What Causes You to Be Infertile?
Lack of fertility is a very distressing disorder. It is also very complex to deal with.

In general, infertility falls into one of five categories:

Ovarian disorders (20-25%) - disturbances in the production and release of eggs.
Male factor (40-50%) - inadequate sperm quality, function or motility. (This category also includes couples who are unable to have intercourse due to injuries or for other reasons.)
Pelvic factor (20-25%) - including uterine abnormalities, fibroid tumors, blocked fallopian tubes, endometriosis and/or pelvic adhesions.
Cervical factor (5%) - abnormalities with the cervix that hamper sperm movement.
Unexplained infertility (10-15%) - infertility that remains undefined in spite of an extensive medical evaluation.
It's not uncommon for couples to have a combination of two or more of the above causes of infertility. Even though your primary concern is about ovarian problems (the first category), you should remain aware of the additional causes of infertility.


The inability of some women with polycystic ovary syndrome to produce and release an egg is due to a complex web of multiple hormone imbalances. The hormones involved include insulin, androgens, estrogens, progesterone, luteinizing hormone, follicle stimulating hormone, adrenal hormones, thyroid hormones, prolactin, and others. All of these hormones influence each other in some way. Therefore, if you can optimize any one of them, you are taking a step towards optimizing the others and increasing your chances of becoming fertile.

In addition, some women have other factors that contribute to infertility (like a husband with a low sperm count or a uterus scarred by a previous infection), which have nothing to do with PCOS. If you have PCOS, it's difficult to estimate your chances of having a baby. Nevertheless, there's plenty you can do to improve your odds.

In the sections below, we'll discuss the conventional medical and natural methods for dealing with infertility.

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Conventional Infertility Treatment - Drugs to Induce Ovulation
Many women with PCOS don't ovulate and thus cannot become pregnant. So the first treatment option for infertility is usually the administration of drugs to induce ovulation.

Clomiphene citrate (Brand names: "Clomid" or "Serophene"). Clomid is taken for 5 days early in your cycle to stimulate ovulation. Clomid may not be effective if taken for more than six menstrual cycles.

There is some evidence to suggest it may increase your risk of ovarian cancer if taken for 12 or more cycles. Clomid also has a number of side effects including bowel problems, headache, dizziness, blurred vision, depression, and more.

After taking Clomid for up to six cycles, it is reported that you have a 30% chance of becoming pregnant. (1)

Metformin (Brand name: Glucophage). Metformin is an insulin-sensitizing agent that is sometimes used in conjunction with Clomid. Metformin may increase your fertility to the extent that it reduces insulin resistance, and thus helps to normalize insulin. Too much insulin reduces your fertility. For more information, please go to our Metformin page.

hCG (human chorionic gonadotrophin). (Brand names: Profasi, Pregnyl). hCG may be used in conjunction with Clomid. hCG has the same effect on the follicle as LH (luteinizing hormone). It stimulates the dominant follicle to release its egg. hCG is given by injection, and has to be carefully timed. If given too soon, ovulation may be blocked. Too much hCG may cause ovarian hyperstimulation and cyst formation.

hMG (human menopausal gonadotrophin) (Brand names: Pergonal, Humegon, Repronex). hMG is a combination of LH (luteinizing hormone) and FSH (follicle stimulating hormone) that is derived from the urine of menopausal women. Both LH and FSH are required for follicle development. It is given by injection. There's a narrow range between giving too little vs. too much. Too much hMG may cause ovarian hyperstimulation and cyst formation. hMG is also expensive and may result in a multiple pregnancy.

FSH (follicle stimulating hormone). (Brand names: Metrodin, Fertinex, Follistim, Gonal-F). This injectable drug is intended for women who already have enough LH. Since many women with PCOS have excessive LH, FSH can be helpful in some cases.

GnRH (gonadotrophin releasing hormone). (Brand name: Lutrepulse). GnRH is naturally released from your hypothalamus gland in pulses every 90 minutes. GnRH causes your pituitary gland to release both LH and FSH, which are necessary for follicle development. To mimic the 90-minute pulse, you will have to wear a pump 24 hours a day, which injects GnRH every 90 minutes. This is inconvenient and very expensive. Infection at the needle site is not uncommon. One benefit of GnRH is reduced risk of ovarian hyperstimulation or a multiple pregnancy. GnRH may be used when Clomiphene and gonadotrophin injections have failed.

GnRHa (GnRH analogs). (Brand names: Lupron, Synarel, Zoladex, Antagon). GnRH analogs are synthetic hormones that have a continuous effect, unlike the normal 90-minute pulsations of GnRH. This blocks production of both LH and FSH. These analogs are commonly used along with gonadotrophin injections in IVF (in vitro fertilization) clinics. Since LH may cause release of eggs from the follicles before they are ready, GnRH analogs are used to prevent that from happening. Reported side effects include headaches, insomnia, and mood swings.

Prolactin inhibition drugs. Bromocriptine ("Parlodel"), pergolide ("Permax"), or cabergoline ("Dostinex") may be used to reduce prolactin levels if they are too high. Excessive levels of prolactin inhibit ovulation. Side effects vary, according to which drug you are using.

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Conventional Infertility Treatment - Assisted Reproduction
There are a number of medical interventions that may help you to get pregnant.

IUI - intrauterine insemination. IUI is a medical procedure that places your partner's sperm directly into your uterus. The advantage of IUI is that it puts a much larger number of sperm into your uterus than would occur normally with intercourse. IUI may be useful if your partner has a low sperm count. Assuming that you are ovulating, a pregnancy success rate of about 15% has been reported.

IVF - in-vitro fertilization. IVF refers to removal of eggs from your body, and then fertilizing them with your partner's sperm. A fertilized egg is then implanted into your womb. Although simple in concept, the execution of this procedure is complex and expensive. Here are the five basic steps involved in IVF for infertility.

Step 1. A GnRH analog is given to suppress follicular development. Then, gonadotrophin injections are started, in order to stimulate several follicles to develop. When the follicles reach a proper size, as determined by ultrasound, an injection of hCG is given to stimulate the follicles to prime the eggs for release.

Step 2. The eggs are collected through your vagina with an aspiration needle. You may be sedated for this procedure or receive general anesthesia.

Step 3. Your eggs are placed into a culture dish and fertilized with your partner's sperm.

Step 4. After 2-3 days, the healthiest fertilized eggs (embryos) are transferred to your uterus by a soft catheter through your cervix.

Step 5. Hopefully, one of the embryos will become successfully implanted in the wall of your uterus. To aid implantation, you may be given hCG or progesterone.


In spite of its popularity for infertility, the pregnancy rate from IVF is quite variable, and may not exceed 20%. An IVF procedure can cost $10,000 and up.

GIFT - gamete intra fallopian transfer. GIFT involves collection of eggs, mixing them with sperm, and placing a maximum of 3 eggs into your fallopian tubes. The eggs are obtained by a laparoscope inserted through the abdomen, so general anesthesia may be required. It is expensive and the "success rate" in PCOS women may be low.

ICSI - intracytoplasmic sperm injection. This procedure involves injecting a single sperm into a single egg. The technique is not very successful in cases where the egg quality is poor, as is often the case in women with PCOS. Another minor factor to consider is that there is no competition among sperm, where, under normal circumstances, the healthiest sperm is the one that joins the egg.

In summary, the overall pregnancy success rate for IVF and embryo transfers is reported to be in the 25%-50% range, (2) with a lot of individual variability.