Prepared by Prof. Dr. Mehmet Çınar (Gynaecology, IVF and Endoscopic Surgery). Polycystic Ovary Syndrome (PCOS) is a very common hormonal disorder among women of reproductive age and affects millions of women worldwide. The syndrome, which shows itself through symptoms such as irregular menstrual cycles, acne, excess hair growth and weight gain, can also affect the chance of pregnancy — one of the greatest concerns for many women. PCOS, however, is not an obstacle to pregnancy. Thanks to advances in medical technology and personalised treatment approaches, many women with polycystic ovary syndrome are able to experience a healthy pregnancy. At the Ankara IVF Center we are here to guide you through this process and to offer you the most suitable treatment methods. In this article we look in detail at the ways in which you can increase your chance of pregnancy with PCOS.
What Is PCOS and Why Does It Occur?
Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that causes hormonal imbalance in women. The term "polycystic" refers to the presence of numerous small, benign cysts (follicles) in the ovaries. However, not every woman who has such cysts has PCOS, and these cysts are usually harmless. The underlying problems in PCOS are that the ovaries produce more male hormone (androgen) than normal, and insulin resistance. Although the exact cause of PCOS is not yet fully understood, a combination of genetic and environmental factors is thought to play a role:
- Genetic predisposition: The risk of the syndrome is higher in women with a family history of PCOS.
- Insulin resistance: This is a state in which the body does not respond adequately to insulin. The pancreas produces more insulin in order to regulate blood sugar, and high insulin levels can cause the ovaries to produce more androgen. This in turn prevents ovulation.
- High androgen levels: High levels of male hormones prevent the ovaries from releasing eggs regularly, leading to menstrual irregularity and the other symptoms.
- Low-grade inflammation: Some research shows that low-grade chronic inflammation in women with PCOS may contribute to hormonal imbalance.
The combination of these factors means the ovaries cannot regularly release mature eggs (anovulation or oligo-ovulation), which in turn makes pregnancy more difficult.
Symptoms and Diagnosis
PCOS can present with a wide variety of symptoms, and not every woman experiences the same number of symptoms or the same severity. The most common symptoms are:
- Menstrual irregularities: This is the most obvious symptom. It may take the form of infrequent periods (oligomenorrhoea), absent periods (amenorrhoea) or prolonged, heavy bleeding. It results from irregular ovulation or no ovulation at all.
- Excess hair growth (hirsutism): An increase in male-pattern hair growth in areas such as the face, chest, back and abdomen due to high androgen levels.
- Acne and oily skin: Raised androgens can make the oil glands in the skin overactive.
- Hair loss (androgenic alopecia): A receding hairline or thinning of the hair at the crown may be seen.
- Weight gain and difficulty losing weight: Fat accumulation, particularly around the abdomen, is common and may be linked to insulin resistance.
- Cysts in the ovaries: The appearance of numerous small follicles in the ovaries on ultrasound.
- Infertility: Difficulty in achieving a pregnancy because ovulation is irregular or absent.
A diagnosis of PCOS is usually made through a combination of assessment of the symptoms, physical examination, blood tests and ultrasound. According to the international Rotterdam criteria, PCOS can be diagnosed when at least two of the following three criteria are present:
- Infrequent periods or absent periods (an ovulation disorder).
- Signs of excess male hormone, either clinical (excess hair growth, acne) or biochemical (high androgen levels on blood tests).
- A polycystic appearance of the ovaries on ultrasound (with modern transvaginal probes with a bandwidth of ≥8 MHz, 20 or more follicles in each ovary, or an ovarian volume of ≥10 mL; a high AMH level may also be used as an alternative to this ultrasound criterion).
During the diagnostic process it is also important to rule out other hormonal disorders that can cause similar symptoms.
Lifestyle Changes
Lifestyle changes play a critical role in managing PCOS and in improving the chance of pregnancy. Indeed, they often form the first-line treatment approach. These changes can help improve hormonal balance, reduce insulin resistance and encourage regular ovulation.
- Healthy nutrition: A low glycaemic index (GI) diet: foods that raise blood sugar slowly should be preferred. Whole grains, pulses, vegetables, fruit and healthy fats should be part of the diet, while processed foods, refined sugar and saturated fats should be avoided. Foods rich in protein and fibre: these increase the feeling of fullness and help to stabilise blood sugar. Small, frequent meals: these can prevent sudden swings in blood sugar. A balanced diet can regulate ovulation by reducing insulin resistance and can also help with weight control.
