Polyendocrine Metabolic Ovarian Syndrome (PMOS) – formerly Polycystic Ovary Syndrome (PCOS) – affects between 10-13% of reproductive-age individuals worldwide, making it one of the most common endocrine disorders. While PMOS can present challenges for conception, understanding this condition and the available treatment options can empower you to make informed decisions about your fertility journey.

What is PMOS?

PMOS is a complex hormonal condition characterized by three main features, though not everyone experiences all three:

• Irregular menstrual cycles due to infrequent or absent ovulation
• Elevated androgens (hormones often associated with typical male characteristics), which can cause symptoms like excess facial/body hair, acne, or hair loss
• Polycystic ovaries visible on ultrasound, showing multiple small follicles

For a diagnosis of PMOS, you typically need to have at least two of these three features, after other potential causes have been ruled out.

How PMOS Affects Fertility

The primary reason PMOS affects fertility is due to irregular or absent ovulation. When you don’t ovulate regularly, the chances of an egg being available for fertilization are reduced. However, it’s important to understand that:

• Most women with PMOS can conceive, though it might take longer or require treatment
• PMOS is one of the most treatable causes of infertility
• Many successful treatment options exist, from lifestyle changes to medications and assisted reproductive technologies

Understanding Your Unique PMOS Profile

PMOS affects everyone differently. Some individuals experience mild symptoms with minimal impact on fertility, while others face more significant challenges. Understanding your specific PMOS profile can help you and your healthcare provider determine the most effective approach for you.

Key factors that may affect your fertility with PMOS include:

• Frequency of ovulation: Some women with PMOS ovulate occasionally, while others rarely or never ovulate without intervention
• Body weight: Weight can influence hormone balance and ovulation
• Insulin resistance: Present in 70-80% of women with PMOS, this can affect hormone production and ovulation
• Age: Fertility naturally declines with age for all women, including those with PMOS

Proactive Steps to Enhance Fertility with PMOS

1. Lifestyle Modifications

For many women with PMOS, especially those who are overweight, lifestyle changes can significantly improve fertility:

• Weight management: For those with higher body weight, even modest weight loss (5-10% of starting weight) can help restore ovulation and improve pregnancy rates. This was demonstrated in studies where individuals who lost weight before fertility treatments had better outcomes than those who proceeded directly to medication. However, it’s important to note that not everyone with PMOS carries excess weight, and weight loss isn’t necessary or appropriate for everyone.
• Regular physical activity: Exercise improves insulin sensitivity and may help regulate hormones. Aim for at least 150 minutes of moderate activity per week, combining both aerobic exercise and strength training.
• Balanced nutrition: While no specific diet has been proven superior for PMOS, focusing on whole foods, lean proteins, healthy fats, and complex carbohydrates can help manage insulin levels and support overall health.

It’s important to note that lifestyle modifications may not be enough for everyone, and that’s completely okay. These approaches work best when combined with medical treatment as needed.

2. Track Your Cycles and Potential Ovulation

Even if your cycles are irregular, tracking them can provide valuable information:

• Use apps and basal body temperature charting to identify potential patterns
• Track physical symptoms like cervical mucus changes, which can indicate approaching ovulation
• Be cautious with ovulation prediction kits (OPKs) if you have PMOS—these kits detect luteinizing hormone (LH) surges, but women with PMOS often have chronically elevated LH levels, which can lead to false positive results
• If using OPKs, track results over multiple cycles and consider pairing with another tracking method
• If you are having a hard time tracking your cycles talk to your provider for individualized advice

This information can be helpful both for timing intercourse and for providing your healthcare provider with a clearer picture of your cycles.

3. Address Inflammation

Chronic low-grade inflammation is a key feature of PMOS that can affect fertility by disrupting hormone balance and ovulation. Research has identified several evidence-based approaches to manage this inflammatory state:

• Anti-inflammatory eating patterns: The Mediterranean diet has shown particular promise for reducing inflammation in PMOS. This eating pattern emphasizes:
  • Abundant fruits and vegetables
  • Whole grains
  • Olive oil as the primary fat source
  • Regular consumption of fatty fish (like salmon and sardines)
  • Limited red meat
  • Moderate intake of dairy products

• Specific anti-inflammatory foods and compounds:
  • Omega-3 fatty acids from fatty fish, flaxseeds, and walnuts
  • Turmeric (curcumin) has shown anti-inflammatory effects in research
  • Green tea contains polyphenols with anti-inflammatory properties
  • Berries are rich in antioxidants that help combat inflammation
• Exercise: Regular physical activity has anti-inflammatory effects. Both aerobic exercise and strength training show benefits in reducing inflammatory markers in PMOS.
• Adequate sleep: Poor sleep quality and insufficient sleep duration increase inflammatory markers. Aim for 7-9 hours of quality sleep and address any sleep disorders, which are more common in people with PMOS.
• Stress management: Chronic stress increases inflammation. Mind-body practices like meditation, yoga, and breathing exercises can help reduce both stress and inflammatory markers.
• Consider supplements (with medical guidance):
  • Fish oil supplements (omega-3s)
  • Vitamin D (many people with PMOS are deficient, and correcting deficiency may reduce inflammation)
  • N-acetylcysteine (NAC) has shown some promising results in reducing inflammation in PMOS
• Medications: For some individuals, your healthcare provider might recommend medications that help address both insulin resistance and inflammation, such as metformin, which has been shown to reduce inflammatory markers in PMOS.

