PCOS is the most common diagnosis in women of reproductive age, affecting roughly 8 to 13% of them, and its main effect on fertility is trouble ovulating. It can also affect egg quality and raises the risk of miscarriage. There are established treatments, from myo-inositol and weight loss (when applicable) to metformin, ovulation induction and, in some cases, IVF, and your doctor chooses among them for your case.
PCOS is defined by the Rotterdam Criteria. The diagnosis requires 2 of these 3:
Signs of excess androgens include severe adult acne, male-pattern hair loss and hair growth on the face, chin or chest. The book lists them among the red flags that call for an appointment, because they are almost always related to PCOS.
| Test | What can point to PCOS |
|---|---|
| AMH (any day of the cycle) | Above 4.5 ng/mL |
| Antral follicle count (ultrasound, day 2 to 5) | Above 25 follicles in total |
| LH/FSH ratio (day 2 to 4) | Frequently above 2 |
| Total and free testosterone | Assesses PCOS and hyperandrogenism |
Values as given in the book's chapter on advanced tests. Your doctor reads them together, in the context of your case.
With PCOS, the main obstacle is ovulation: cycles can be irregular, or ovulation can be absent. The book also lists possible effects on egg quality and a higher risk of miscarriage.
Women with PCOS frequently have chronically elevated baseline LH. That means ovulation tests can read positive several times in a cycle without any real ovulation happening. For PCOS, basal body temperature plus cervical mucus are more reliable than LH tests.
A previous diagnosis of PCOS is also one of the situations in which the book says not to wait the standard 12 or 6 months of trying before seeing a specialist.
The order and the combination depend on your case. PCOS can also come with a second diagnosis: more than one diagnosis at the same time happens in 20 to 30% of cases, and PCOS plus male factor is the book's own example. That doesn't automatically mean a more serious case, but it can change the strategy, so ask your specialist how much each factor weighs.
PCOS is the first of the 8 diagnoses in Chapter 33 of Map to the Positive, in Station IV (Signs). That station also gives you the age cutoffs for seeing a specialist, the 13 red flags, the advanced tests with their reference values and the treatment ladder, from ovulation induction to IVF. Earlier stations cover supplements and exercise in detail, and how to read your cycle when ovulation tests mislead you.
Take 30 days. If it does not give you more clarity than everything you have read for free so far, ask for a refund and you get every cent back. We cannot promise you a pregnancy. We can promise you will not be guessing.
References: ESHRE Guideline on PCOS (2023). · Unfer V et al. Myo-inositol effects in women with PCOS. Gynecological Endocrinology, 2017.