- PCOS is one of the leading causes of infertility but can be effectively managed with proper hormone balance.
- Hormonal imbalances such as high androgens, low progesterone, and insulin resistance disrupt ovulation.
- Common fertility medications include Clomid, Letrozole, Metformin, and gonadotropins.
- Fem Excel focuses on restoring natural ovulation through bioidentical hormones, thyroid and insulin support, and lifestyle guidance.
- Balancing hormones first often makes fertility treatments more effective or unnecessary.
- Personalised hormone therapy can help regulate cycles, improve ovulation, and support a healthy pregnancy.
Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility, but it does not mean the door to starting a family is closed. Many women with PCOS conceive healthy pregnancies once their hormones are properly balanced and cycles return to a natural rhythm.
Hormone therapy can play an important role in that process. By regulating cycles, encouraging ovulation, and rebalancing the hormones that make conception difficult, treatment can help the body work as it should again.
It can feel overwhelming at first, especially with the number of medication names and acronyms involved. Understanding how hormone therapy works can help you make confident, informed choices on your fertility journey.
This article explains how PCOS affects fertility, how hormone therapy supports ovulation, and what treatment options are available, including how Fem Excel's approach helps restore natural hormone balance before fertility drugs are considered.
What Is PCOS?
Polycystic ovary syndrome, sometimes also called polycystic ovarian syndrome or PCOS, is a hormonal condition that affects up to 1 in 10 women of reproductive age. It's one of the most common causes of irregular periods and ovulation issues, yet many women don't even know they have it until they begin trying to conceive or notice unusual symptoms.
Some hallmark signs of PCOS include:
- Irregular or missed periods
- Excess or irregular facial or body hair (hirsutism)
- Acne or oily skin
- Weight gain or difficulty losing weight
- Thinning hair on the scalp
- Cysts on the ovaries (though not always present)
Despite the name, not everyone with PCOS has cysts on their ovaries, and not everyone with ovarian cysts has PCOS. The diagnosis typically involves a combination of symptoms, hormone testing, and imaging. PCOS can also impact long-term health and increase the risk of issues like type 2 diabetes, high blood pressure, and mood disorders. That's why early diagnosis and treatment are so important.
How PCOS Affects Fertility
Fertility and PCOS are closely connected. PCOS is one of the most common causes of ovulatory infertility (1), meaning it makes it harder for the ovaries to release eggs regularly.
Without ovulation, pregnancy can't happen. The good news is that this process can often be supported and corrected with treatment. The main reason PCOS affects fertility is because of hormonal imbalances.
Women with PCOS typically have elevated levels of androgens (like testosterone), which can interfere with the development and release of eggs during the menstrual cycle. At the same time, many women with PCOS also have insulin resistance, which can worsen the hormonal imbalance and make regular ovulation even less likely.
Irregular or absent periods are often the first clue that ovulation isn't happening consistently. Some women with PCOS may ovulate occasionally, while others may go months without it. This unpredictability makes it hard to time intercourse or fertility treatments.
In some cases, the uterine lining can also become too thick or out of sync with ovulation, which makes implantation more difficult, even when an egg is released.
It's also important to know that PCOS can affect egg quality in some women (2), though this varies and is often related to age, weight, and insulin levels. That said, many women with PCOS have healthy eggs and go on to have healthy pregnancies.
Fortunately, there are many effective ways to manage PCOS, especially when it comes to improving fertility. Hormone therapy is one of the key tools in that toolbox.
What Is Hormone Therapy?
In the context of PCOS and fertility, hormone therapy refers to medical treatments that help correct hormonal imbalances and encourage the body to ovulate, something that often doesn't happen regularly (or at all) in women with PCOS.
Unlike hormone replacement therapy (HRT) used during menopause, this type of hormone therapy is designed specifically to support reproductive function. When you have PCOS, your body may produce too much androgen and not enough of the hormones needed to trigger ovulation.
Hormone therapy works by adjusting those levels, either by blocking excess androgens, increasing the hormones needed for ovulation, or making your body more sensitive to insulin, which in turn helps regulate reproductive hormones (3).
Of course, there's no one-size-fits-all approach. Hormone therapy can include pills taken orally, injectable medications, or sometimes a combination. Some medications are used to help regulate your menstrual cycle and prepare your body for pregnancy, while others are meant to directly stimulate your ovaries to release an egg.
