What is PCOS?
💡 PCOS = polycystic ovary syndrome. Most common cause of female infertility (anovulation). Diagnosed by Rotterdam criteria: 2 of 3 — irregular periods, high androgens (testosterone/DHEAS), polycystic ovaries on USS (≥20 follicles per ovary or volume >10mL). Treatment: letrozole OI (first-line), IUI, IVF (if OI fails). High AMH and AFC typical.
PCOS (polycystic ovary syndrome) is the most common hormonal disorder affecting women of reproductive age, present in approximately 8–13% of women globally. It is characterised by a combination of irregular ovulation, androgen excess, and polycystic ovarian morphology on ultrasound. PCOS is the single most common cause of anovulatory infertility, accounting for 70–80% of cases.
🇮🇳 India Context: PCOS is widely assessed and treated across major Indian fertility centres including Chennai, Mumbai, Bangalore, Delhi, and Hyderabad.
What are the key characteristics of PCOS?
- Rotterdam criteria (2003): diagnosis requires ≥2 of 3: (1) Oligo/anovulation (cycles >35 days or <8 cycles/year); (2) Clinical/biochemical hyperandrogenism (acne, hirsutism, elevated testosterone/DHEAS/FAI); (3) Polycystic ovarian morphology on USS (≥20 follicles per ovary or ovarian volume >10mL)
- Hormonal profile: elevated LH:FSH ratio (>2:1 in ~60%); elevated total or free testosterone; elevated DHEAS; elevated AMH (typically >3.5–5 ng/mL); normal or low FSH; oestrogen normal or mildly elevated
- Metabolic features: insulin resistance in 50–70% (irrespective of weight); elevated fasting insulin; dyslipidaemia; impaired glucose tolerance; increased risk of type 2 diabetes
- Fertility impact: primary cause of anovulatory infertility; also causes luteal phase deficiency; increased miscarriage risk (possibly due to insulin resistance and elevated LH); increased OHSS risk in IVF
- Ovulation induction first-line: letrozole 2.5–7.5mg Days 3–7 (superior to clomiphene per NICHD RCT — higher live birth rates, lower multiple pregnancy); add metformin in insulin-resistant PCOS
- IUI in PCOS: after 3 failed OI cycles; TMC must be adequate; monitor carefully for multifollicular response
- IVF in PCOS: for OI-resistant PCOS or other co-existing factors; high OHSS risk — use low-dose stimulation (75–100 IU FSH), antagonist protocol, GnRH agonist trigger, freeze-all strategy
- Weight: 5–10% weight loss in overweight PCOS women restores ovulation in 55–80% of cases; first-line intervention before any pharmacological treatment
How does PCOS work?
Why does PCOS matter in fertility?
PCOS is the most treatable cause of female infertility — the majority of PCOS patients will achieve pregnancy with systematic management. The treatment algorithm is clear: lifestyle optimisation → letrozole OI (3–6 cycles) → IUI → IVF. The most dangerous management error is aggressive IVF stimulation in PCOS without OHSS prevention measures — severe OHSS is a life-threatening complication that is almost entirely preventable with agonist trigger and freeze-all strategy.
What are related terms to PCOS?
Ovulation Induction
Ovulation Induction is a fertility treatment that uses medications to stimulate …
IUI (Intrauterine Insemination)
IUI (Intrauterine Insemination) is a fertility treatment where washed, concentra…
IVF (In Vitro Fertilisation)
IVF (In Vitro Fertilisation) is an assisted reproductive technology (ART) in whi…
LH (Luteinizing Hormone)
LH (Luteinizing Hormone) is produced by the pituitary gland. It triggers ovulati…
FSH (Follicle-Stimulating Hormone)
FSH (Follicle-Stimulating Hormone) is produced by the pituitary gland. In women,…
AMH Test (Anti-Müllerian Hormone)
The AMH Test is a simple blood test that measures the level of Anti-Müllerian Ho…
FAQs about PCOS
Can I get pregnant naturally with PCOS?
Yes, many women with PCOS conceive naturally, especially with lifestyle modifications like weight management, diet changes, and exercise. However, PCOS is the leading cause of anovulatory infertility, so medical treatment may be needed.
What is the best treatment for PCOS infertility?
First-line treatment is lifestyle modification + Letrozole (ovulation induction). If unsuccessful, IUI with stimulation is tried. IVF is recommended after 3–6 failed IUI cycles. Over 70% of women with PCOS conceive with appropriate treatment within 12 months.
Does PCOS affect IVF success rates?
PCOS patients often respond well to IVF stimulation, producing many eggs. Success rates are comparable to or slightly higher than average. However, there is a higher risk of Ovarian Hyperstimulation Syndrome (OHSS), which requires careful monitoring.
How is PCOS diagnosed?
PCOS is diagnosed using the Rotterdam criteria: at least 2 of 3 features — irregular/absent periods, elevated androgens (blood test or symptoms like acne/excess hair), and polycystic ovaries on ultrasound.
What foods should I eat with PCOS?
Focus on a low-glycemic, anti-inflammatory diet: whole grains, lean protein, vegetables, healthy fats, and fibre-rich foods. Limit refined carbs, sugar, and processed foods. Weight loss of even 5–10% can restore ovulation in many cases.
Is PCOS curable?
PCOS is a chronic condition that is manageable but not curable. Symptoms can be effectively controlled with lifestyle changes, medications, and hormonal treatments. Many women see significant improvement with consistent management.
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