognised internationally, having volunteered in Ethiopia’s Gimbie Hospital, and later receiving the Bernhard Baron Travelling Fellowship from the Royal College of Obstetricians and Gynaecologists which led to his work in the University of Buenos Aires. Here he worked on the techniques needed to surgically manage morbidly adherent placental disorders - a serious condition that can occur in women with multiple caesarean sections.

He believes in an open doctor-patient relationship, being sure to include the patient and educating them so that they understand their condition better and they can be directly involved in their care and management at every stage. Aside from his clinical work, he is actively involved in research, which together with his experience, has given him the opportunity to publish the first stand-alone textbook on postpartum haemorrhage which was launched by HRH Princess Anne.

At the core of Mr Karoshi's practice is a high standard of professionalism where patients are involved in their treatment and where the latest techniques and advancements are used to provide an extremely high level of care.

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