It's also worth noting that not all hormone therapy is intended to lead to immediate pregnancy. In some cases, healthcare providers may first use birth control pills to regulate cycles and reduce symptoms like acne or excess hair growth before starting fertility-focused treatments.
Types Of Hormone Therapies for PCOS-Related Fertility Issues
1. Combined Oral Contraceptives (for Cycle Regulation)
Birth control pills are sometimes prescribed in conventional care to regulate periods or lower androgen levels before fertility treatment begins. They can temporarily create a predictable cycle, but they also suppress ovulation.
At Fem Excel, we do not advise use synthetic contraceptives. Instead, we focus on restoring your body's natural rhythm using bioidentical progesterone and thyroid support so your cycle becomes regular on its own.
2. Ovulation Induction Medications
Clomiphene Citrate (Clomid) and Letrozole (Femara) are commonly prescribed fertility drugs that help trigger ovulation. Clomid works by blocking estrogen receptors to stimulate the release of FSH and LH, while Letrozole briefly lowers estrogen levels to encourage the ovaries to release an egg.
These medications can help some women ovulate, but they work best when the underlying hormone imbalance has already been corrected. Fem Excel's treatment focuses on achieving that balance first. Once hormones such as progesterone, testosterone, thyroid, and insulin are stabilised, ovulation often returns naturally. If medication is still needed, it tends to work more effectively and predictably.
3. Gonadotropins (Injectable Hormones)
In advanced fertility treatments such as IUI or IVF, injectable gonadotropins containing FSH and LH are used to stimulate the ovaries. These medications require close monitoring and are usually managed by fertility specialists.
Fem Excel does not perform IVF or injectable fertility cycles. Instead, we help women improve natural ovulation and overall hormonal health, which can reduce the need for more invasive fertility procedures.
4. Insulin-Sensitising Agents (Metformin and GLP-1 Therapy)
Insulin resistance is one of the main drivers of PCOS symptoms. Medications such as Metformin can help the body use insulin more effectively, lowering androgen levels and supporting more regular ovulation.
At Fem Excel, we also use GLP-1 receptor agonists, such as semaglutide, which improve insulin sensitivity, assist with healthy weight management, and promote consistent cycles.
5. Progesterone Therapy
When menstrual cycles are irregular or absent, bioidentical progesterone can be prescribed to bring on a period and protect the uterine lining. While it does not directly induce ovulation, it plays an important role in re-establishing hormonal rhythm and supporting future fertility.
Fem Excel's progesterone therapy is bioidentical and individually tailored, helping restore natural balance rather than suppress normal hormonal activity.
Bringing It All Together
While conventional fertility care often begins with medications to trigger ovulation, Fem Excel starts by correcting the underlying hormone imbalance. By restoring progesterone, improving thyroid function, and managing insulin resistance, many women begin ovulating naturally before fertility drugs are ever needed.
For those who later choose assisted fertility treatments, a stable hormonal foundation can greatly improve outcomes and support a healthier pregnancy.
Hormone Therapy Versus Lifestyle Changes: Do You Need Both?
This is one of the most common questions women ask when navigating fertility with PCOS: Is hormone therapy enough on its own, or do I need to make lifestyle changes, too?
The short answer? In most cases, both approaches work best when used together.
Hormone therapy can do a lot of heavy lifting. It can regulate your cycle, help you ovulate, and balance out the hormones that are standing in your way.
But if insulin resistance, inflammation, or excess weight is contributing to your PCOS symptoms (which is true for many women), then lifestyle changes can make those treatments even more effective.
That doesn't mean you need to overhaul your life overnight. Small, sustainable steps can make a big difference. For example:
- Nourish Your Body: A diet rich in whole foods, fiber, lean proteins, and healthy fats can help stabilize blood sugar and reduce inflammation. Some women with PCOS find that lowering refined carbs and added sugars supports more regular ovulation.
- Stay Active: Regular movement, whether it's walking, yoga, strength training, or dancing in your living room, can improve insulin sensitivity and support hormonal balance.
- Manage Stress: High stress can throw hormones even further out of sync. Practices like meditation, journaling, or simply carving out time to rest can be beneficial.
- Prioritize Sleep: Poor sleep can affect insulin, appetite hormones, and mood. A consistent sleep schedule helps keep everything in check.
