PCOS is the leading cause of female infertility in France. Although little known to the general public, this endocrine disorder impacts the fertility of menstruating people in various ways, including disrupting their menstrual cycle: getting pregnant becomes more complicated. More complicated, but not impossible. If you have PCOS and are considering pregnancy or are currently trying, you will find answers to your questions in this article, as well as testimonials from people with PCOS who have managed to get pregnant. We hope this will give you strength for your own journey: good luck ❤️

Understanding Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome, commonly abbreviated as “PCOS,” which we will also use in this article, is caused by hormonal imbalance. It is very common among people of childbearing age, affecting between 5 and 10% of them, from adolescence to menopause.

What is PCOS?

The menstrual cycle is regulated by hormones . When these hormones are disrupted, the cycle is disrupted: this is what happens in polycystic ovary syndrome.

In people with PCOS, sex hormone levels typically vary little during the cycle. The baseline LH level, which is naturally higher than FSH, does not increase mid-cycle and does not trigger ovulation.

Additionally, this high LH level causes excessive production of ovarian androgens, particularly testosterone, which is usually produced in small amounts in the female body. The presence of this hormone in large quantities in the bodies of people with PCOS also has repercussions.

What are the symptoms of PCOS?

This high LH level, coupled with this high testosterone level, is responsible for several types of abnormalities in affected menstruators. These are the symptoms of PCOS:

• Menstrual irregularity see anovulation: The menstrual cycle is irregular (the difference between the durations of the cycles exceeds a difference of 9 days considered normal), to the point where ovulation may not take place;
• Hirsutism: Women with PCOS may experience excessive hair growth on the face, chest, back, or other areas of the body where men typically have hair;
• Significant hormonal acne: Acne may be more common and severe in women with PCOS due to hormonal imbalances, particularly high androgen levels;
• Thinning hair or baldness: Some women with PCOS may experience hair loss on the top of their heads, similar to male pattern baldness;
• Weight gain and difficulty losing weight: Women with PCOS often tend to gain weight, especially around the waist, and may have difficulty losing weight despite diet and exercise efforts. This may be due to lipid abnormalities (high cholesterol and triglyceride levels) and insulin resistance. These factors can increase the risk of developing type 2 diabetes;
• Presence of a very large number of follicles with incomplete development on the ovaries : This condition hinders fertility by preventing ovulation.

These symptoms vary from one woman to another and are not always present at the same time, in particular because they depend on the intensity of the disease and the hormonal imbalance.

How to be diagnosed with PCOS?

If you have any doubts about whether you have PCOS, especially because you are having trouble getting pregnant, it is important to consult your doctor.

🖐️ Whether or not you are diagnosed with PCOS, if your couple is having difficulty conceiving a child, the possibility of endometriosis will be considered and you will undergo various tests.

The Rotterdam criteria

After much debate, the diagnosis of PCOS has been based on the three Rotterdam criteria since 2014. To be considered a PCOS patient, you must present at least two of the three Rotterdam criteria among:

• Clinical hyperandrogenism (hirsutism, acne, androgenic hair loss) or biological (abnormally high testosterone levels).
• Menstrual cycle disorders, with rare or absent ovulation (oligo-anovulation or anovulation). The Rotterdam criteria established that cycles shorter than 21 days or longer than 35 days were considered dysovulatory.
• Large ovarian volume (greater than 10 mL and without the presence of a cyst or dominant follicle) and/or a significant number of small follicles detected during a vaginal ultrasound.

Diagnostic tests

There are three tests that can be used to diagnose PCOS:

• Hormonal assessment: this assessment takes stock of the levels of different hormones (FSH / LH, androgen hormones, etc.). Several blood tests are carried out at different times during the menstrual cycle to study their evolution;
• Pelvic and/or abdominal ultrasound: ultrasound is a controversial examination because its results are often inconclusive. It can be used to study the size of the ovaries, which can enlarge (1.5 to 3 times the “normal” size) in cases of PCOS;
• Laparoscopy: As with endometriosis, laparoscopy is a reliable examination due to its precision, although it is more invasive (it is a surgical procedure). It consists of observing the interior of the abdominal cavity, the uterus, the ovaries and the fallopian tubes. It allows the observation of significant ovarian activity linked to the disease (large ovarian volume and a large number of small follicles).

