PCOS and fertility: why it can be harder to conceive and what helps

The NHS describes polyendocrine metabolic ovarian syndrome (PMOS), previously called PCOS, as a hormone condition that can affect hair growth, periods, fertility and mood. Symptoms can be mild, severe or absent, and include irregular periods or long gaps between periods, excess hair growth or hair loss, weight gain, difficulty getting pregnant, oily skin and acne.

The NHS says PMOS can sometimes cause problems getting pregnant, usually because the ovaries do not release an egg each month. Its infertility page lists lack of regular ovulation as one of the common causes of infertility in general. The cause of PMOS is unknown, but it may be to do with hormones such as insulin and testosterone not working properly.

The NHS says PMOS can only sometimes cause problems with getting pregnant, so having it does not mean you cannot conceive. Because fertility problems can affect either partner, the NHS says it is best for both to see the GP.

The NHS says more than 8 out of 10 couples where the woman is under 40 will conceive within a year of regular unprotected sex, every 2 or 3 days. It advises seeing a GP if you have not conceived after a year of trying. Women aged 36 or over, and anyone with reason to think they may have fertility problems, should see the GP sooner, because fertility tests can take time and female fertility decreases with age.

If you have irregular periods or other symptoms of PCOS and plan to conceive, it is reasonable to raise this earlier. Irregular or absent periods suggest ovulation may not be happening regularly.

The GP will ask about medical and sexual history, previous pregnancies, how long you have been trying, medicines, and lifestyle factors including smoking, weight, alcohol and stress. A physical examination and referral for tests may follow.

For women, the NHS lists blood tests for progesterone to check ovulation, with gonadotrophin tests if periods are irregular, a chlamydia test, and ultrasound scans of the ovaries, womb and fallopian tubes. Further tests, such as hysterosalpingo-contrast-ultrasonography, a hysterosalpingogram or laparoscopy, are used when a tubal problem is suspected. Men are offered a semen analysis and chlamydia test. For PMOS itself, the NHS says tests include blood tests to check hormone levels and insulin resistance and an ultrasound scan of the ovaries, which is only done in people over 18.

The NHS advises a healthy, balanced diet, regular exercise and weight loss if you are overweight. It notes that being overweight, with a BMI of 30 or over, reduces fertility, and that in women being overweight or severely underweight can affect ovulation. Smoking and alcohol can also affect fertility. The NHS says the safest approach to alcohol when trying for a baby is not to drink at all.

These measures are not a failure of effort if conception still takes time. They support ovulation and general health and can be combined with medical treatment.

The NHS lists clomifene, which encourages the monthly release of an egg in women who do not ovulate regularly or at all, tamoxifen as an alternative that may be offered, metformin, which it says is particularly beneficial for women with PMOS, gonadotrophins and other hormone medicines. Possible side effects include nausea, vomiting, headaches and hot flushes, so it is worth discussing specific medicines with the doctor.

Treatment is usually offered under specialist supervision. Medicine that stimulates the ovaries is not recommended for unexplained infertility because it has not been found to improve chances.

If ovulation medicine has not worked, the NHS says a minor procedure called laparoscopic ovarian drilling can be used. It uses heat or a laser to destroy part of the ovary and may help release more eggs, which can sometimes increase the chance of getting pregnant.

Assisted conception includes intrauterine insemination (IUI) and in vitro fertilisation (IVF). In IVF fertility medicine encourages the ovaries to produce more eggs, which are collected, fertilised in a laboratory and returned to the womb as embryos. The NHS notes that IVF can cause complications such as multiple pregnancy, where more than one embryo is placed in the womb, and a slightly increased risk of ectopic pregnancy.

The NHS says the treatment offered depends on the cause and on what is available from your local integrated care board (ICB). NHS-funded fertility treatment varies across the UK, waiting lists can be long and eligibility criteria vary, but everyone has the right to be referred to an NHS clinic for initial investigation.

Private treatment is available but can be expensive and there is no guarantee of success. The NHS says to choose a clinic licensed by the Human Fertilisation and Embryology Authority (HFEA), ask for a personalised, fully costed plan and compare treatments offered, success rates, waiting times and costs. It also says there is no evidence that complementary therapies for fertility problems are effective.

The NHS notes that PMOS can increase the risk of conditions such as type 2 diabetes, high blood pressure, cardiovascular disease, non-alcoholic fatty liver disease and womb cancer, and advises regular check-ups. Support is available from charities such as Verity and the British Fertility Society, which are signposted by the NHS.