Polycystic ovarian syndrome (or PCOS) affects about 5 million women in the United States alone. It is both one of the most common hormonal endocrine disorders and one of the most frequent causes of infertility in women. The good news is that having PCOS doesn’t mean you can never get pregnant. In fact, with fertility treatments, most women with PCOS will be able to conceive. It’s just a matter of finding what works for you (because each case of PCOS can present differently).

What are the symptoms of PCOS, and how does it affect fertility?

Every woman is different; while one with PCOS may have no external symptoms, another may have all of them. The severity of the symptoms also differs between women. According to womenshealth.gov, these symptoms can include acne, thinning hair or male-pattern baldness, weight gain or difficulty losing weight, darkening of the skin, skin tags, abnormal amounts of facial or body hair for women (called hirsutism), and heavy or irregular menstrual cycles.

All of the symptoms of PCOS can be frustrating and embarrassing but, to better understand how it affects fertility, it’s important to look at the hormones that cause it — androgens, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

While understanding the way hormones function in the body is somewhat complex, here’s an easy way to understand it:

Women with PCOS have an imbalance in the production of LH and FSH, two hormones that are necessary for ovulation. FSH has the job of stimulating the growth of the follicles in the ovaries that contain a maturing egg. When levels of FSH are too low, the follicles won’t mature and the ovaries won’t release an egg. When LH levels are too high the body produces too much estrogen, testosterone, and other androgens, causing the uterine lining to become thick (this is where the heavy and irregular menstrual cycles come in).

In order to become pregnant, a woman must ovulate (release an egg from her ovaries) and that egg must become fertilized. Due to the imbalanced hormones, women with PCOS may never ovulate or, if they do, it can be infrequent and hard to track.

To make things even more challenging, women with PCOS have an insensitivity to insulin, which can cause these hormonal imbalances. The weight gain associated with insulin resistance can contribute to fertility problems, too.

What it boils down to is a problem with ovulation. Thankfully, there are ways to improve fertility for women with PCOS.

PCOS and Fertility Treatment Options

The typical first step in treating infertility in women with PCOS is weight loss, if necessary. Even losing a small percentage of weight can help balance hormones (which in turns lessens your symptoms and promotes ovulation), as well as make you more responsive to fertility treatments. It can be challenging to lose weight when you have PCOS, so it may be necessary to consult a doctor and ask what options are available to you.

There are a few other common treatments for PCOS that are known for their ability to improve fertility:

Metformin — This prescription drug helps to reduce high insulin levels and stabilize your hormones. This, in turn, can help restore your ovulation cycles, making it easier to become pregnant.

Clomid —  Clomid is a fertility drug that helps you ovulate and has about an 80% success rate. Though not solely used for women with PCOS, Clomid can be especially effective if used in taken in conjunction with metformin.

Gonadotropins — If Clomid treatments aren’t effective, your doctor may prescribe gonadotropins. These naturally occurring hormones stimulate your ovaries to release eggs.

In vitro fertilization — Having PCOS can prevent ovulation but it doesn’t mean that you can’t have a healthy pregnancy. In cases where no other treatment options are successful, in vitro fertilization may be recommended.

When you seek treatment for fertility depends: for women under age 32, who have PCOS and regular cycles, you should see a fertility specialist after 3 to 6 months of trying. Women over 32 should wait about 3 months before seeking professional treatment. This is, however, if you have a regular cycle. Women with irregular cycles can benefit from seeing a specialist early on.

Ultimately, how you approach trying to conceive with PCOS should be something you talk about with your doctor. They can make the best recommendations, based on your personal situation. Just know this: there is hope for you to become pregnant with PCOS.