Understanding PCOS: What You Need to Know About Hormones and Fertility

Polycystic Ovarian Syndrome — more commonly known as PCOS — is a genetic endocrine condition that impacts about 1 in 10 women. It can often take several years to diagnose due to the variety of symptoms people present with.  Some don’t even know they have it until they struggle to conceive.

PCOS is primarily a disorder of androgen excess — androgens are hormones often thought of as "male" hormones, like testosterone, though women have them too. Despite this, much of the focus is often on high estrogen or low progesterone.  However, there isn’t really one thing alone that causes PCOS – it is multifactorial, meaning several hormones and body systems contribute to it.

The primary systems we consider include:

• Reproductive hormones – estrogen, progesterone, LH, FSH

• Cortisol – your main stress hormone

• Insulin – which regulates blood sugar

• Thyroid hormones – which influence metabolism and ovulation

When we say we “look at the whole picture,” we mean we consider how each aspect of your life and health is impacting — and being impacted by — this condition.

How do I know if I have PCOS?

The Rotterdam Criteria is the current standard for diagnosing PCOS.

It defines PCOS as having two of the following three symptoms:

▪ Irregular periods (typically longer than 35 days)

▪ Polycystic ovaries (as seen on ultrasound)

▪ Clinical or physical symptoms of hyperandrogenism (elevated testosterone levels, excess facial or body hair, cystic acne, etc.)

This means you could have normal periods and still have PCOS.

You could have ovaries without cysts on them and still have PCOS.

(The name is a bit of a misnomer — some effort has been made to rename it more accurately, but nothing has been confirmed yet.)

So not everyone with PCOS will present the same way?

Correct.

There are four main phenotypes (subtypes) of PCOS, and while Types A and B are the most common or “classic” presentation, every person is a little different.

Insulin resistance plays a big role in many cases of PCOS and can make it difficult to lose weight.

Because of this, people with a leaner body type are sometimes dismissed by providers because they don’t “look like” a typical PCOS patient.

But an atypical presentation does not rule it out. Many people have what is called lean-type PCOS, where insulin resistance is not as much of an issue, but they still meet the diagnostic criteria.

How does PCOS impact fertility?

Fertility challenges are common with PCOS and can stem from several reasons:

• Irregular cycles make it difficult to predict when ovulation will occur.

• Anovulation (not ovulating during a cycle) is frequent, especially with cycles longer than 40 days.

• Egg quality can sometimes be affected due to higher levels of inflammation, which can make fertilization more challenging.

Will I have to do IVF to get pregnant?

Not necessarily.

While assisted reproductive technology (ART) — including medication-assisted cycles, IUIs, and IVF — is commonly recommended as first line treatment in mainstream medicine, it is not your only option.

If you are looking for a more natural approach, there are several ways to successfully manage PCOS with diet, lifestyle changes, and targeted supplementation.

When making this decision it’s important to consider a few factors:

• Natural approaches can take several months before you start seeing changes.

• IVF is a process that also takes time.

• Your age and desired family size often play a role in decision-making.

I always aim to be open about these factors in my conversations with patients and support them in whatever path they choose.

Taking a lifestyle and nutrition approach can also work synergistically with the IVF process, supporting better outcomes.

Can I get pregnant naturally if I have PCOS?

Yes!

It is possible to get pregnant naturally with PCOS. Every body is different and will respond to treatment in its own way.

When we take this approach, we often use tools like cycle tracking to better understand your menstrual cycle and help restore rhythm to your cycles over time.

PCOS is a lifelong condition, but once recognized, it can often be well managed with diet, lifestyle changes, and targeted supplementation.

Curious about what your next steps might look like?

Book a free 15-minute discovery call today — we’ll talk through your symptoms and options together.