Ask any PCOS patient, and they’ll probably tell you they’ve had to deal with a lot, even before they tried to conceive (TTC).
“PCOS was a silent disruptor in my life for years,” says Kristyn Hodgdon, Rescripted’s co-founder and chief creative officer. Well before she started TTC, Hodgdon says she struggled with irregular periods and hormonal acne. But it wasn’t until she was diagnosed with PCOS at age 28, “that the puzzle pieces started coming together.” As it turns out, PCOS was “the root” of Hodgdon’s irregular cycles, her ovulation issues, and “ultimately, my infertility diagnosis.”
Before we delve into Hodgdon’s PCOS-influenced fertility story, let’s backtrack real quick: PCOS stands for polycystic ovary syndrome, a hormone condition that occurs during the reproductive years. A PCOS diagnosis is made if you have two of the following three symptoms:
- Irregular periods: Patients with PCOS may not have periods very often, or they may have periods that last longer than normal.
- An excess of androgen: Patients with high levels of the androgen hormone can experience hirsutism, or too much body and facial hair, as well as severe acne.
- Polycystic ovaries: These are larger than normal ovaries that occur when follicles containing immature eggs develop around the edge of the ovary.
While Hodgdon was grateful for her diagnosis, she regrets her lack of awareness about PCOS and how it connected to her eventual fertility problems. “I wish someone had told me in my 20s that PCOS isn’t just about irregular periods or hormonal acne,” she says. “It can deeply impact your ability to conceive, especially if you’re not ovulating regularly.”
To better understand why PCOS affects fertility, Rescripted spoke with Jessica Ryniec, M.D., a double-board-certified reproductive endocrinologist and infertility specialist at CCRM Fertility in Boston.
PCOS and fertility: What’s the connection?
The main reason why PCOS can cause fertility problems is something Hodgdon already alluded to: Ovulatory dysfunction. This is “the most obvious way” that PCOS causes infertility, says Dr. Ryniec. People with PCOS can experience a variety of ovulation issues, including “irregular” or “unpredictable” periods, or even “no ovulation at all.”
Ovulation occurs when your ovary releases an egg, usually around the 14th day of a 28-day menstrual cycle.
“I’m a little embarrassed to admit it now, but I didn’t even realize you had to ovulate to get pregnant,” says Hodgdon. “Like many women, I assumed that as long as we were having unprotected sex, pregnancy would just… happen. Spoiler alert: it didn’t.”
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But even those with PCOS who are ovulating are prone to “more subtle ovulatory dysfunction such as luteal phase defects,” says Dr. Ryniec. A luteal phase defect is when your uterine lining doesn’t thicken enough to support a pregnancy.
TTC with PCOS
Well before TTC, it’s a good idea to get a handle on both your PCOS and your fertility status.
“Treatment of PCOS starts with lifestyle interventions including a healthy diet (often lower carbohydrates/low glycemic index and anti-inflammatory foods), regular physical activity, staying hydrated, and getting adequate sleep,” says Dr. Ryniec. She goes on to say that some PCOS patients “may benefit from insulin sensitizers like metformin or a supplement called inositol.”
In addition to these lifestyle changes, Dr. Ryniec recommends investigating your fertility sooner rather than later: “PCOS may increase the likelihood of infertility even if ovulating regularly, so it is worthwhile to have a full evaluation on the earlier side when ready to start trying to conceive – even right away – to identify if there are any other barriers.”
For patients who are not ovulating, she says, “it is very likely you will need medications to induce ovulation, so you do not need to wait any length of time before seeing a fertility doctor.” Dr. Ryniec also mentions that some, “but not all,” OB/GYNs are comfortable prescribing patients oral ovulation induction medication. So, depending on your provider, you may be able to start fertility treatment before meeting with a fertility specialist.
Once Hodgdon had her PCOS diagnosis in hand, she began her pregnancy journey by working with a fertility specialist. “We tried ovulation induction medications like letrozole and Clomid, but ultimately, we ended up doing in-vitro fertilization (IVF),” she says. “I’m grateful that I had access to fertility coverage, and after what felt like endless injections, monitoring appointments, and emotionally exhausting ups and downs, we welcomed our twins through IVF.”
Hodgdon’s fertility treatment process tracks with Dr. Ryniec’s recommendations for patients with PCOS. Dr. Ryniec highlights letrozole as a “first-line medication,” as well as clomiphene (aka Clomid) and gonadotropin injectable hormones for ovulation induction. “Each of these medications works via slightly different mechanisms to induce ovulation, and this can be paired with timed intercourse or intrauterine insemination (IUI),” she says.
But, she continues, “If these options are not successful, in vitro fertilization (IVF) remains an option as well.”
Although Hodgdon had success with IVF, she understands “that’s not everyone’s path (or everyone’s option).” What’s most important, she says, when it comes to PCOS treatments, is that “it’s all about having the right team, getting the right diagnosis early, and being proactive. That’s what made the biggest difference for me.”
Why knowledge (about PCOS) is power
One of the reasons why Hodgdon is so passionate about educating women about our reproductive health is “because we’re taught to fear pregnancy from the time we hit puberty, not to understand it.” So when she began to suspect there was an actual reason for her irregular periods, she was initially dismissed: “I spent most of my teens and twenties trying not to get pregnant, and when I brought up my irregular periods to my doctor, I was simply told to go on the pill or 'wait and see.’” This lack of compassion resulted in “no one explaining what PCOS actually was, or that it could have long-term implications for my fertility.
“What needs to change? Education, plain and simple,” she continues. “We need to talk about reproductive health before it becomes a crisis. We need to empower women with the knowledge to advocate for themselves, because when we don’t know what’s going on with our own bodies, we can’t make informed decisions. We also need healthcare providers to take our concerns seriously and look deeper when something feels off.”
So let’s start with some of that empowering knowledge, courtesy of Dr. Ryniec. Below are some common PCOS symptoms. If you’re experiencing any of these symptoms, consider making an appointment with your healthcare provider.
- Irregular or no periods
- Thick/coarse hair growth on the jaw, upper lip, chest, and stomach – or loss of hair on the head
- Acne
- Darkening of skin in armpits or behind the knees
- Weight gain that seems unrelated to diet and difficulty losing weight
- Depression and mood disturbances
“No one should be blindsided by an infertility diagnosis,” reflects Hodgdon. “And yet, so many of us are. It’s time to change that through honest conversations, accessible education, and shared stories. That’s why I do what I do with Rescripted, and why I share my own journey so openly.”
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.