frequent reason for female subfertility

Approximately 5 – 10 % of women of reproductive age are affected by polycystic ovarian syndrome (PCOS). This syndrome is, in fact, a hormonal disorder with symptoms including hair loss, acne and subfertility

As early as 1721, Italian scientist Antonio Vallisneri described women who were „obese and infertile, with two bigger-than-normal ovaries, and acne“. Even though almost 300 years have passed meanwhile, the underlying reasons are still not quite clear yet. Experts assume interactions between predisposition and environmental factors. It seems clear, however, that a couple of hormonal disturbances add up to form the vicious cycle seen in PCOS:

1. Shift in LH / FSH ratio:

2. Hyperandrogenemia:

3. Elevated estrogen levels:

4. Hyperinsulinemia:

In summary, excess estrogen, androgens and insulin together contribute to the symptoms typical for PCOS.


For diagnosis, the doctor will record the patient’s clinical history and take blood samples. In addition to this, an ultrasound examination of the ovaries is important. In PCOS, the ovaries are often enlarged and exhibit many (poly) immature oocytes. Because oocytes are located within little „bubbles“, which are referred to as „cysts“, this is described as „polycystic“.

According to the current definition, in PCOS, at least two of the following three features are present:

PCOS: Therapeutic options

It is not always necessary to treat PCOS straight away. If the woman does not suffer from the condition, is lean and without insulin resistance, no immediate action is required. Overweight women, on the other hand, are at risk of developing metabolic syndrome. In addition to that, studies have shown that shedding endometrium at least once a year may contribute to low cancer-risk.

Prior to treatment

…it is recommendable to have thyroid function checked. Quite frequently thyroid hypofunction can cause symptoms similar to PCOS. If this is the case, symptoms may vanish quickly once thyroid function has been restored.

Therapy options

Weight loss

The contraceptive pill


Bowel cleanse

Orthomolecular therapy

Planning for pregnancy

Just like every woman planning for pregnancy, it is important to get enough folic acid well before conception, thus diminishing the risk of spina bifida. Importantly, PCOS-patients often have an increased demand due to metformin-therapy and weight-loss programs.

Women with polycystic ovary syndrome will often need artificial induction of ovulation by fertility experts using medication such as clomifen.

Sometimes surgery can be helpful as well. Laser is employed to destroy some immature follicles, trying to interrupt the vicious cycle and regulate hormone metabolism.

Another option is hormonal treatment with FSH.

PCOS and pregnancy

During pregnancy, PCOS-patients face an increased risk to develop gestational diabetes. Regular screening is advisable to check for this and offer treatment quickly.

Is PCOS curable?

Unfortunately not. However, most patients benefit from medical therapy and lifestyle changes. Sometimes, there is an improvement after pregnancy and menopause.