PCOS and your fertility: Can you get pregnant with polycystic ovarian syndrome?

Does having PCOS make it more difficult to conceive? Photo / Getty Images

Polycystic ovarian syndrome (PCOS) affects one in eight women in New Zealand and is a leading cause of infertility, according to the World Health Organisation. But research including a recent study from the University of Queensland shows women with PCOS undergoing fertility treatment have the same birth rate as those without. So what does having PCOS really mean for your fertility?

When Clare Goodwin was diagnosed with PCOS at 24, she immediately opened up a bank account to start saving for fertility treatment - even though she wasn’t planning to get pregnant “anytime soon”.

“All I really got told was, ‘You’re going to struggle to get pregnant’, and that was it, with no further explanation. And so my immediate assumption was, ‘I am infertile’,” she tells the NZ Herald.

Goodwin, a qualified nutritionist who’s since written a book, Getting Pregnant with PCOS, and founded online clinic Ovie to help women manage their PCOS symptoms, says she wishes her doctor had reassured her about her ability to conceive.

“My doctor said, ‘Just come back and see us when you want to get pregnant’. It’s very assumptive that everybody can afford medical treatment or that everybody even wants medical treatment,” she says.

“Fertility treatment can be really effective, and that’s amazing - I love that it’s an option for women with PCOS.

“But what I think we need to be better at is saying, ‘There are multiple options for you. You’re not infertile. It’s just that your hormones aren’t allowing you to ovulate at the moment or ovulate regularly. And that’s why, if you were trying to conceive, it might just take you a little bit longer to get back to ovulating regularly so that you can conceive’.”

An elite athlete during her 20s, Goodwin always had a “very irregular” menstrual cycle.

“I didn’t get a cycle for about three years and then I had weight gain which didn’t match with my lifestyle ... I was training 20-plus hours a week and eating along the sports nutrition guidelines,” she explains.

She was then diagnosed with insulin resistance, also known as pre-diabetes, and had acne - both common with PCOS.

Other drivers include stress, thyroid issues and inflammation, all of which “contribute to this hormonal, metabolic storm that is PCOS”, she says.

“But that doesn’t mean that they can never regulate, and there are lots of ways you can regulate this, so fertility treatment is one. Also, lifestyle changes have been shown to be super-effective for ovulatory menstrual cycles - a majority of people find that their cycles can regulate within three to six months of really easy lifestyle tweaks.”

Those tweaks include making changes to your diet, sleep and exercise routine, which Goodwin credits with helping her conceive and give birth to her daughter, now a toddler.

Clare Goodwin, PCOS nutritionist and founder of the app Ovie. Photo / Supplied by Clare Goodwin

“I got pregnant very easily at 36, no issues at all - but only because I had then been ovulating very regularly for the last seven years once I changed those lifestyle factors,” she notes.

“But had I tried to conceive at that time when I got diagnosed, I absolutely would have had problems because I just was not ovulating.”

A December 2023 study conducted by the University of Queensland found women with PCOS undergoing fertility treatment have the same birth rate as women who don’t have the condition.

Dr Katrina Moss, of the university’s School of Public Health, said at the time, “We studied 1109 women who were using fertility treatments and found no difference in births between the women with and without PCOS or between those on different treatment paths.

“More women with PCOS used fertility treatment - 38% compared to 13% of women without PCOS - but the birth rate was equivalent, so women with PCOS were not disadvantaged.”

What is PCOS?

Repromed medical director Dr Devashana Gupta says polycystic ovarian syndrome is “a bit of a misnomer”, not to be confused with ovarian cysts.

Ovarian cysts are growths on the ovaries, often asymptomatic, which don’t typically lead to a hormone imbalance like PCOS does.

Rather, women with PCOS have “multi-follicular ovaries”. Follicles are small sacs of fluid in the ovaries, each containing an immature egg.

“They have multiple follicles that are stuck at a certain stage and aren’t growing beyond that level to produce that egg,” Gupta explains.

“They have irregular periods and that’s a consequence of not releasing eggs or ovulating, so therefore they have ovulatory dysfunction.”

What causes PCOS?

It’s believed genetics may play a part in causing PCOS, though the exact cause isn’t known.

“We do know it runs in families ... but there’s no defined cause, and obviously there’s no defined cure - symptoms can vary,” Gupta says.

To be diagnosed with PCOS, you need to display at least two of these symptoms:

• Irregular periods - absent, frequent, or far apart;
• High androgen levels evident in blood tests and in physical features, such as excess body hair, facial hair or frontal balding, acne, oily skin;
• Multiple follicles on at least one of your ovaries - at least 20 - determined by an ultrasound;
• A high egg count according to an AMH (anti-Mullerian hormone) test - for women with PCOS, that number is typically higher than average.

“We do see that for various reasons, a lot more women with PCOS do have stress, anxiety and depression, whether it’s around the body image, whether it’s the blood features,” Gupta adds, noting that weight gain, lethargy and chronic fatigue are also common.

But while PCOS does have an impact on fertility, women with the condition can usually conceive successfully unless other complications are involved, such as endometriosis.

Women with PCOS can undergo ovulation induction, during which they are given medication to stimulate the ovaries to release an egg.

“Helping them ovulate usually does the trick, unless they have other problems,” Gupta explains.

“The reassuring thing is that you know, if you need treatment, you are probably one of the higher prognostic candidates, because you’re seeking treatment earlier because you’re having irregular cycles and therefore you’re already in the system with the gynaecologist.

“The problem is, if people don’t have periods, they can’t be actively trying. [If] they don’t have regular cycles, they can’t be trying.”

However, since women with PCOS typically seek help with fertility at a younger age, they have “very similar or even slightly higher odds of conceiving”, Gupta explains.

Repromed medical director Dr Devashana Gupta says women with polycystic ovarian syndrome can usually conceive successfully.

Getting pregnant with PCOS

If you have PCOS, changes to your diet and exercise and achieving a healthy weightt with the help of a dietician or nutritionist can help regulate your cycle.

“You want to have a low glycemic index diet and make sure you’re not having too many refined carbohydrates and sugars, because later on in life you could be prone to diabetes, so you need to optimise that right from the word go,” Gupta says.

Getting at least 150 minutes of moderate to high-intensity exercise a week, avoiding excess chemicals and taking your usual vitamins and supplements can also help.

“Subsequent to that, you’ll start having periods on your own, and then you hopefully can conceive on your own without needing any assistance.

“It’s better to seek help earlier rather than later, just to ensure you can manage your lifestyle, your health, any gynaecological concerns and then fertility.”

Bethany Reitsma is an Auckland-based journalist covering lifestyle and entertainment stories who joined the Herald in 2019. She specialises in telling Kiwis’ real-life stories, money-saving hacks and anything even remotely related to coffee.