PCOS and Fertility: Understanding Ovulation and Your Options

Polycystic ovary syndrome (PCOS) can affect menstrual cycles and ovulation, which may make it harder to predict when pregnancy is most likely. A PCOS diagnosis does not mean that pregnancy is impossible. Many people with PCOS conceive, sometimes without fertility treatment and sometimes with clinical support.

Why ovulation matters

Ovulation is the release of an egg from an ovary. When cycles are irregular or ovulation happens infrequently, there may be fewer chances to conceive over time. Irregular cycles can also make it harder to estimate the fertile window. A clinician can help determine whether ovulation is occurring and whether other factors should be assessed.

Look at the whole fertility picture

PCOS may be one part of the picture, but it should not automatically be assumed to be the only factor. Depending on personal history, an assessment may include cycle and health history, blood tests, ultrasound, review of the uterus and fallopian tubes, and a semen analysis for a partner. The recommended tests vary, and not everyone needs every test.

PCOS can also be associated with metabolic and emotional health concerns. A respectful care plan may include support for general health, sleep, wellbeing, and conditions such as high blood pressure or diabetes when relevant. This is about supporting health, not blaming someone for their body size or their fertility.

What treatment may be discussed?

If a person has infertility due to anovulation alone and no other infertility factors, the 2023 international evidence-based guideline recommends letrozole as the first-line medication for ovulation induction. It is a prescription medicine and is off-label for this use in many countries. A fertility specialist should explain whether it is suitable, how response is monitored, and the possible benefits and risks. Do not take ovulation medicines or hormones without medical supervision.

If the first approach is not suitable or does not work, a clinician can discuss other options based on test results and personal preferences. This may include other medicines or assisted reproduction. Age, duration of trying, other health factors, and access to monitoring can all affect the plan.

Questions to bring to your appointment

• How will we check whether I am ovulating?
• Are there other fertility factors we should assess at the same time?
• What are the benefits and risks of the proposed medicine or procedure?
• How will you monitor treatment and decide what to do next?

Evidence-based care should be individual and collaborative. If PCOS is affecting your cycles or you have questions about pregnancy planning, speak with a fertility specialist at ATG IVF Centre.

Further reading: ASRM: Recommendations from the 2023 international evidence-based guideline.