Can people with polycystic ovary syndrome have children?

One of the most common causes of infertility is polycystic ovary syndrome (PCOS). PCOS is the most frequently seen endocrine disorder affecting 5–10% of women of reproductive age [1]. This hormonal condition, which commonly leads to irregular menstruation, excessive hair growth, and fat accumulation around the waist, can often be detected early through regular gynecological examinations.

However, in some cases, PCOS may remain asymptomatic and go unnoticed until pregnancy does not occur. It is estimated that PCOS is the underlying cause in 70–80% of anovulatory infertility cases [1].

PCOS and Obesity: Lifestyle Change Is the First Step

PCOS often worsens in parallel with excess weight (obesity). In such cases, lifestyle modifications significantly increase the chances of conception. The 2023 International PCOS Guideline (ASRM/ESHRE) recommends lifestyle intervention as the first-line treatment in overweight and obese PCOS patients [2].

If both PCOS and obesity are present, losing 5–10% of body weight can help restore regular ovulation. However, due to insulin resistance, these patients may find it more difficult to lose weight. Positive changes in diet and physical activity can help regulate menstrual cycles [1].

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Infertility Treatment and PCOS

Since most women with PCOS do not ovulate regularly, they may have difficulty conceiving. Therefore, treatment is planned in the following steps [2]:

Step 1 — Lifestyle and medication: According to the 2023 ASRM/ESHRE guideline, letrozole is the preferred first-line pharmacological treatment for infertility in PCOS; clomiphene citrate combined with metformin is also recommended as an alternative [2].

Step 2 — Gonadotropin therapy or laparoscopic ovarian surgery: In patients who do not respond to first-line treatment, gonadotropin injections or laparoscopic ovarian drilling may be considered.

Step 3 — IVF/ICSI: In cases where ovulation induction fails or other infertility factors are present, in vitro fertilization (IVF) is applied. Meta-analyses show that pregnancy and live birth rates in women with PCOS undergoing IVF are comparable to those without PCOS [3].

Since PCOS patients have a higher risk of ovarian hyperstimulation syndrome (OHSS), IVF protocols should be carefully selected; GnRH antagonist protocols and freeze-all strategies are often preferred [3].

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