Think of lifestyle changes as the foundation and hormone therapy as a targeted tool that works even better with that strong base. You don't have to be perfect, but combining medical treatment with supportive daily habits gives your body the best chance at responding well and increases your chances of a healthy pregnancy.
When To See A Fertility Specialist
If you've been trying to get pregnant for 6 to 12 months without success, or if you know you have PCOS and aren't ovulating regularly, then it's a good idea to see a doctor and/or fertility specialist or endocrinologist.
You should also reach out sooner if you're over 35, have irregular periods, or suspect something more complex may be going on. A reproductive endocrinologist or OB-GYN can run tests, discuss treatment options like hormone therapy, and help you create a personalized fertility plan. Remember: early support can make a big difference.
What To Expect When Using Hormone Therapy For Fertility
Starting hormone therapy to treat PCOS-related fertility issues can feel like stepping into the unknown, but knowing what to expect can make the journey less overwhelming and more empowering.
1. Initial Testing And Monitoring
Before starting treatment, your doctor will likely run a series of tests to understand your hormone levels, check for ovulation, and rule out any other fertility factors.
You might also have an ultrasound to look at your ovaries and uterine lining. These tests help create a personalized treatment plan that's tailored to your needs.
Once hormone therapy begins, regular monitoring via bloodwork and ultrasounds is common. These check-ins help your provider track how your body is responding and adjust medications as needed to avoid complications like overstimulation.
2. Medication Cycles
Hormone therapy is usually administered in cycles that align with your menstrual cycle (or induce one if needed). Oral medications like Clomid or Letrozole are typically taken for five days early in the cycle, followed by monitoring to see if ovulation occurs. If injectable hormones are used, the schedule may be more intensive and require close supervision.
3. Timing Intercourse Or Fertility Treatments
Once ovulation is triggered or expected, your doctor will advise on the best timing for intercourse, intrauterine insemination (IUI), or, in some cases, in vitro fertilization (IVF). Predicting and timing ovulation correctly is a major benefit of using hormone therapy under medical guidance.
4. Side Effects And Emotional Impact
Side effects vary depending on the medication. Some women experience hot flashes, mood swings, bloating, or mild cramping.
More intensive treatments may increase the risk of multiple pregnancies or ovarian hyperstimulation syndrome (OHSS), though these risks are usually monitored carefully.
Emotionally, the process can feel like a rollercoaster. There's often a mix of hope, frustration, and anxiety during each cycle. It's completely normal to feel overwhelmed, but support from healthcare providers, partners, or even online communities can help make the process feel less isolating.
5. Results And Adjustments
Some women respond quickly to treatment and conceive within a few cycles. For others, it may take longer or require trying different medications or combinations.
Don't be discouraged. Your provider will work with you to adjust the plan if needed. Hormone therapy is rarely a one-and-done solution, but it is a well-established and often successful path to parenthood for many women with PCOS. Patience, persistence, and support go a long way.
Final Thoughts
Fertility challenges with PCOS can feel frustrating and confusing, but they're not insurmountable.
Hormone therapy is one of the most effective and well-researched tools available to help regulate your cycle, promote ovulation, and improve your chances of getting pregnant.
When combined with supportive lifestyle changes and guided by a knowledgeable healthcare provider, it can make a meaningful difference.
Everyone's journey looks a little different, but you don't have to navigate it alone. If you're ready to take the next step, visit Fem Excel, a trusted online clinic for personalized hormone health and fertility support.
From expert guidance to empowering education, Fem Excel can help you understand your options and move forward with confidence.
References
(1) Shukla A, Rasquin LI, Anastasopoulou C. Polycystic Ovarian Syndrome. [Updated 2025 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
(2) Nikbakht R, Mohammadjafari R, Rajabalipour M, Moghadam MT. Evaluation of oocyte quality in Polycystic ovary syndrome patients undergoing ART cycles. Fertil Res Pract. 2021 Jan 5;7(1):2. doi: 10.1186/s40738-020-00094-z. PMID: 33397466; PMCID: PMC7784377.
(3) Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health. 2011 Feb 8;3:25-35. doi: 10.2147/IJWH.S11304. PMID: 21339935; PMCID: PMC3039006.
(4) Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Prediction of Responsiveness to Clomiphene Citrate in Infertile Women with PCOS. J Reprod Infertil. 2019 Jul-Sep;20(3):143-150. PMID: 31423417; PMCID: PMC6670260.
