Treating Infertility in Polycystic Ovary Syndrome (PCOS): Causes and Fertility Solutions

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• PCOS and Infertility Link
• PCOS Causes and Insulin Resistance
• Fertility Treatments for PCOS
• Lifestyle and Weight Impact on PCOS
• PCOS Prevalence and Western Lifestyle
• PCOS Heterogeneity and Diagnosis
• When to Seek Aggressive Treatment

PCOS and Infertility Link

Polycystic ovary syndrome is a leading cause of female infertility, impacting an estimated 5% to 10% of all women. Dr. Heather Huddleston, MD, describes PCOS as the most common endocrine disorder in women, characterized by a classic triad of symptoms: irregular menstrual cycles, elevated androgen levels (leading to acne or excess hair growth), and the presence of polycystic ovaries on an ultrasound. The primary fertility problem for women with PCOS is anovulation, or the failure to release an egg regularly, which is indicated by having very irregular or absent periods.

PCOS Causes and Insulin Resistance

The underlying etiology of polycystic ovary syndrome is complex and multifaceted. Dr. Heather Huddleston, MD, explains that while the exact cause is still debated, a key factor is insulin resistance. This condition results in elevated insulin levels in the blood, which is found in high levels in women with PCOS. Insulin resistance is believed to disrupt normal ovarian function, contributing to the hormonal imbalances and lack of ovulation that define the syndrome. This metabolic component links PCOS directly to broader health issues.

Fertility Treatments for PCOS

The good news, according to Dr. Heather Huddleston, MD, is that infertility from PCOS is highly treatable. The primary goal of treatment is to induce regular ovulation. First-line therapy typically involves simple oral medications taken for just five days. Clomiphene citrate (Clomid) and letrozole (Femara) are the most common agents used to trick the body into stimulating an egg to develop and be released. These treatments are remarkably effective, successfully restoring fertility and allowing for conception in approximately 70% to 80% of women with PCOS.

Lifestyle and Weight Impact on PCOS

Lifestyle and body weight play a crucial role in the manifestation of polycystic ovary syndrome. Dr. Heather Huddleston, MD, notes that a subset of women may have a latent form of PCOS that only becomes clinically apparent after weight gain. An increase of 10 to 20 pounds, especially when coupled with a sedentary lifestyle, can elevate insulin levels enough to shift the body into a full PCOS phenotype, unmasking the condition. This highlights how modifiable factors can significantly impact the syndrome's severity and symptoms.

PCOS Prevalence and Western Lifestyle

While high-quality data on historical trends is lacking, Dr. Heather Huddleston, MD, suggests that the prevalence of PCOS may be influenced by modern Western lifestyles. Diets high in sugar and processed foods are known to exacerbate insulin resistance. Dr. Anton Titov, MD, adds context from discussions on how sugar consumption has driven average insulin levels up nearly threefold in recent decades, which correlates with increases in obesity, metabolic syndrome, and certain cancers. This environment likely makes PCOS more common and more severe than it might be in populations with different dietary and activity patterns.

PCOS Heterogeneity and Diagnosis

Polycystic ovary syndrome is a heterogeneous condition, meaning it has multiple underlying causes and presents differently from patient to patient. As Dr. Heather Huddleston, MD, explains, this variability is precisely why it is classified as a syndrome rather than a single disease. Some women will have clinical PCOS regardless of their weight or lifestyle, while for others, it is directly tied to metabolic health. This heterogeneity can make diagnosis and treatment planning complex, underscoring the value of a thorough medical evaluation.

When to Seek Aggressive Treatment

For the small percentage of women with PCOS who do not respond to first-line oral ovulation induction medications, more aggressive treatment is available. Dr. Heather Huddleston, MD, describes the next step as injectable medications (gonadotropins), which are more potent and require daily injections. Fortunately, she emphasizes that the majority of patients achieve success with oral medications and never require this level of intervention. A medical second opinion can be invaluable for confirming a PCOS diagnosis and ensuring the chosen treatment plan is the most appropriate and effective path forward.

Full Transcript

Dr. Anton Titov, MD: Infertility and polycystic ovary syndrome often coexist. How does PCOS cause infertility? How to treat infertility in women with polycystic ovary syndrome? Which life events can unmask latent PCOS?

A leading fertility expert explains the link between polycystic ovary syndrome and infertility.

Polycystic ovary syndrome is a frequent cause of infertility. Polycystic ovary syndrome makes getting pregnant more difficult due to problems with ovulation.

Clomiphene citrate (Clomid) is an effective medication in treating infertility due to PCOS. Insulin resistance is a problem for getting pregnant. Insulin resistance increases with rising body mass index. Obesity also unmasks subclinical PCOS.