What causes PCOS?

The origin of the hormonal imbalance leading to PCOS is still not clearly identified. It is considered to be multifactorial.

The two most convincing factors are:

• Genetics: Approximately twenty genes predisposing to PCOS have been identified. However, they only explain the occurrence of PCOS in less than 10% of cases. In addition, family history (presence of the disease in female relatives, particularly close relatives) exposes a woman to a 30% increased risk of developing the disease.
• Environmental: Endocrine disruptors (substances found today in nature, in our food, in our cosmetic products, and even in our clothing) could play a role in the onset of the disease. However, no evidence or link between endocrine disruptors and the occurrence of the disease has been established to date.

Can PCOS be cured?

Currently, there is no definitive cure or treatment for PCOS. However, there are various treatments available to slow its progression, alleviate its symptoms, and live as well as possible with PCOS.

How can this impact my fertility?

PCOS is also the leading cause of infertility in France. It can therefore impact your fertility . The disruption of fertility in a person with PCOS most often depends on the severity of the disease and the number of symptoms affecting them.

Here are the elements that can affect your fertility:

• Irregular menstrual cycle: People with PCOS often have irregular menstrual cycles. This makes it difficult to determine the time of ovulation and therefore the optimal time to have sex in order to conceive. Therefore, using an app to track your menstrual cycle appears to be insufficient for conceiving;
• Poor egg quality: The eggs produced by the ovaries may be of impaired quality in women with PCOS. This can reduce the chances of conception and increase the risk of miscarriage. In this case, your doctor may consider IVF to help select good quality eggs;
• Anovulation: In PCOS, the ovaries often produce eggs irregularly or not at all. Because ovulation is necessary for conception, you may experience difficulty conceiving. In this case, your doctor may consider treatment to trigger ovulation;
• Hormonal imbalance / hyperandrogenism: PCOS is associated with high levels of male hormones (androgens) such as testosterone. This can disrupt the hormonal balance necessary for ovulation and fertility;
• Insulin resistance: Many women with PCOS have insulin resistance, which means their cells have difficulty properly using insulin, a hormone that regulates blood sugar. Insulin resistance can negatively affect fertility by disrupting the levels of other hormones involved in ovulation and menstrual cycle regulation;
• Metabolic syndrome: PCOS is often associated with other medical conditions, such as obesity, high blood pressure, and high cholesterol levels, which are grouped together under the term metabolic syndrome. These conditions can also negatively impact fertility.

I can't get pregnant and I think I have PCOS: what should I do?

It's also possible that the name PCOS came to you when you were already planning a baby. Faced with failures month after month, you began to conduct your initial research and considered that PCOS could be the culprit behind your difficulties. What should you do?

Step #1: Talk to a doctor about your doubts

Have you been trying to get pregnant for several months without success? We strongly recommend that you consult your doctor and gynecologist about this: they will be familiar with your medical history and will be able to answer your questions.

We also urge you not to be too impatient: according to INED, it takes an average of seven months to achieve pregnancy . In their survey published in 2010, after a year of trying, 97% of couples managed to have a child. If after two years and despite regular sexual intercourse without contraception, the couple is unable to conceive, this is called infertility.

Step #2: Pass the diagnosis and fertility testing phase

In cases of infertility and difficulty conceiving, doctors offer various tests. PCOS and endometriosis are two common and often cited conditions for infertility. Both are considered, while your partner may also undergo tests (including a spermogram to assess the quality of his sperm).

If the diagnosis is made, you will be included in the follow-up of diagnosed people – see the next section. Otherwise, other avenues will be sought.

I have PCOS and I want to get pregnant, what should I do?

