Fertility Treatments for PCOS: A Guide to Increasing Your Chances of Conception

Polycystic Ovary Syndrome (PCOS) is one of the most common causes of infertility in women, but it doesn’t mean you cannot have children. PCOS often disrupts ovulation, making it harder to conceive, but thanks to advancements in fertility treatments, many women with PCOS successfully become pregnant. 

In this post, we will explore how PCOS is diagnosed and the most common fertility treatments for PCOS and how they work to help you achieve your dream of starting a family. 

How PCOS is Diagnosed 

Women with irregular menses, abnormal or excess body hair, or acne should consult with her physician and consider an evaluation for PCOS. Many women do not present symptoms until their 20s or 30s. PCOS is commonly associated with weight gain and the common diagnostic criteria are:  

• Disordered ovulation - manifesting as irregular menstrual cycles  

• Evidence of high “male type hormone” levels (androgens) – This can manifest as acne, abnormal hair growth or with elevated levels of these hormones (such as testosterone) in a blood test. 

• A “polycystic” appearance of the ovaries on ultrasound - Ovaries tend to be enlarged with many follicles during a pelvic ultrasound. 

When 2 out of 3 of the above criteria are present and no other reason is found the diagnosis of PCOS is made.  

It is common to do further testing for other complications that frequently accompany PCOS. 

• Laboratory Testing – Measurement of fasting blood sugar, insulin, FSH, LH, DHEAS, total testosterone, TSH, prolactin, and lipid profile.  

• Physical Exam – Assessment of height and weight with body mass index (BMI) calculation and blood pressure. 

Treatment for PCOS 

Lifestyle Changes: The First Step in Fertility Treatment 

Before moving to medical treatments, doctors often recommend lifestyle changes as the first step in managing PCOS-related infertility. Losing even 10% of body weight can significantly improve insulin resistance, reduce blood levels of male hormones, improve lipid abnormalities, and increase your chances of conception. 

Healthy diet: A diet rich in whole foods, lean proteins, healthy fats, and low in refined carbohydrates can improve overall health. Consulting with a nutritionist who has experience treating PCOS is recommended. 

• Eat: 

• • High-fiber veggies & complex carbs 

• • Lean protein 

• • Anti-inflammatory foods 

• Don’t Eat: 

• • Fried foods 

• • Processed carbs 

• • Sugary desserts, candy, or drinks/juices 

Exercise: Regular physical activity helps regulate menstrual cycles, improve insulin sensitivity, and promote weight loss. It is important to consult with your physician before starting any new exercise regimen. 

For many women with PCOS, these small lifestyle adjustments can lead to spontaneous ovulation and increase the likelihood of pregnancy without further intervention. 

Medications 

If lifestyle changes alone aren’t enough, doctors may prescribe medications to help stimulate ovulation. The most common fertility drugs used for women with PCOS include: 

Metformin 

Although Metformin is typically used to treat diabetes mellitus, it can also help women with PCOS. When eating a healthy diet, Metformin has been shown to reduce body weight, abdominal fat, hirsutism, androgen levels, and insulin resistance. Since PCOS is often associated with insulin resistance, Metformin improves insulin sensitivity, which can restore ovulation. Since there are better medical treatments available metformin alone is rarely used today to induce ovulation, however, it is sometimes used in combination with Clomid or Letrozole to improve the chances of conception. 

Clomiphene Citrate  

Clomid is an oral medication used for PCOS-related infertility. It works by changing the way hormones are secreted in the body and results in stimulation of the ovaries to recruit follicles and release eggs. Many women experience successful ovulation within the first few months of treatment. 

Letrozole  

Letrozole is another ovulation-stimulating oral medication that works by lowering estrogen levels, which in turn encourages the ovaries to recruit a follicle and release an egg.  

Gonadotropins: Injectable Hormones to Stimulate Ovulation 

Gonadotropins are injectable hormones that stimulate the ovaries directly. These hormones, which include follicle-stimulating hormone (FSH) and luteinizing hormone (LH), are used to encourage the ovaries to mature and release eggs. 

In-Vitro Fertilization (IVF) for PCOS 

In-vitro fertilization (IVF) may be recommended if medications and other therapies are unsuccessful in aiding conception. It involves stimulating the ovaries to produce multiple eggs, retrieving the eggs, and fertilizing them with sperm in a lab. Once the fertilized egg becomes an embryo, it is transferred back into the uterus in hopes of achieving pregnancy. Many times, patients with PCOS have more than one embryo available and these excess embryos can be then frozen for future use.