PCOS Fertility Treatments & PCOS Infertility: Your Expert Guide

Navigating polycystic ovary syndrome (PCOS) while trying to conceive can be... challenging, to say the least.

PCOS infertility can be a common symptom, messing with cycles and ovulation timing.

But there is hope.

Embryologist Navya Muralidhar is here to unravel the mysteries of PCOS fertility treatments.

So, ready to flip the script on PCOS and fertility?

We're right behind you.

In this article: 📝

Is it harder to get pregnant with PCOS?

Sometimes, yes, it can be a longer journey to pregnancy for people with PCOS.

PCOS is a common (yet curable or treatable) cause of infertility in women, which leads to hormonal imbalance, issues with ovulation, or even mild to moderate infertility in women.

But there are fertility treatments that can cure or treat PCOS-based infertility and help you get pregnant.

What are fertility treatments for PCOS?

Around 70% of women with PCOS experience no ovulation, or disrupted, irregular ovulation, so many of the PCOS fertility treatments available look at those specific issues.

And there are options ‒ here are the seven most common PCOS fertility treatments, along with more information about what they do and who they might be suitable for.

1. Clomiphene citrate

Clomiphene citrate is an anti-estrogen drug, used in cases of anovulation (meaning no ovulation or egg release) or dysregulated ovulatory cycles.

This can help address the hormonal imbalance caused by PCOS and help with timely menstrual cycles or induce ovulation.

Clomiphene is often recommended to people with PCOS who are trying to conceive in their natural cycle or undergoing IUI.

2. Tubal evaluation

In some cases of PCOS, where there is an absence or irregular egg release, it’s essential to check for any blockage in the fallopian tubes (the path where the egg travels and stays until it's fertilized).

This may be a causative factor, contributing to infertility.

So in these cases, tubal evaluation may be offered to see if there are any obstructions in your fallopian tubes.

3. Letrozole

Letrozole is a nonsteroidal drug that's used to treat the hormonal imbalance due to PCOS and helps the follicle housing the egg to grow.

Letrozole also works best in cases where patients do not respond well to clomiphene citrate.

Some studies showcase higher birth rates and lesser risks of multiple pregnancies with letrozole.

Letrozole can be prescribed to those trying to conceive in their natural cycle or through IUI.

4. Gonadotropins

Gonadotropins are often a second option for those with PCOS who don't respond to treatment with CC (clomiphene citrate) or Letroz (Letrozole).

The hormones that help grow the follicle and mature the egg in the ovary are called gonadotropins.

While these are present naturally, the hormone imbalance in PCOS leads to a drastic change in its levels.

In this treatment, synthetic gonadotropins are prescribed, increasing or decreasing the dosage as needed, as the growing egg is monitored.

When combined with metformin (a drug to balance insulin sensitivity in PCOS), studies found a higher live birth rate, compared to using gonadotropins alone.

Another study also found higher chances of clinical pregnancies without an increase in multiple pregnancies, when using gonadotropins in comparison with clomiphene citrate.

So, as always, it's worth discussing with your doctor to find the most suitable PCOS fertility treatment for you.

5. IUI

IUI (intrauterine insemination), also known as artificial insemination, involves the use of ovulation drugs (like clomiphene citrate, letrozole, or gonadotropins), and monitoring egg growth.

Then your doctor will administer a dose of hCG (human chorionic gonadotropin), to mature your eggs.

On the day of egg release, you'll be called to your clinic, the semen sample will be collected from your donor or partner, or a frozen sperm sample will be washed, clinically prepared, and inserted into the uterus.

According to this study, in IUI, the thickness of the endometrium (the inner lining of the uterus) plays a key role in predicting positive pregnancy outcomes.

The results showed that having optimal thickness can lead to more positive pregnancy outcomes for patients with PCOS.

6. IVM

IVM (in vitro maturation) is an emerging treatment for PCOS infertility ‒ an alternative to IVF for people with PCOS.

This is because the dosage of medications in IVF may overstimulate or may not be effective for those with PCOS.

IVM is a procedure similar to IVF, but it involves low costs for procedures and medications.

7. IVF or ICSI

IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection) are often recommended as a third-line treatment for those with mild to moderate PCOS if ovulation induction drugs fail, or if there is male factor infertility involved.

But it's advised to continually monitor and prescribe lower dosages of drugs for people with PCOS, due to the higher risk of ovulation overstimulation.

8. Semaglutides

Okay, so these aren't technically fertility treatments, but they can help you shift some PCOS weight gain, which could help improve your chances of conception.

Semaglutides, like Ozempic, Wegovy, and Mounjaro, were originally diabetic treatments, but have been proven to aid with significant weight loss, many times for people with PCOS, which has helped them to conceive naturally.

Is infertility due to PCOS curable?

Yes, PCOS infertility can be curable and doesn't mean that you can't conceive.

PCOS interferes with the hormonal events that lead to proper maturation and release of the egg.

Medications are given to stimulate this cycle or induce egg growth and maturation in anovulatory (no egg release) or dysregulated cycles.

Can I do IVF if I have PCOS?

Yes, when other forms of first-line treatments do not work, IVF is an option if you have PCOS.

Generally speaking, those who try to conceive with IVF have around a 70% success rate, but there aren't any definitive figures for the IVF success rate for people with PCOS.

Some studies suggest around a 60% success rate, while others show results of around 35%.

But with IVF, it's important to keep regular appointments with your doctor, because, for those with PCOS, there is a higher risk of ovulatory overstimulation from IVF medications.

What fertility treatment is best for PCOS?

Clomiphene citrate is the most common fertility treatment option for PCOS.

But there are other alternatives, like letrozole and gonadotropins, that can treat irregular and anovulatory menstrual cycles.

If these treatments do not work, methods such as IUI, IVM, and IVF/ICSI are other PCOS fertility treatments that can be offered, usually after medication.

How can I increase my fertility with PCOS?

Along with medical treatments, there are other lifestyle changes that could help increase your fertility with PCOS.

Eating a balanced diet rich in proteins, healthy fats, and vegetables, staying active through regular exercise, and managing your stress levels (through activities like yoga and meditation) can help.

The journey to conceive with PCOS can be a challenging one.

But regardless of the roadblocks, there are diverse and personalized treatments available that can help you on your journey to a successful pregnancy.

If you think you have PCOS, the best first step is to talk to your doctor.

From there, medications and recommended lifestyle changes could help boost your fertility.

And if you want to chat with other women who get it, you're always welcome to join our Peanut Community.

You're not alone.