If you've been diagnosed with PCOS and want to get pregnant as soon as possible or soon , you may be worried about the possibility of difficulties. We'll walk you through the steps to increase your chances of getting pregnant despite PCOS.

Step #1: Consult your doctor

If you have PCOS and are being monitored by your gynecologist and an endocrinologist (a doctor specializing in hormones), we highly recommend that you consult them when you stop using contraception and start planning a baby.

Depending on your medical profile, your age, and the severity of your illness and symptoms, the professional will advise you. They will generally have two options:

1. Invite you to try to get pregnant naturally , most often with a deadline (usually one year). If beyond this limit, it does not work, he will check that your PCOS is indeed the cause of your difficulties by ruling out other causes and will offer you solutions to get pregnant in an assisted way. Several solutions exist.
2. Invite you to enter directly into a process to get pregnant in an assisted manner , especially if you and your partner are older and if the disease is more severe. The goal: not to waste time.

Step #2: Try to get pregnant naturally

We want to reassure you that it is completely possible to get pregnant naturally despite PCOS. And even very quickly! To give yourself the best possible chance, here are some good practices and lifestyle habits you can implement.

• Adopt a healthy lifestyle: sleep well, eat a balanced and varied diet, drink enough, exercise, avoid stress and anxiety, limit alcohol, tobacco, and stimulants... you know what a healthy lifestyle is. The healthier your lifestyle, the greater your chances of getting pregnant.
• Track your cycle through apps: Period tracking apps also, and more importantly, allow you to track ovulation. Having sex in the days surrounding your ovulation will definitely increase your chances of getting pregnant naturally! Record information about your period each month, and apps can give you information about your ovulation.
• Track your cycle with your basal temperature: Your basal body temperature changes depending on the time of your cycle. These very precise temperature variations can help you identify your fertile window by taking your temperature during ovulation . However, if you have PCOS and your cycles are very irregular, apps alone may not help you know when you are ovulating. Taking your temperature almost daily with a basal thermometer will help you better identify it!

• Track your cycle using symptothermal method: Due to PCOS, your menstrual cycle may be completely irregular with chaotic ovulation. In this case, menstrual cycle tracking apps will have difficulty helping you. As for basal temperature, the method can be tedious. Other, more comprehensive solutions may be more relevant to you, such as symptothermal method. This method involves accumulating knowledge about all the symptoms of your cycle so that you can predict your ovulation simply by knowing your body. At Gapianne, we have recently been working with Alix, from Magic ovaries, to help you navigate all the symptoms and thus increase your chances of getting pregnant.
• Track your cycle with ovulation tests: Like pregnancy tests, there are ovulation tests that work in the same way and according to the same principle. They detect the presence of hormones linked to ovulation and can help you better identify this precise moment.
• Regulate your hormones to increase your fertility: Herbal medicine involves treating yourself with plants. These plants act on our hormones, and consuming specific dietary supplements and herbal teas can help restore your hormonal balance when you're planning a baby.

✴️ Be careful though: herbal treatments can interact with other medications you may be taking. If you are taking fertility medication, consult your doctor and/or pharmacist before supplementing with herbal products.

• Increase your chances with a fertility cup: The fertility cup is a silicone cup that holds your partner's sperm in your vagina once they have ejaculated inside you. Simply place the cup in your vagina and keep it there for up to an hour after intercourse: this way, three times more sperm will enter your vagina. The advantage of this device is that it is hormone-free and will not interact with any medications you are taking.

❤️ Disclaimer: Because we are all different and health is sometimes also a matter of (bad) luck, we would like to remind you here that everything is not completely in your hands and you are not responsible . It is possible that you put all these tips in place without getting pregnant and it is possible that you put none of them in place and you get pregnant... These practices are only tools to increase your chances, they are in no way guarantees.

Step #3: Test for other causes of infertility

If, unfortunately, you were unable to get pregnant naturally at first, it is then customary to consider specific treatments to increase your chances.

