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Understanding Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is a common reproductive disorder and one of the leading causes of infertility in individuals assigned female at birth. At Boston IVF, we specialize in treating PCOS to help individuals overcome fertility challenges and achieve their family building goals.

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What is PCOS?

PCOS is a common endocrine and reproductive disorder, affecting 6% to 12% of people with ovaries. It is estimated that PCOS causes 80% of infertility cases in patients who aren’t ovulating regularly. Polycystic ovary syndrome is somewhat of a misnomer, as the issue is not due to ovarian cysts. It is a metabolic syndrome affecting hormones, ovulation, and fertility.

Because PCOS is a syndrome, it is characterized by a set of symptoms. The Rotterdam Criteria, which is the most accepted definition of PCOS, states that a person has PCOS if they have at least two of these three symptoms: hyperandrogenism , ovulatory dysfunction, and polycystic appearing ovaries on ultrasound.

Let’s look a bit closer at how these symptoms might appear:

✓ Hyperandrogenism (elevated male-type hormones like testosterone) can be expressed as acne, excess facial and body hair (hirsutism), and thinning of hair on the crown of the head. It may also be measured in lab tests.

✓ Ovarian dysfunction in the form of irregular or absent ovulation or periods is typically a central aspect of PCOS.

✓Polycystic ovaries, often seen in PCOS, may be diagnosed via ultrasound, showing a ‘string of pearls’ appearance around the edge. This results from immature follicles (egg-containing sacs) accumulating in the ovaries—misleadingly called cysts—that started developing but didn’t reach ovulation.

My husband and I started actively trying to get pregnant with no success. I have PCOS and was rarely ovulating on my own. I was losing hope, but my doctor reassured me that she believed I would get pregnant.

Tiffani & Tim, New York

PCOS

Read their story>

HOW DOES PCOS AFFECT FERTILITY?

For a person with PCOS, an egg is not released during ovulation, so the fluid-filled follicles don't break down and may appear as small cysts. Over time these cysts can accumulate, hence the name poly-cystic ovary syndrome. What can be confusing is that you don’t need to have cystic-appearing ovaries to be diagnosed with PCOS. When present, the cysts are not causing PCOS but rather are a side effect of the hormonal changes and imbalances seen in PCOS that can disrupt the hormone messaging needed to trigger ovulation.

WHAT CAUSES PCOS?

Abnormal levels of sex hormones and excess insulin due to insulin resistance are the causes of many of the symptoms of PCOS and associated infertility.

People with PCOS have an unbalanced production of the main hormones that control ovulation - follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Elevated levels of insulin can also lead to overproduction of other hormones such as testosterone. This imbalance of hormones can contribute to the inability of a mature egg to be released, resulting in absence of ovulation.

View nutritionist Hillary Wright’s talk on diet and PCOS>

While PCOS is believed to be genetic and incurable, it is controllable. It’s not like just flipping a light switch—there are a number of little pieces that need to come together to create a healthy body and support fertility.

Hillary Wright, MEd, RD, LDN

Director of Nutritional Counseling

WHAT ARE THE SYMPTOMS OF PCOS?

PCOS symptoms are different from person to person, but many of these symptoms are caused by hormone imbalances. Some common symptoms include:

✓ Irregular, infrequent, or absent menstrual periods
✓ Excess facial and body hair (hirsutism)
✓ Acne
✓ Infertility
✓ Thinning hair on the scalp
✓ Weight gain or obesity
✓ Insulin resistance or type 2 diabetes

HOW ARE PCOS AND INSULIN RESISTANCE RELATED?

Insulin resistance occurs when the body’s cells have a decreased ability to respond to insulin, the hormone that controls the level of glucose in the blood. In a person with insulin resistance, the pancreas secretes extra insulin to overcome this resistance and balance blood sugar levels. This excess insulin circulating in the body is thought to contribute to the hormonal changes seen with PCOS. The extra demand for insulin can also stress the pancreas over time, which if left untreated may lead to type 2 diabetes.

Insulin resistance can occur in people of all weights but tends to be more severe in people with obesity. Weight loss of as little as 5 - 10% may help balance insulin and sex hormone levels and improve a person’s chances of ovulating and conceiving.

HOW IS PCOS DIAGNOSED?

No single test can be used to diagnose PCOS. To make a PCOS diagnosis, a healthcare provider will look at a person’s medical history in combination with certain tests, including hormonal blood testing and often an ultrasound of the ovaries.

Treatment options for PCOS

Infertility due to PCOS is highly treatable. Once we’ve established a diagnosis of PCOS, a world of treatment possibilities opens up to help you get pregnant. Diet and exercise may help successfully manage some of the general PCOS symptoms, but often medical treatment is needed as well.

Learn more about PCOS-focused nutritional counseling +

Helping people with PCOS conceive since 1986

Prospective parents with PCOS are in the best possible hands at Boston IVF. Since our founding, we’ve helped thousands of families to grow, including many individuals and couples facing PCOS.

With a personalized approach tailored to each patient’s unique needs, we provide the support, guidance, and advanced care necessary to turn the dream of starting a family into a reality.

Boston IVF is a fertility clinic unlike any other:

Experience treating the toughest infertility cases since 1986

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A longstanding affiliation with Harvard Medical School

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Once a person undergoes IVF, it’s up to the lab to give any embryos the best possible conditions to grow in. Boston IVF utilizes the most cutting-edge technology to maximize embryo development and help your clinical team select the best embryo for transfer.

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PCOS Nutrition Counseling

On staff at Boston IVF is Hillary Wright, MEd, RD, LDN, a registered dietitian and PCOS expert who specializes in fertility nutrition. Hillary works seamlessly with Boston IVF doctors to help support diet and lifestyle management, especially in patients with PCOS.

Nutrition Support at Boston IVF

Pioneering modern fertility treatments for all modern families.

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