PCOS and Fertility: What You Really Need to Know- PART #1
Let’s be honest: PCOS is one of those conditions that gets talked about a lot, but so many people still misunderstand what it really is. So let’s unpack it in a way that’s practical, grounded in research, and doesn’t leave you feeling confused or defeated. Here’s Part #1:
PCOS Is a Whole‑Body Hormone Condition — Not Just an Ovary Issue
Firstly, the name ‘Polycystic Ovarian Syndrome’ suggests that ovarian cysts are the main problem — but that’s not exactly accurate. Those “cysts” on ultrasound are actually immature follicles that didn’t mature or ovulate. They aren’t harmful cysts like you might imagine, and ultrasound findings alone do not confirm PCOS. (OUP Academic)
PCOS isn’t “bad ovaries.” It’s a hormonal and metabolic pattern that can affect many systems in the body.
Because of this naming confusion, people are often misdiagnosed or misunderstood. That’s why specialists like Professor Helena Teede in Australia are leading efforts to rename PCOS to better reflect its hormonal and metabolic nature. (The Australian)
How PCOS Should Be Diagnosed (Not Just by Scan)
Diagnosis comes from a pattern, not a picture. Specialists use criteria like this in the evidence-based international guideline, which considers:
Irregular cycles or absent periods
Signs of high androgens (either on blood tests or physical signs like acne, hair growth)
Ovarian appearance on ultrasound (only part of the picture)
You need two of the three, and doctors must rule out other causes first. (OUP Academic)
Quick Tip: If your diagnosis was made only by ultrasound — especially while you were on the pill — it’s worth re-evaluating with a specialist using hormone tests and cycle tracking.
PCOS Symptoms Beyond Fertility
It’s common for PCOS to show up as:
Irregular or infrequent periods
Acne or oily skin
Excess facial/body hair
Trouble with weight
Insulin resistance and cravings
Mood changes, anxiety, or depression
It’s not unusual for people with PCOS to not have every symptom, and for symptoms to express differently from person to person. (Jean Hailes for Women’s Health)
PCOS can feel like a reproductive condition — but it’s really a systemic hormone and metabolism condition.
Fertility With PCOS — Separating Myth From Reality
Here’s where research helps dial down fear and dial up facts.
1. Ovulation Patterns Are Often the Biggest Fertility Barrier
PCOS commonly causes irregular or absent ovulation, making it harder to predict fertile windows. Standard ovulation apps and LH tests often don’t work reliably because hormone signals can be unpredictable. (UQ News)
Quick Tip: Working with a clinician for cycle tracking gives the best snapshot of your fertility rather than relying on apps or home tests alone.
2. Egg Quality — The Evidence Is Encouraging
There’s a long-standing myth that PCOS automatically means poor egg quality. Australian research shows women with PCOS can have the same fertility outcomes as women without PCOS when supported appropriately. A large study of over 1,000 women found that birth rates were equal when fertility treatments were used. (UQ News)
Note: Egg quality isn’t just about PCOS. Lifestyle factors like nutrition, sleep, stress, and metabolic health play huge roles.
3. Miscarriage and Pregnancy Outcomes
Some international studies indicate slightly higher risks of miscarriage or pregnancy complications (like gestational diabetes or hypertension) in women with PCOS, likely due to underlying hormonal and metabolic differences. (PubMed)
Important: A trend isn’t a guarantee — awareness and early support help maximise healthy outcomes.
So Is Pregnancy Possible With PCOS?
Absolutely. Many people with PCOS conceive naturally with cycle support, timed intercourse, or ovulation induction. Others go on to have success with IUI or IVF. Importantly, long-term birth outcomes are no different between women with and without PCOS when treatments are used. (UQ News)
Remember this: PCOS doesn’t close the door on motherhood — it just might mean using different keys at different stages.
Aussie Resources & Where to Go for Support
Your Fertility — practical, evidence-based info on PCOS and fertility
Jean Hailes for Women’s Health — comprehensive PCOS guides and fact sheets
Healthdirect Australia — reliable info and links to support services
AskPCOS (Monash/NHMRC) — educational resources developed for patients and clinicians
What’s Next — Part 2
In Part 2, we’ll dive into what actually works for supporting fertility with PCOS, including:
Lifestyle and metabolic strategies that make a difference
Evidence-backed supplements and nutrition tips
When and how to consider interventions like ovulation induction or IVF