However, before starting this type of treatment, it is necessary to ensure that there are no other factors causing infertility, in addition to your PCOS, and particularly in your partner (sperm abnormalities, for example). Indeed, this could modify the therapeutic management.

Step #4: Implement specific treatments

Once other causes of infertility have been ruled out, your primary care physician will be able to deploy a range of tools, tests, and treatments to support your childbearing goals. While in vitro fertilization (or IVF) is a well-known name, it's not the only method used!

• Ovulation induction: This is a medical process used to stimulate the ovaries to produce and release an egg as part of fertility treatments or to regulate menstrual cycles.
• Laparoscopic ovarian drilling: This is a surgical procedure used to treat certain cases of polycystic ovarian syndrome (PCOS), particularly for people in whom the disease is so advanced that ovulation induction does not work.
• Intrauterine insemination (IUI): Also known as artificial insemination, this is a medically assisted reproductive technique used to help couples having difficulty conceiving naturally. It can be used in addition to ovulation induction.
• In vitro fertilization (IVF): IVF is a medically assisted reproductive technique in which an egg is fertilized by a sperm outside the body of the menstruating person, in a laboratory. The fertilized eggs are then implanted in the uterus, which has been previously prepared by various treatments.

These different methods all have in common that they help you get pregnant. They are mostly invasive (injections, heavy and recurring treatments, surgical procedures) but can allow you to achieve your baby goal. According to the National Institute of Demographic Studies (INED), 71% of couples engaged in IVF became parents within 8 years of starting this process: 41% through IVF, 11% through adoption and 12% naturally.

Advice and testimonies from women who became pregnant with PCOS

Personal history with PCOS

When were you diagnosed with PCOS?

I was diagnosed when I wanted to have a child, when I stopped taking the pill in 2014, that is to say at 27 years old.

What were your main symptoms?

I didn't have a cycle or it was very irregular. Of course, I couldn't get pregnant. At first, I waited. I had seen a gynecologist years ago... I should have understood at that time if the doctor had explained it to me, but I was young (18), I had taken the morning-after pill, and it all seemed very far away. Too bad...

Journey to Conception How long did you try to conceive before succeeding?

I went through different stages of treatment... up to artificial insemination. We made several attempts. The whole process took 2 to 2.5 years.

Have you used fertility treatments? If so, which ones?

I have amnesia for names... but almost all of them, down to the daily stimulation and insemination injection.

Managing PCOS

How did you manage your PCOS symptoms before and during your attempt to conceive?

Wrong.

In addition to the psychological suffering and the multiplicity of heavy hormonal treatments that had an effect on morale, I had acne… I felt useless, ugly, depressed, I isolated myself… I cried a lot. No one talked about this at the time. But I found two solutions:

I trained in reflexology and natural health: I met people, it did me good, I was surrounded, advised... I learned, I understood how the body worked with anatomy and physiology courses... I had the impression of moving forward, of learning despite the fact that I was stagnating and staying in my job to be able to honor all the medical appointments...

I went to see a shrink but I wasn't ready to open up, she directed me towards mindfulness meditation: Christophe André entered my life, even though he wasn't at all well-known at the time!

And finally, I found a support group... which was very valuable to me. My partner agreed to go through this with me and it also reassured him a lot to see the other women's excitement, that it was normal... that I wasn't going crazy. That I needed support, to share... we were very close, it strengthened us a lot even if we don't have the same sensitivity, so it's not always easy to understand each other.

I finally changed gynecologists because it's very important to have confidence and to feel understood. That there is a match. You shouldn't persist with someone who doesn't reassure you, with whom you don't feel comfortable or confident.

Have you made any changes to your diet or lifestyle to improve your chances of conception?

No, I overcompensated a lot... my diet was comfort food... that is to say very fatty and sugary, which is counterproductive... but we do what we can...

I was a little more careful with alcohol in certain phases of treatment, but nothing much more.

Challenges and Solutions What were the biggest challenges you faced in your fertility journey?

Juggling schedules, keeping appointments, blood tests, etc.

