Women with PCOS generally have irregular, infrequent, or even absent ovulation. Without ovulation there is no egg or ovum that is available for fertilization. Also, due to the abnormal hormone levels, the endometrium, or inside lining of the uterus, does not develop normally in women with PCOS. Therefore, even if a rare ovulation was to occur and the egg was fertilized, the endometrium may not be properly developed to allow for the attachment and growth of the embryo.
The good news is that this problem with ovulation can be fixed with medications. These include ovulation induction agents, insulin sensitizing drugs and Gonadotropins. It is important to know that these options work best for women who are not obese. Even a modest amount of weight loss may improve the effectiveness of the medications.
Medications called ovulation induction agents, such as clomiphene citrate stimulate the ovaries to release one or more eggs. Clomiphene citrate triggers ovulation in about 80 percent of women with PCOS, and about 50 percent of these women will actually become pregnant. In women taking clomiphene, ovulation can be confirmed by blood and urine tests or by measurement of body temperature. If the original dose of clomiphene does not trigger ovulation, a higher dose may help.
Several studies have shown that the insulin-sensitizing drug, metformin, increases the effectiveness of clomiphene in producing ovulation. However, it is unknown if this drug is safe during pregnancy, and is stopped once the woman is pregnant.
Gonadotropin therapy is the second line of medical treatment for PCOS-related infertility. Gonadotropins include Leutinizing hormone (LH) and Follicle Stimulating Hormone (FSH). FSH is used without LH for women with PCOS, and is given as a daily injection under the skin for 7 to 10 days. These drugs trigger ovulation in almost all women with PCOS and can lead to pregnancy in approximately 60 percent.
Surgery is an option in rare situations. In very rare cases, ovulation is not achieved with medications and ovarian surgery may be necessary to stimulate ovulation. This surgery is usually performed via the laparoscope.
If the above mentioned treatments are not successful in producing a normal pregnancy, then the use of the assisted reproductive technologies (ART), such as in vitro fertilization, can be attempted.
In conclusion, a diagnosis of PCOS suggests that you are likely to have some difficulty becoming pregnant. However, with help from your physician, pregnancy should be an option for almost everyone with PCOS.