How Polycystic Ovary Syndrome (PCOS) Impacts Fertility

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions affecting women, and one of the leading causes of infertility. Yet despite its prevalence, PCOS and fertility is still widely misunderstood. Many people are familiar with the “classic” profile: irregular periods, higher body weight, and symptoms like excess hair growth. However, emerging research shows that PCOS affects a much broader community of women than once believed.

As the scientific community learns more about this condition, one thing is clear: PCOS doesn’t look the same for every woman, and it doesn’t uniformly impact fertility, either. Understanding the nuances that can change how PCOS affects you individually can empower you to seek the right evaluation and support earlier in your journey.

About PCOS: Going Beyond the Stereotypes

For decades, PCOS has been portrayed through a narrow lens—most commonly associated with weight gain, insulin resistance, and visibly elevated androgen symptoms. This stereotype has shaped diagnostic patterns and even influenced which women doctors thought “fit” the condition. Today, reproductive endocrinologists recognize that PCOS is far more diverse.

PCOS Affects Women of All Body Types, Backgrounds, and Ages

Women of all shapes, sizes, and ethnicities are diagnosed with PCOS. In fact, recent research highlights how many women, particularly those who are lean or who don’t present with metabolic symptoms, go undiagnosed for years simply because they don’t match the outdated profile. This broader awareness is changing how clinicians screen and evaluate symptoms. For example:

• Leaner women with PCOS may experience ovulatory irregularities, acne, or mild androgen excess without noticeable weight changes—making their symptoms easy to overlook.
• Women of color have historically been underdiagnosed due to disparities in care and less awareness of how PCOS presents across different skin tones and ethnic backgrounds.
• Teenage girls are often told that irregular cycles are normal during adolescence, which can delay diagnosis and early intervention.

Recognizing that PCOS is not defined by a particular body type or any one symptom is essential for getting women the timely care they need, especially when fertility is a concern.

Understanding the Link Between PCOS and Fertility Issues

PCOS affects fertility in several interconnected ways. While many women with PCOS conceive naturally or with help, the condition commonly creates obstacles that make trying to conceive more difficult.

Hormonal Imbalances and Irregular Ovulation

Ovulatory dysfunction is the primary fertility challenge in PCOS. Because hormonal communication between the brain and ovaries becomes disrupted, ovulation may occur infrequently or not at all. Some women ovulate only a few times per year, while others experience unpredictable cycles that make it hard to identify fertile windows. 

Key contributors include:

• Elevated androgens, which interfere with follicle development
• An imbalance of LH and FSH, two hormones essential for egg maturation
• Insulin resistance, which can amplify hormonal disruptions and further destabilize ovulation

These hormonal patterns commonly produce irregular menstrual cycles and can lead to difficulty conceiving without treatment.

Egg Maturation and Quality Challenges

Even when ovulation occurs, hormonal imbalances may impact the size and readiness of the follicle containing the egg. Ultrasounds often show multiple small follicles that do not progress to full maturity—known as the “polycystic” appearance of the ovaries.

Higher Risk of Miscarriage and Uterine Concerns

PCOS can influence fertility even after conception. Women with PCOS may experience:

• Elevated miscarriage rates, often connected to untreated insulin resistance or inflammation
• Irregular shedding of the uterine lining, which can affect implantation and early pregnancy
• Endometrial thickening occurs when periods are infrequent, posing additional reproductive risks

These issues highlight the importance of early diagnosis and tailored treatment plans when pregnancy is the goal.

PCOS Diagnosis and Assessment

Accurate diagnosis is the first step toward addressing fertility challenges related to PCOS. Most clinicians use the Rotterdam criteria, which require two of the following three findings:

1. Irregular or absent ovulation
2. Elevated androgens (based on symptoms or bloodwork)
3. Polycystic ovarian appearance on ultrasound

Because PCOS can look different from one woman to the next, a fertility-focused assessment often includes additional testing.

Hormone Testing

A thorough hormone panel provides essential insight into how a woman’s reproductive system is functioning. In PCOS, hormone levels often fall outside expected patterns, so evaluating key markers in areas like progesterone and estrogen levels helps identify the root of ovulatory issues. This may involve testing:

• LH and FSH levels
• Estradiol
• AMH (anti-Müllerian hormone)
• Total and free testosterone
• DHEA-S
• Thyroid function

Together, these values help providers determine whether hormonal patterns align with PCOS or point to other reproductive or endocrine conditions. They also guide decisions about ovulation induction, medication choices, and the most effective fertility strategy moving forward.

Ovarian Reserve Assessment

Women with PCOS often have a higher number of small resting follicles visible on ultrasound, but this doesn’t always reflect how well those follicles will mature or respond to treatment. Ovarian reserve testing, typically using AMH levels and an antral follicle count, helps assess both the quantity and the potential responsiveness of eggs during fertility treatment.