And managing these hormones… with the moral impact that has.

Support and Resources What type of support (medical, family, community) did you find most helpful?

The community. The medical system is dysfunctional because it separates the things of the body from those of the mind: we are very poorly equipped to "live" the treatments.

Family life is also difficult because it is difficult to understand what the other person is going through and the "don't think about it anymore and it will happen" attitude sometimes reinforces isolation. But communication within a couple is essential and if it works, it allows us to be united and to stick together.

Finally, paramedical and alternative medicine really allow you to escape and reconnect.

Are there any specific resources or tips you would recommend to other women with PCOS? Surrounding yourself with people who have been through it, just to understand that it's normal to have a very disturbed mood while injecting so many hormones...

Experiences with health care

How did you work with your healthcare team to manage your PCOS and fertility?

Do you have any specific advice on communicating with healthcare professionals? I found it very difficult to understand them. I had an MRI, for example, without understanding a word... I had to go and train myself in anatomy and physiology (as part of my two-year reflexology training) to understand their language. Time is limited at each appointment, for them as well as for us, it's difficult not to feel lost, we quickly get carried away and it has a dehumanizing side.

Emotions and mental well-being

How did you manage the emotional and mental aspects of the conception process with PCOS? Not very well, but it strengthened my relationship.

Do you have any recommendations for mental well-being during this journey? Talk, surround yourself with people who are going through the same struggle, especially not isolating yourself, and taking care of yourself.

Retrospective and advice

Looking back, is there anything you would have done differently?

I would surround myself differently, earlier, I would have found another gynecologist earlier to evolve in a gentler and more trusting environment and I would have fewer expectations of my sisters and mother who were ultimately very helpless.

What advice would you give to a woman with PCOS who is trying to conceive?

Just understand that her mind is disturbed, that she doesn't become sad or depressed, that the power of hormones is crazy and that she remains full of life and vitality. Don't seek comfort from those around you who don't understand... who aren't equipped to support you. Look for testimonies, people who are in the same situation, and open up. And organize yourself to face it.

For my part, I went through this process without telling the office, I cheated... I hid my appointments, etc. It was easier to say that I had gotten drunk the day before rather than that I had cried before arriving at the office because my umpteenth pregnancy test was negative... I don't know if it would have been better to say it. It wasn't a time when it would have been accepted, my boss was misogynistic and I didn't want to share this with my team, but maybe it's a reflex from the past, I don't know what's best. I preferred to keep it in my secret garden. I held on all day, and sometimes I burst into tears when I left the office. But hey, it was worth it and it allowed me to organize myself. You have to create the personal and professional framework that allows you to honor all your medical commitments. You have to manage your time. For the record, my pregnancy had to rebalance certain things and then above all, with PCOS (4 in my case) we become more fertile at older ages. Infertility is due to our inability to produce viable eggs due to ovarian overactivity. So the ovarian reserve decreases over time, this slowly compensates... we become more fertile, we are more able to complete the process. It's the revenge of PCOS.

I got pregnant on my first cycle after stopping the pill to conceive my second child.

Sources:

Inserm, Polycystic Ovary Syndrome (PCOS): a common disorder, the leading cause of female infertility, 2019: https://www.inserm.fr/dossier/syndrome-ovaires-polykystiques-sopk/

Inserm, Infertility: difficulties conceiving from multiple causes, 2019: https://www.inserm.fr/dossier/infertilite

Ministry of Health and Prevention, Report on the causes of infertility: towards a national strategy to combat infertility, 2022: https://solidarites-sante.gouv.fr/IMG/pdf/rapport_sur_les_causes_d_infertilite.pdf

Association for Hope for Polycystic Ovary Syndrome (Esp'OPK), Nat'OPK: natural methods and/or alternative medicines!, 2018: https://www.esp-opk.org/post/nat-opk-des-méthodes-naturelles-et-ou-médecines-douces

Deuxiemeavis.fr , PCOS, 2021: https://www.deuxiemeavis.fr/pathologie/sopk