Condition guide
Polycystic ovary syndrome (PCOS)
The most common cause of ovulatory infertility — and one of the most treatable.
Written and reviewed by the MyBabyBridge editorial team · Last reviewed · 3 sources · General information, not medical advice. Our editorial standards
What it is
PCOS is a hormonal and metabolic condition in which ovulation becomes irregular or stops. It is diagnosed clinically, usually by a combination of irregular or absent ovulation, signs of elevated androgens on examination or bloodwork, and a characteristic appearance of the ovaries on ultrasound, after other causes have been excluded. The name is misleading: the follicles seen on ultrasound are not cysts, and a person can have PCOS without them.
Unfamiliar term? See the fertility glossary.
Signs people notice
Having one of these does not mean you have this condition, and having none does not rule it out.
- Irregular, infrequent, or absent periods
- Difficulty conceiving because ovulation is unpredictable
- Acne, oily skin, or excess hair growth
- Hair thinning at the scalp
- Weight gain or difficulty losing weight, though many people with PCOS are not overweight
- Insulin resistance, which may be present without obvious symptoms
How it is diagnosed
Cycle history, a hormonal panel including androgens and tests that exclude thyroid disease and elevated prolactin, a pelvic ultrasound, and often screening for glucose intolerance and lipids. There is no single test that confirms it.
Treatment paths that usually follow
- Ovulation induction with letrozole, which is commonly first-line for PCOS
- Metformin in some cases, particularly with insulin resistance
- Weight and lifestyle changes where relevant, which can restore ovulation in some people
- IUI with ovulation induction
- IVF, which also allows careful control of the risk of hyperstimulation to which PCOS patients are prone
- Long-term management of metabolic and endometrial health, which matters beyond fertility
Each of these is explained in the treatment library. Which one is right depends on your age, your history, and your own priorities.
What to ask your clinician
- Which criteria did you use to make this diagnosis, and what was excluded?
- Have I been screened for insulin resistance and lipid changes?
- Why this ovulation medication first?
- Given PCOS, what is my hyperstimulation risk in an IVF cycle and how will you manage it?
- What should I be doing for long-term health, not only for conceiving?
Sources
- Women's Health Frequently Asked Questions — American College of Obstetricians and Gynecologists
- Infertility and Fertility — Eunice Kennedy Shriver National Institute of Child Health and Human Development
- Infertility — MedlinePlus, U.S. National Library of Medicine
A diagnosis is a starting point, not a plan.
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