PCOS: everything you need to know, simply explained
Polycystic ovary syndrome (PCOS) affects about 1 in 10 women. It’s not a serious illness, and with good management, you can live very well with it!
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Questions & answers about fertility
Clear answers, written by doctors, minus the jargon.
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How are embryos selected?
Embryologists grade embryos on cell number, stage and blastocyst structure to pick the best for transfer, but grading never guarantees a pregnancy.
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How does embryo transfer work?
Embryo transfer is a critical step in IVF success, requiring close coordination between the fertility specialist and the embryologist.
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How is the number of embryos for transfer decided?
Before starting IVF, a detailed discussion takes place between the couple, fertility specialist, and embryologist to decide how many embryos to transfer.
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Is pregnancy after assisted reproduction considered high-risk?
Not usually. Pregnancies after IVF, ICSI or IVM follow standard prenatal care, with no extra monitoring unless specific risk factors are present.
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Under what conditions are embryos frozen?
Embryo freezing (cryopreservation) is a technique that preserves embryos in liquid nitrogen at -196°C.
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What is in vitro maturation (IVM)?
In IVM, immature eggs are collected from antral follicles and matured in the lab, not in the ovaries. It suits women at high risk of OHSS, among others.
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What is preimplantation genetic diagnosis (PGD)?
PGD tests IVF embryos for a known genetic or chromosomal disorder before transfer, so couples at risk can avoid passing it on to their child.
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When does embryo transfer take place?
Embryo transfer happens between Day 2 and Day 5 after egg retrieval. The day depends on how many embryos there are and on the lab’s strategy.
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When is egg donation recommended?
Egg donation is considered when a woman can no longer produce eggs of sufficient quantity and/or quality for conventional assisted reproduction.
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Are some gonadotropin treatments more effective than others?
No gonadotropin preparation has been proven more effective than another. LH is essential only in hypogonadotropic hypogonadism, where ovulation needs it.
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Are there higher risks of early miscarriage or pregnancy complications?
Yes. PCOS raises the risk of early miscarriage, especially with obesity, and of gestational diabetes and high blood pressure. Closer monitoring helps.
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Are there treatments for ovulation disorders in women with PCOS?
Weight loss can restore ovulation in some women with PCOS. If not, clomiphene citrate comes first, then ovarian drilling or ovarian stimulation.
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Can a normal pregnancy still happen after three consecutive miscarriages?
Yes, despite experiencing three consecutive miscarriages, many women still have a good chance of carrying a pregnancy to term.
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Can a sexually transmitted infection affect fertility?
Yes. Often silent, STIs like chlamydia and gonorrhea can scar and block the Fallopian tubes. Antibiotics clear them but can’t always undo the damage.
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Can in vitro fertilization fail?
Yes, fertilization failure or abnormalities can occur. Complete fertilization failure happens in about 5% of IVF cases, meaning no embryos are formed.
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Can ovarian aging be reversed?
Not yet. Mitochondrial transfer, PRP injections and follicular activation are being studied, but all remain experimental, with uncertain results.
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Can the amount of hormones administered affect egg quality?
No, the intensity of ovarian stimulation and the number of eggs retrieved do not increase the risk of genetic abnormalities in embryos created through IVF.
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Can we reverse the impact of age on fertility?
The biological mechanisms behind age-related infertility are well understood, but current medical treatments cannot fully reverse ovarian aging.
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Do all women respond the same way to ovarian stimulation?
No. AMH and antral follicle count guide the FSH dose, yet some women over- or under-respond. Treatment is adjusted for each group.
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Does age affect IVF success rates?
A man’s age has a minor effect on IVF success. A woman’s age matters far more: older eggs carry more chromosomal errors, lowering the chances.
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Does taking the pill reduce fertility?
No, taking the pill—regardless of the type—does not accelerate ovarian aging or reduce fertility.
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How are eggs retrieved?
Eggs are collected by transvaginal aspiration under ultrasound, with local anesthesia or light sedation. A thin needle drains the follicles.
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How can uterine fibroids affect fertility?
Fibroids are rarely the sole cause of infertility, but their size and location can impact reproductive outcomes.
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How does a woman’s age affect fertility?
Fertility peaks between 20 and 30, then declines, faster after 35–37, as eggs drop in number and quality. AMH and follicle counts estimate the reserve.
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How does Fallopian tube blockage affect fertility?
Natural conception needs at least one open tube. Blockages near the uterus or near the ovaries are treated differently, and hydrosalpinx can hinder IVF.
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How does ovarian stimulation work?
Ovarian stimulation involves daily injections of FSH (follicle-stimulating hormone), starting at the beginning of a menstrual cycle.
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How is endometriosis managed?
The main goals of endometriosis treatment are to reduce symptoms, slow the progression of lesions, and support fertility in women who wish to conceive.
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How is ovulation disorder diagnosed in hypogonadotropic hypogonadism?