Polycystic ovarian syndrome—getting pregnant is possible with oral medications like Clomid and Femara, but infertility rates still remain high in women with PCOS. Sometimes women require intravenous medications.

Infertility and polycystic ovary syndrome are closely linked together. A medical second opinion confirms that polycystic ovary syndrome diagnosis is correct and complete. A medical second opinion also confirms that PCOS infertility treatment is required.

Medical second opinion helps to choose the best treatment for polycystic ovary syndrome infertility. Get a medical second opinion on PCOS infertility and be confident that your treatment is the best. Infertility and polycystic ovary syndrome can be treated successfully.

Dr. Anton Titov, MD: Polycystic ovary syndrome (PCOS) is a common disorder. What is it? What impact does PCOS have on fertility and reproductive potential of a woman? What are common treatments for the fertility problems in women with polycystic ovary syndrome?

Dr. Heather Huddleston, MD: Polycystic ovary syndrome, or PCOS, impacts about 5% to 10% of all women. It's the most common endocrine disorder in women. It is associated with irregular menstrual cycles and increased androgens.

Women with PCOS have higher levels of testosterone, acne, or hair growth. There is also a characteristic finding of polycystic ovaries on ultrasound. That is a classic triad that we often see in polycystic ovary syndrome.

The biggest issue from a fertility standpoint for these women is that they are not ovulating very regularly, or they may not be ovulating at all. They are not releasing an egg. We know this because they are having very irregular periods or no periods at all.

Dr. Anton Titov, MD: What is the underlying etiology? What's causing polycystic ovary syndrome?

Dr. Heather Huddleston, MD: This is still somewhat debatable. There are probably multiple causes of PCOS. But we do think insulin resistance may be causing some of the disorder in the ovary. Insulin resistance means elevated insulin levels in the blood.

We do find a high level of insulin resistance in women with PCOS. Regarding fertility treatment, the good news for women with PCOS is that it is highly treatable. We need to just help women release an egg on a more regular basis.

Usually we are able to treat women with PCOS by using just oral medication. One medication to treat PCOS is clomiphene citrate (Clomid). Letrozole (Femara) is another medication that we are using.

These medications, when taken for just five days, can trick the body into stimulating an egg to develop in the ovary. Ovulation will happen. We think that this will treat the fertility concerns of women with PCOS about 70% of the time.

Fertility returns maybe even in 80% of the time. It will allow for an egg to be released, and then generally conception will follow pretty quickly. There is a small percentage of women who don't respond to these medications.

Then we would need to go for more aggressive treatment with injectable medications. These are medications that have to be taken as injections. But fortunately most women don't ever need to get to that stage.

Dr. Anton Titov, MD: It's interesting that you mentioned insulin resistance playing a major role in polycystic ovary syndrome. I had a discussion with Dr. Robert Lustig about the effects of sugar consumption on insulin resistance.

It was interesting to see that the levels of insulin over the last several decades increased almost three times on average in people. Does it mean that the prevalence of polycystic ovary syndrome has increased over the last several decades?

Is there any correlation between sugar consumption and infertility? This is an interesting topic. Obesity might correlate with increased amounts of insulin. Even cancer rates correlate with increased amounts of insulin.

There are certainly mutations in insulin-like growth factors and insulin receptors. So this all seems like a part of metabolic syndrome. What is known about that?

Dr. Heather Huddleston, MD: PCOS may have increased in its prevalence. I don't know that we really know it. There have not been any high-quality clinical trials done to answer that question.

We do know that there are a subset of women who may not have symptoms of polycystic ovary syndrome. They may not even really know they have PCOS unless they gain a certain amount of weight.

Women who had a lower BMI might have regular menstrual cycles. They might not really notice anything different about them. But then they happen to gain 10 to 20 pounds. They also have a very sedentary lifestyle.

Then they will manifest PCOS. Because maybe the insulin levels go up and shift the body more into polycystic ovary syndrome phenotype. So PCOS is to some degree in some patients modifiable and impacted by lifestyle and obesity.

Other women are different. No matter what they do, whether they are lean or overweight, they will have clinical PCOS.

Dr. Anton Titov, MD: This is probably why it's called a syndrome and not a disease.

Dr. Heather Huddleston, MD: Yeah, exactly. PCOS is probably very heterogeneous. There is probably multiple underlying etiology. So it's very difficult sometimes to group all patients with polycystic ovary syndrome together.

For sure, with the Western lifestyle, PCOS rates are going to be pretty high. Whereas sometimes in a different environment, it's possible that many cases of PCOS would either not really be obvious, or these PCOS cases would be less severe than they are now with Western lifestyle.

Infertility and polycystic ovary syndrome. PCOS is the most frequent infertility cause.