Infertility refers to the concept that pregnancy happens infrequently and the failure of conception between couples. This term can be used interchangeably with sterility.

Infertility

Excess testosterone, also known as hyperandrogenism, is the primary source of hormonal dysregulation in people with PCOS. A common misconception is that PCOS is caused by hypoestrogenism, or low estrogen; in fact, the fluctuations of both hormones and the body's attempt to compensate for them are the reason for symptoms. 

Excess Testosterone

Due to unwanted symptoms, such as excess body and facial hair, obesity and excess adipose tissue concentrated in the midsection, male patterned baldness, painful cystic acne, and irregular menstruation, many people with PCOS develop poor self-esteem and body image. Common psychiatric comorbidities include depression, anxiety, OCD, body dysmorphic disorder, borderline personality disorder, and more.

 Women with PCOS are 4 times more likely to attempt suicide than women without PCOS.

PCOS and Psychiatric Comorbidities

As a chronic condition, PCOS requires lifelong monitoring and maintenance. Some challenges patients and providers face in creating a long-term treatment plan include:
- Attrition
- Stigma
- Lack of health literacy
- Poor relationship between patient and provider
- Distressing symptoms and psychiatric comorbidities

Difficulties in Maintaining PCOS Treatment

Symptoms of PCOS include; infertility, mental health issues, hirsutism, insulin resistance, absence of menstruation, obesity, acne, and more.

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Polycystic ovarian syndrome, or PCOS, is an endocrine disorder that is diagnosed in 4% to 12% of women (who are of reproductive age). Unfortunately, PCOS does not have a cure and includes several life debilitating symptoms.

Polycystic Ovarian Syndrome (PCOS)

Sheehan, M. T. (2004). Polycystic Ovarian Syndrome: Diagnosis and Management. Clinical Medicine &amp; Research, 2(1), 13–27. Retrieved July 18, 2022, from http://www.clinmedres.org/content/2/1/13.full.pdf. 

Polycystic Ovarian Syndrome:
Diagnosis and Management

Women diagnosed with PCOS are more at risk for developing life-threatening health conditions such as type 2 diabetes and coronary artery disease, among others.

PCOS Health Risks

While PCOS can cause infertility and is a source of significant physical and psychological distress for people with the syndrome, focusing only on the reproductive aspect, be it from providers or patients themselves, can minimize and even obscure symptoms impacting all aspects of well being. PCOS fits the definition of chronic illness but is not always presented as a "serious" or multifaceted disorder. 

Infertility Focus: Framing PCOS as a Chronic Illness Rather Than a Reproductive Disorder

Given that PCOS is viewed primarily as a reproductive concern as opposed to a lifelong illness, well meaning practitioners advocate for weight loss (especially normal BMIs) as a primary goal for management. However, without the acknowledgement that there is no cure for PCOS and that it is a chronic illness requiring daily maintenance of symptoms, there is a risk for unhealthy thinking and behavior patterns that can exacerbate the disorder, including disordered eating, noncompliance, and more. 

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