When the pituitary makes too little FSH and LH, ovulation stops though the ovaries are healthy. Absent periods and hormone tests point to it.
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Is PCOS linked to overweight and obesity?
Yes: about half of women with PCOS are overweight or obese. Excess weight worsens ovulation problems, but losing weight can help restore ovulation.
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Should endometriosis surgery always be performed?
Not always. Ovarian surgery can lower ovarian reserve, cysts under 6 cm rarely need it, and IVF often comes first for endometriosis-related infertility.
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What are gonadotropin treatments?
Gonadotropins are injectable FSH and/or LH. They induce ovulation in PCOS or hypogonadotropic hypogonadism and stimulate the ovaries for IUI and IVF.
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What are the causes of recurrent miscarriages?
Recurrent miscarriages can result from genetic, hormonal, anatomical, environmental, or immunological factors.
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What are the possible complications of IVF?
Complications from IVF are rare, but couples should be informed of potential risks associated with ovarian stimulation and egg retrieval.
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What are the symptoms of endometriosis?
Pelvic pain, lower back pain, digestive issues and pain during sex, often worse around periods. Many women with endometriosis have no symptoms.
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What happens to the retrieved eggs in the laboratory?
In the lab, retrieved eggs are placed in culture with prepared, motile sperm. About 18 to 20 hours later, embryologists check for fertilization.
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What is assisted oocyte activation (AOA)?
Assisted oocyte activation (AOA) chemically triggers an egg that sperm fail to activate after ICSI. Still experimental, it’s prohibited in France.
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What is endometriosis?
Endometriosis is a condition where tissue similar to the lining of the uterus (endometrial glands) grows outside the uterus, triggering inflammation.
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What is ICSI?
Intracytoplasmic Sperm Injection (ICSI), developed in 1991, is an advanced fertilization technique used in assisted reproduction.
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What is IMSI?
IMSI is ICSI with sperm chosen under ultra-high magnification (6,000x to 10,000x). Its benefits are debated, so it isn’t recommended for everyone.
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What is in vitro fertilization (IVF)?
In vitro fertilization (IVF) is a form of assisted reproductive technology (ART) developed in the late 1970s and early 1980s.
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What is intrauterine insemination (IUI)?
IUI places lab-prepared sperm directly in the uterus around ovulation. Who it suits, what tests come first, how it’s done, and its 10–20% success rate.
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What is polycystic ovary syndrome (PCOS)?
PCOS causes 10% of female infertility. Despite the name, there are no real cysts: it’s an excess of follicles, with irregular cycles and excess androgens.
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What is premature ovarian insufficiency?
Premature ovarian insufficiency (POI) means no periods for over six months before 40. Its causes, its symptoms and the rare chances of pregnancy.
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What is the difference between inducing and stimulating ovulation?
Induction restores ovulation, aiming for one follicle, in women who don’t ovulate. Stimulation matures several follicles in women who do, mainly for IVF.
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What is the link between ovarian reserve and ovarian insufficiency?
Ovarian reserve naturally declines with age, but low ovarian reserve does not always mean ovarian insufficiency.
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What tests are required before IVF?
Before IVF, women usually have an ovarian reserve assessment, a check of the fallopian tubes and an evaluation of the uterine cavity, and men a semen analysis.
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When are recurrent miscarriages diagnosed?
Recurrent miscarriage means three consecutive miscarriages before 20 weeks, each confirmed by ultrasound. It affects about 1% of women.
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Who is IVF recommended for?
IVF is primarily offered to couples or individuals facing medical conditions that prevent natural conception.
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Why is ovarian stimulation necessary for assisted reproductive technology (ART)?
A natural cycle yields one egg. Stimulation matures several: mildly for IUI, to avoid multiples, and more for IVF, where extra embryos can be frozen.
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Why is ovulation blocked?
Under normal physiological conditions, ovulation occurs when a pre-ovulatory follicle reaches a size of 16 to 22 mm in diameter.
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Are hormone tests reliable?
AMH has largely replaced FSH as the marker of ovarian reserve. Still, a high FSH early in the cycle points to a poorer prognosis in assisted reproduction.
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Are some sexual positions better for conception?
No position boosts the chances of conception. What counts is ejaculation inside the vagina and timing sex around ovulation, not a handstand afterwards.
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Can a man and a woman be biologically incompatible for conception?
No, there is no scientifically proven incompatibility that would prevent a specific man and woman from conceiving together.
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Can a woman ovulate more than one egg in the same cycle?
Yes. In some cycles, a woman may release two eggs instead of one, meaning that two follicles reach maturity and ovulate.
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Can I track my ovulation by measuring my temperature?
Tracking your basal body temperature (BBT) to determine ovulation is an old method based on a slight rise in body temperature after ovulation.
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Can the quality of ovulation be predicted?
Currently, there is no method to accurately determine the quality of a woman’s ovulation.