This information is especially valuable when planning ovulation induction or IVF, as women with PCOS may respond differently to medication than women without the condition. Understanding ovarian reserve helps fertility specialists personalize medication dosing and reduce the risk of overstimulation.

Metabolic Screening

Metabolic health plays a major role in how PCOS affects fertility, even for women who aren’t experiencing weight changes. Because many women with PCOS have some degree of insulin resistance, roughly 35% to 80% show measurable insulin resistance on testing, metabolic screening is often included early in the evaluation. This may involve:

• Fasting glucose and fasting insulin
• Lipid panels to assess cholesterol and triglycerides
• Hemoglobin A1C to evaluate long-term blood-sugar stability

These markers help identify whether underlying metabolic factors could be contributing to irregular ovulation, elevated androgens, or early pregnancy complications. Addressing insulin resistance can dramatically improve cycle regularity and fertility outcomes in some cases.

PCOS Treatment Options & Fertility Support

With the right plan, many women with PCOS achieve healthy pregnancies. Treatment is always individualized, but most plans involve a blend of lifestyle adjustments, targeted medications, and, when needed, assisted reproductive technologies. 

By addressing hormonal balance, supporting regular ovulation, and optimizing metabolic health, fertility specialists can significantly improve a woman’s chances of conceiving and carrying a healthy pregnancy.

Lifestyle Interventions

Even modest improvements in overall well-being can support hormonal balance.

• Nutrition: Anti-inflammatory eating patterns, steady blood sugar support, and balanced macronutrients can help regulate cycles.
• Regular exercise: Improves insulin sensitivity and ovarian response—even in women who are not overweight.
• Stress management: Chronic stress can influence hormones involved in ovulation and menstrual regularity.

These strategies are not cures, but they can enhance the effectiveness of medical treatments.

Medical Management

Several medications can help support ovulation and hormonal stability:

• Ovulation induction medications such as letrozole or clomiphene are often first-line treatments for women trying to conceive.
• Metformin and other insulin-sensitizing agents can be beneficial, especially for women with insulin resistance or metabolic symptoms.
• Hormonal therapies like birth control may be used before fertility treatment to regulate cycles and protect the endometrium.

Assisted Reproductive Technologies (ART)

For women who don’t respond to ovulation induction alone, or who have additional fertility factors, ART may be recommended. This may include:

• IUI (intrauterine insemination): Often used when ovulation can be reliably induced.
• IVF (in vitro fertilization): Allows close monitoring of follicle development and egg retrieval timing, which can be especially advantageous for women with PCOS.
• Egg freezing: Egg preservation is an option for women who want to preserve fertility for future family building.

Fertility specialists carefully customize treatment plans to minimize complications such as ovarian hyperstimulation syndrome (OHSS), which women with PCOS can be more prone to during IVF.

Fertility Center’s PCOS Success Story

Many women with PCOS go on to build the families they’ve dreamed of—with the right care, guidance, and individualized fertility support. At the Fertility Center, we’ve helped countless patients navigate the uncertainty of PCOS and find a clear path to successful conception. 

Here’s one story we’re proud to share from our patient Ashley:

“I was diagnosed with PCOS as a teenager, but did not understand the full impact this diagnosis would have on my fertility until I met with Dr. Donesky at The Fertility Center. At age 14, I was put on birth control and was told that it would regulate my cycle and then I would just come off it when I was ready to conceive. No further explanation as to what PCOS was or what was happening physiologically was provided.

After years of ‘trying’ on our own, my husband and I decided to set up a consultation to go over testing and possible treatment options. Dr. Donesky not only went over our options, he educated my husband and I on how PCOS actually affects not only fertility but my body as a whole.

At first, we wanted to try to conceive as ‘naturally’ as possible. After failed timed intercourse and IUI cycles, we moved on to IVF. Through the entire process, the staff never stopped encouraging us. There was no pressure to ‘move on’ to more invasive treatment. We were allowed to go at our own pace. The doctors made sure we were educated every step of the way and we knew that we were fully supported as we navigated through our journey. 

Even after starting IVF, there were hurdles due to the nature of PCOS and the way my body responded to treatment. Dr. Donesky never gave up. ‘Hang in there, and we will get this,’ he said. And we did. I was blessed to be able to carry and deliver our beautiful son, who is now 4 years old. There are truly no words that can possibly describe our gratitude. To everyone at The Fertility Center that cheered us on every step of the way, we are eternally grateful.”

Contact the Fertility Center for Questions About PCOS and Fertility

If you’ve been diagnosed with PCOS—or suspect that your symptoms may be connected to it—you’re not alone, and you don’t have to navigate the fertility journey without expert support. Our specialists in Chattanooga and Knoxville provide individualized evaluations and treatment plans to help women understand their reproductive health and take meaningful steps toward building the family they envision.

Have questions or want to schedule a consultation? Reach out to us at the Fertility Center for support.