- Regular exercise: At least 30 minutes of moderate-intensity exercise (for example brisk walking, swimming or cycling) on most days of the week is recommended. Exercise increases insulin sensitivity, makes it easier to lose weight and supports overall hormonal balance. Resistance exercise aimed at building muscle mass is also beneficial.
- Weight control: In women with PCOS who are overweight or obese, losing even just 5-10% of body weight can regulate the menstrual cycle, restore ovulation and significantly increase the chance of pregnancy. Weight loss reduces insulin resistance and lowers androgen levels.
- Stress management: Chronic stress can have an adverse effect on hormonal balance. It is important to manage stress through methods such as yoga, meditation, breathing exercises or pursuing hobbies.
- Adequate sleep: Good-quality, sufficient sleep is important for hormonal balance and insulin sensitivity.
These lifestyle changes not only increase the chance of pregnancy; they also play a major part in reducing the long-term health risks associated with PCOS (type 2 diabetes, heart disease).
Ovulation Treatments and IVF
When pregnancy is not achieved despite lifestyle changes, or when additional factors are present, medical treatment is used. PCOS offers a range of treatment options for achieving pregnancy, and these options generally progress from the simplest to the more complex.
Ovulation Induction
The most common problem in women with PCOS is irregular ovulation or a complete absence of ovulation. Ovulation induction is therefore one of the first-line treatments.
- Oral medication: This is usually the first-choice treatment. These medicines aim to promote the development and release of an egg by increasing the secretion of the hormones from the brain that stimulate the ovaries. They are used under a doctor's supervision and with regular monitoring.
- Injectable gonadotropins: In cases where oral medication does not work or is not suitable, injectable hormone medicines that stimulate the ovaries directly may be used. Close monitoring of this treatment is critically important in order to prevent overstimulation of the ovaries (OHSS).
Intrauterine Insemination (IUI)
In couples in whom regular ovulation has been achieved with ovulation induction but pregnancy has not occurred, and where sperm quality is normal, intrauterine insemination (IUI) may be considered. In this method, specially prepared sperm is injected into the uterus at the time of ovulation, increasing the chance of it meeting the egg. IUI is generally tried for several cycles, and if it is not successful more advanced treatments are considered.
IVF
In women with PCOS, when pregnancy cannot be achieved with ovulation treatments and insemination, or when additional infertility factors are present (for example blocked tubes or a severe male factor), IVF treatment becomes one of the most effective options. The IVF process we carry out at the Ankara IVF Center can be specially adapted for patients with PCOS.
The IVF process generally involves the following steps:
- Ovarian stimulation: Medication is used to make the ovaries produce more than one egg. Because the risk of overstimulation of the ovaries can be higher in patients with PCOS at this stage, careful monitoring by an experienced team and individually tailored dose adjustments are very important.
- Egg collection: The mature eggs are collected vaginally under ultrasound guidance.
- Fertilisation: The collected eggs are fertilised with sperm in the laboratory. At this stage, especially if there is also a male factor, the microinjection (ICSI) method is frequently preferred.
- Embryo development: The development of the fertilised eggs (embryos) is followed in the laboratory.
- Embryo transfer: The healthiest embryos are transferred into the uterus.
Women with PCOS generally respond well to IVF treatment, because they tend to develop a large number of eggs. The success of treatment, however, depends on many factors, including age, additional health problems and the experience of the centre where the treatment is carried out. With an experienced specialist such as Prof. Dr. Mehmet Çınar and a personalised treatment plan, the chance of success can be optimised. You can find out more about him on Prof. Dr. Mehmet Çınar's profile page. It should not be forgotten that achieving a pregnancy with polycystic ovary syndrome is absolutely possible. What matters is an accurate diagnosis, a personalised treatment plan and working with a trustworthy medical team that will support you throughout the process.
Conclusion
Achieving a pregnancy with Polycystic Ovary Syndrome (PCOS) is largely possible with the right approach and appropriate treatment methods. Although PCOS can create difficulties during the journey to pregnancy, there are many options available, from lifestyle changes through to modern medical treatments such as ovulation induction, insemination and IVF. Because every woman's situation is different, it is very important that the treatment plan is drawn up individually. At the Ankara IVF Center we are proud to offer hope and professional support to couples who have been diagnosed with PCOS and who dream of a pregnancy. With our expert team and our state-of-the-art equipment, we are here to determine the most suitable and effective treatment methods for you. Please do not hesitate to contact us so that we can map out a route tailored to you on your pregnancy journey and answer your questions. Remember: with the right steps, reaching your dream is possible. You can visit our contact page to arrange a free initial consultation or an appointment.