PCOS and Your Fertility Journey: What You Need to Know

Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age, yet it remains a source of confusion, frustration and worry — particularly for those trying to start a family. PCOS impacts reproductive health in a variety of ways, from irregular ovulation to increased risks during pregnancy, but advances in diagnosis, lifestyle strategies and fertility treatments are offering new hope. Three reproductive endocrinology experts at HRC Fertility — Shahin Ghadir, M.D., FACOG; Kay Waud, M.D., Ph.D., FACOG; and Christo Zouves, M.D. — share their insights on how PCOS affects fertility and what patients can do to take control of their reproductive health.

Shanin Ghardir, M.D., FACOG

Credit: HRC Fertility

How PCOS Affects the Reproductive System

Shanin Ghadir, M.D., FACOG, explains, “PCOS in some individuals can cause a lack of ovulation and for that reason, it is a direct correlation with affecting the reproductive system and fertility. There are also individuals with PCOS that ovulate regularly and do not have this problem.”

Kay Waud, M.D., Ph.D., FACOG, adds that PCOS often begins with insulin resistance, which can disrupt hormonal signaling from the brain and interfere with ovulation. “As a result, PCOS is characterized by elevated androgens (male hormones) … irregular or absent ovulation … [and] altered ovarian response, where many follicles begin to develop but do not mature properly.”

Pregnancy Risks and Management

Women with PCOS face higher risks in pregnancy, including gestational diabetes, preeclampsia, miscarriage and preterm birth. Waud explains, “Managing these risks starts with optimizing health before pregnancy.… Achieving a healthy weight, maintaining stable blood sugar levels and managing blood pressure can significantly reduce complications.” Cristo Zouves, M.D., agrees, noting that preconception optimization and close monitoring during pregnancy are essential to improving outcomes.

Kay Waud, M.D., Ph.D., FACOG

Credit: HRC Fertility

The Power of Early Diagnosis

Experts stress that early diagnosis is key. Ghadir says, “Early conception of an individual with PCOS can help control symptoms that can affect overall fertility.” Waud emphasizes that early management through lifestyle changes and medication can prevent worsening of insulin resistance or weight gain. Zouves highlights that “Early reproductive life planning and patient education are emphasized in recent guidelines to facilitate informed decision-making and proactive management.”

Effective Fertility Treatments

While lifestyle modification is always the first step, medications like letrozole (Femara) or clomiphene citrate (Clomid) are commonly used to induce ovulation. Waud explains that Femara is now considered first-line due to its effectiveness and safety profile. For those who don’t respond, gonadotropins, IVF or surgical options may be considered. Zouves stresses that IVF (reserved as third-line therapy) with single embryo transfer is often recommended to reduce risks.

Christo Zouves, M.D.

Credit: HRC Fertility

Lifestyle Changes That Make a Difference

All three experts emphasize that weight management, regular physical activity, balanced nutrition, stress management and good sleep hygiene can significantly improve fertility outcomes in PCOS. Even modest weight loss of 5% to 10% may restore ovulation and improve overall reproductive health.

Encouragement for Patients

For those who feel discouraged, Ghadir offers reassurance: “PCOS can be a very stubborn diagnosis; however, there are multiple fertility treatment options, including IVF, that ultimately help these patients conceive and have beautiful babies.” Waud reminds patients that the condition is common and manageable, and building a supportive care team can make a world of difference. Zouves adds that “pregnancy is often achievable” and highlights the importance of emotional support.

Looking Ahead

Research is driving new treatment options and personalized care strategies for PCOS. Waud notes that emerging approaches such as genetic profiling, microbiome research and innovative IVF techniques are helping create safer, more effective options for patients.

“At HRC Fertility, we are actively exploring in vitro maturation (IVM) technology — an innovative approach that allows immature oocytes to mature in the laboratory,” she says. “This technique offers a promising alternative for patients at higher risk of ovarian hyperstimulation syndrome (OHSS), including those with PCOS, allowing them to benefit from IVF while minimizing associated complications. Our ongoing research reflects our commitment to expanding safe, personalized treatment options for all patients.”

While PCOS presents unique challenges, early diagnosis, lifestyle management, evidence-based medical care and advancing research are helping patients achieve their family-building goals. With knowledge, support and tailored treatment, women with PCOS can look forward to healthier outcomes and renewed hope.

Shahin Ghadir, M.D., FACOG, is board-certified in both obstetrics and gynecology and reproductive endocrinology and infertility. He sees patients at HRC Fertility in Beverly Hills.

Kay Waud, M.D., Ph.D., FACOG, is a double board-certified physician specializing in obstetrics and gynecology and reproductive endocrinology and infertility. She sees patients at HRC Fertility San Francisco.

Christo Zouves, M.D., is board-certified in obstetrics and gynecology. He has been involved in IVF since it came to North America. He sees patients at HRC Fertility’s Silicon Valley location.