Remember that reducing inflammation is a multi-faceted approach that works best when several strategies are combined. These approaches not only may improve fertility but also support overall health and well-being.

4. Medical Treatments for Ovulation

If lifestyle modifications aren’t sufficient to restore regular ovulation, several effective medications can help:

• Letrozole: Now considered the first-line medication for ovulation induction in people with PMOS. Studies show higher live birth rates compared to other medications.
• Clomiphene citrate: Was first-line therapy before letrozole, it still remains an effective option for many.
• Metformin: While primarily used for insulin resistance, metformin can help restore ovulation in some people with PMOS, particularly when combined with lifestyle changes.
• Gonadotropins: These injectable hormones may be used if oral medications are unsuccessful.
• Ovarian drilling: A surgical procedure that can trigger ovulation in some individuals who don’t respond to medication.

PMOS-Related Pregnancy Risks

People with PMOS have higher rates of certain pregnancy complications, including gestational diabetes, pregnancy-induced hypertension, and preeclampsia. However, with proper monitoring and care, most individuals with PMOS have healthy pregnancies and babies.

Proactive steps you can take:

• Optimize your health before conception
• Work with healthcare providers who understand PMOS

Mental Health and Emotional Wellbeing

The fertility journey with PMOS can be emotionally challenging, and it’s important to acknowledge that PMOS itself is strongly associated with mental health impacts. Research has consistently shown that people with PMOS have significantly higher rates of depression and anxiety disorders:

• Depression: Studies show that individuals with PMOS are approximately 3 times more likely to experience depression compared to those without PMOS
• Anxiety: Anxiety disorders are also about 3 times more common in people with PMOS
• Quality of life: PMOS can impact overall quality of life due to both physical symptoms and emotional distress
• Body image concerns: Symptoms like weight gain, hirsutism, and acne can affect body image and self-esteem

These mental health challenges can be exacerbated by fertility struggles but are important to address regardless of where you are in your fertility journey. They’re not just reactions to having PMOS—they appear to be linked to the hormonal and biochemical aspects of the condition itself.

Consider these strategies for supporting your mental wellbeing:

• Recognize it’s not your fault: The mental health aspects of PMOS are part of the condition, not a personal failing
• Connect with others: Join PMOS support groups or and engage in the Obi communities where you can share experiences with others who understand
• Seek professional support: Mental health professionals, particularly those familiar with PMOS and fertility issues, can provide valuable tools for managing depression and anxiety
• Discuss with your healthcare provider: Treatment options may include therapy, support groups, or in some cases, medication
• Practice self-compassion: Be kind to yourself throughout this journey
• Explore stress-reduction techniques: follow along in Mindful Conception and the Pearls of WellBeing

When to Seek Specialized Fertility Care

While many women with PMOS conceive with the approaches outlined above, some may benefit from additional fertility treatments. Consider consulting a reproductive endocrinologist if:

• You aren’t ovulating regularly
• You’re over 35 and have been trying to conceive for 6 months or more
• You’re under 35 and have been trying for 12 months or more
• You’ve tried ovulation-inducing medications without success
• You have additional fertility factors beyond PMOS

Success Rates and Reasons for Hope

There’s substantial reason for optimism if you’re trying to conceive with PMOS:

• Most people with PMOS will be able to have at least one child with appropriate treatment
• Success rates for ovulation induction in PMOS are high, with 70-80% of individuals ovulating with medication
• Even if initial treatments aren’t successful, multiple options exist
• PMOS doesn’t affect egg quality the way advancing age does, so the prognosis remains good even if conception takes time

Partnering With Your Healthcare Team

Building a collaborative relationship with knowledgeable healthcare providers is essential. Consider these tips:

• Seek providers who have experience with PMOS and fertility
• Prepare questions before appointments
• Keep records of your cycles, symptoms, and treatments
• Don’t hesitate to seek second opinions if needed
• Advocate for yourself if you feel your concerns aren’t being addressed

Final Thoughts

While PMOS presents fertility challenges, it’s important to remember that it’s one of the most treatable causes of infertility. With the right combination of lifestyle changes, medical treatments, and support, most people with PMOS can achieve pregnancy. Your journey may take time and patience, but with each step, you’re moving closer to your goal of building your family.

The path might not always be straightforward, but by being informed and proactive, you can navigate this journey with confidence. Remember that each person’s experience with PMOS is unique, and what works best will vary from person to person. By working closely with your healthcare team and taking care of both your physical and mental wellbeing, you’re giving yourself the best chance of success.

Sources

Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.

Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome.

Legro RS, Dodson WC, Kunselman AR, et al. Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS.

Samarasinghe SNS, Leca B, Alabdulkader S, et al. Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial.

Qin JZ, Pang LH, Li MJ, et al. Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis.

Joham AE, Ranasinha S, Zoungas S, et al. Gestational diabetes and type 2 diabetes in reproductive-aged women with polycystic ovary syndrome.

Dokras A, Stener-Victorin E, Yildiz BO, et al. Androgen Excess-Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome.

Bozdag G, Mumusoglu S, Zengin D, et al. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis.

Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome.