Every month, couples across the world, including many here in Pakistan, sit across from a doctor and hear the words “You may have PCOS.” For women who dream of becoming mothers, this diagnosis can feel heavy.
Polycystic Ovary Syndrome, or PCOS, is one of the most common hormonal disorders in women of reproductive age. Yet it remains misunderstood, surrounded by myths and half-truths.
PCOS does not mean infertility. Many women with PCOS do conceive and carry healthy pregnancies. However, the condition does create obstacles, and for parents trying to understand why conception is difficult, it is important to know what PCOS is, how it affects ovulation, and what steps can help overcome the challenges.
This article will walk you through PCOS step by step, just as I would if you were sitting across from me in the clinic.
What Exactly Is PCOS?
Polycystic Ovary Syndrome is a hormonal imbalance that affects how the ovaries work. Normally, each month, the ovaries develop follicles that grow and release a mature egg in a process called ovulation.
In PCOS, the hormonal balance is disturbed. Instead of one follicle maturing and releasing an egg, many small follicles start to grow but stall midway. The ovaries often look enlarged and dotted with tiny cyst-like follicles on ultrasound, though the word “polycystic” can be misleading because these are not true cysts but immature follicles.
The main hallmark of PCOS is irregular ovulation or anovulation (no ovulation). Without regular ovulation, it becomes difficult to predict fertile days or even have an egg available for fertilization, which is why conception can be delayed.
Causes and Risk Factors
PCOS does not have a single cause. It is a combination of genetic and lifestyle factors. Research shows that PCOS tends to run in families, meaning if your mother or sister has it, your chances may be higher.
At the same time, lifestyle choices such as diet, weight, stress, and more can also worsen the symptoms.
Two main processes play a role:
- Insulin Resistance: Many women with PCOS have higher insulin levels. This makes it harder for the body to manage blood sugar and can trigger the ovaries to produce more androgens (male hormones).
- Hormonal Imbalance: Higher levels of androgens interfere with the development of follicles, preventing the release of a mature egg.
Symptoms That Signal PCOS
PCOS affects each woman differently, but there are some common signs that doctors look for:
- Irregular or missed periods
- Difficulty conceiving despite regular attempts
- Excess hair growth on the face, chest, or back (hirsutism)
- Oily skin and acne
- Weight gain or difficulty losing weight
- Thinning hair on the scalp
- Darkened skin patches, especially around the neck or armpits
Not all women with PCOS will experience all these symptoms. Some women only discover they have PCOS when they face difficulty conceiving and undergo fertility testing.
How PCOS Makes Conception Difficult
The main reason PCOS creates fertility problems is the disruption of ovulation. In a healthy cycle, one dominant follicle matures fully and releases an egg. In PCOS, this process is disturbed. Multiple small follicles begin to develop but fail to reach maturity, leaving no egg to release.
This irregular or absent ovulation is the biggest barrier to conception. But PCOS affects fertility in other ways as well:
- Hormone Imbalance: Higher androgen levels interfere with normal menstrual cycles and disrupt the uterine environment.
- Egg Quality: Even when ovulation occurs, the eggs released may be immature or of lower quality.
- Uterine Lining Issues: Hormone imbalance sometimes prevents the uterine lining from thickening properly, which reduces the chances of implantation.
- Metabolic Problems: Insulin resistance can lead to weight gain, which further disrupts hormones and fertility.
PCOS and Fertility at a Glance
| Function | Normal Ovary | PCOS Ovary |
| Follicle growth | One follicle matures fully each cycle | Many follicles remain immature |
| Ovulation | Egg released monthly | Irregular or absent egg release |
| Hormones | Balanced estrogen and progesterone | Higher androgens, disrupted balance |
| Menstrual cycle | Regular periods | Irregular or missed periods |
This comparison helps explain why women with PCOS often try for months or years without success, even though they are otherwise healthy.
Can Women with PCOS Get Pregnant?
Yes! Absolutely. PCOS does not mean permanent infertility. Many women with PCOS conceive naturally, and many more with medical support. The challenge is timing and consistency. Without predictable ovulation, the window for conception becomes unclear. Pregnancy is achievable by regulating cycles and supporting ovulation.
Treatment and Management Options
Doctors approach PCOS-related infertility in two ways: lifestyle changes and medical treatment.
Lifestyle Approaches
These are the first steps because they often improve symptoms dramatically.
- Weight Management: Losing even 5–10% of body weight can restore ovulation in many women.
- Diet: Focus on whole foods, high-fiber vegetables, lean proteins, and fewer refined sugars.
- Exercise: Regular physical activity improves insulin sensitivity and hormonal balance.
- Stress Management: Mindfulness, prayer, or yoga can support cycle regularity.
Medical Approaches
When lifestyle changes alone are not enough, doctors prescribe treatments.
- Ovulation Induction Tablets: Medicines like Letrozole or Clomiphene encourage follicles to grow and release eggs.
- Insulin-Sensitizing Drugs: Metformin helps reduce insulin resistance, supporting ovulation.
- Hormone Injections (Gonadotropins): Used when tablets do not work, especially in IVF cycles.
- In-Vitro Fertilization (IVF): Eggs are collected from stimulated follicles and fertilized in the lab.
Living with PCOS
Fertility struggles with PCOS go beyond biology. The irregular cycles, repeated disappointments, and visible symptoms like weight gain or acne can weigh heavily on self-esteem and relationships. Women blame themselves, though PCOS is not their fault.
Counseling, support groups, and open conversations with partners can make the journey easier. Parents need to remember that medical science today offers many tools, and with the right support, hope remains strong.
Conclusion
Polycystic Ovary Syndrome is one of the most common reasons couples face delays in conception. It disrupts ovulation, alters hormones, and sometimes affects egg quality. But PCOS does not mean the end of hope. With early diagnosis, lifestyle improvements, and timely treatment, many women with PCOS go on to conceive and have healthy children.
Understanding PCOS is the first step. For parents, it is reassuring that the struggle is not personal failure but a medical condition with solutions. With knowledge, patience, and the right medical care, parenthood remains within reach.
FAQs
Q1: Does PCOS mean I cannot get pregnant?
No. PCOS makes conception more difficult but not impossible. Many women conceive naturally, while others need medication or fertility treatments. With proper lifestyle changes, timely medical care, and patience, the chances of pregnancy remain very realistic.
Q2: What is the biggest fertility issue in PCOS?
The main challenge is irregular or absent ovulation. Without consistent egg release, conception cannot occur. Even when ovulation happens, it may be unpredictable, which complicates timing. This is why women with PCOS often need medical support to conceive.
Q3: Can lifestyle changes really help?
Yes. Lifestyle improvements are often the first step. Modest weight loss, a balanced diet, and regular exercise improve hormone balance and insulin sensitivity. For many women, these changes are enough to restore ovulation and significantly improve fertility outcomes naturally.
Q4: Do all women with PCOS need IVF?
No. IVF is not always required. Many women conceive with tablets like Letrozole or Clomiphene, or with simple hormone injections. IVF is usually reserved for those who do not respond to other treatments or have additional fertility challenges.
Q5: Is PCOS common in Pakistan?
Yes. PCOS is highly prevalent among South Asian women, including Pakistan. Studies estimate that up to 1 in 10 women may be affected. Increasing rates are linked to genetic predisposition, lifestyle habits, insulin resistance, and modern dietary patterns.