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Do early or late first periods predict menopause timing?
No. The age at which a woman gets her first period does not determine when she will reach menopause.
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Do I always ovulate from the same ovary?
No. Ovulation typically alternates between the two ovaries each month. However, this process is not strictly predictable, and some variations can occur.
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Do I always ovulate in the middle of my cycle?
No. The timing of ovulation can vary from one woman to another and even within the same woman over time.
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Do tight underwear reduce male fertility?
While tight underwear may slightly increase testicular temperature, current research does not strongly link them to infertility.
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Do vacations increase the chances of conceiving?
No “vacation effect” boosts fertility. More frequent sex on holiday does raise the odds, but timing intercourse around ovulation is what counts.
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Do vitamins improve sperm and egg quality?
So far, no vitamin supplementation has been proven to significantly enhance male or female fertility.
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Does frequent ejaculation affect sperm production?
No. Sperm production is continuous, however often you ejaculate. Frequent ejaculation may slightly lower the volume and sperm count, not the quality.
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Does male or female masturbation reduce the chances of conception?
No, as long as regular sexual intercourse is maintained, masturbation does not negatively impact fertility.
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Does the flow of menstrual bleeding affect fertility?
In most cases, the amount of menstrual bleeding does not directly correlate with fertility.
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How are eggs produced?
Each egg cell (oocyte) is contained within a small structure called a follicle, with each follicle holding just one oocyte.
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How are the Fallopian tubes evaluated?
The gold standard test for assessing Fallopian tube function is the hysterosalpingography (HSG).
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How are the testicles structured?
The testicles contain a specialized tissue called testicular parenchyma, made up of several meters of seminiferous tubules where sperm cells are produced.
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How do sperm travel through the male reproductive system?
Sperm travel through a network of ducts that stores them until ejaculation, maturing on the way. Accessory glands make most of the semen.
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How do the ovaries work?
The ovaries make female hormones, mainly estrogen, and release an egg each month from puberty to menopause. Estrogen also supports bones and the heart.
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How does an embryo develop?
A fertilized egg is called a zygote, the first stage of embryonic development, formed after the fusion of the sperm and egg.
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How does an ovulation test work?
An ovulation test detects the LH surge in urine, about 36 hours before ovulation. Fairly reliable for timing sex, it says nothing about egg quality.
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How does embryo implantation happen?
Implantation needs a genetically healthy embryo and a receptive uterine lining. If either is missing, it can fail or end in an early miscarriage.
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How does fertilization occur?
Each month, a mature egg is released. Fertilization happens when it meets a sperm cell: the two fuse, and their chromosomes combine into a zygote.
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How is the uterus examined?
A pelvic ultrasound early in the cycle checks the uterus for fibroids and malformations. Hysterosonography or hysteroscopy look inside the cavity.
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Infertility: when should you see a doctor and what to check?
If you have been trying to conceive for one year without success, it is time to see a specialist.
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Is infertility just “in the mind”?
Rarely. Stress affects health, but most infertility has a biological cause. And telling couples to “just relax” doesn’t help; medical support does.
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Is it a problem if semen leaks out of the vagina after sex?
No. Sperm quickly travel up through the cervix and uterus to the Fallopian tubes. The semen that leaks out is normal and doesn’t lower your chances.
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Ovarian function evaluation: assessing ovarian reserve
Blood tests early in the cycle (FSH, LH, estradiol, progesterone, AMH) and an ultrasound follicle count show whether ovarian stimulation is feasible.
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Should sexual intercourse be frequent?
Yes! While there is an optimal fertility window around ovulation, ovulation timing is not always predictable.
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What does the menstrual cycle reveal about fertility?
The length and regularity of menstrual cycles can provide some insight into ovarian function and fertility.
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What happens to sperm after ejaculation in the female reproductive tract?
Sperm head through the vagina, cervix and uterus to the Fallopian tubes. Most never get there, and usually only one fertilizes the egg.
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What is a menstrual period?
A period reflects the ovaries’ estrogen and progesterone and how the uterus responds. With no implantation, the top layer of the lining sheds.
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What is spermatogenesis?
Spermatogenesis is the process through which sperm stem cells (spermatogonia) develop into mature sperm cells capable of fertilizing an egg.
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What is the role of the Fallopian tubes?
The Fallopian tubes catch the egg after ovulation, host fertilization and carry the embryo to the uterus. One healthy tube is often enough.
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What is the role of the uterus?
The uterus is the organ where the embryo implants and develops during pregnancy.
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When should you suspect an ovulation disorder? What are the causes?
No periods, or cycles under 24 or over 45 days, suggest an ovulation disorder. Causes include PCOS, hypogonadism, POI and some medications.
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Why is testosterone important for sperm production… and more?
Testosterone starts and sustains sperm production. It also drives muscle and libido, and declines with age, along with sperm quality.
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