Does Aging Increase Fertility in PCOS?

Updated June 2019

by Amy Medling, founder of PCOS Diva

Infertility.  Out of all of the symptoms of Polycystic Ovarian Syndrome (PCOS), this is nearly always the first on the list.

It seems obvious that it would be the most common symptom, right? Polycystic Ovarian Syndrome has “ovary” right in its name. Women with PCOS must be infertile.

NOT SO FAST…now a study from Miriam Hudecova and colleagues at Uppsala University in Sweden [i] turns this maxim on its head.

Hudecova’s study indicates that women with PCOS not only have roughly the same amount of spontaneous pregnancies, but that their rates of miscarriage are not increased.  Her research concludes this to be true because of a couple of hidden benefits of PCOS for women who wish to have children later in life.

First, women with PCOS may begin life with more eggs than women without PCOS.

In fact, “An important biopsy-study showed a much increased density of follicles at primary stages in polycystic ovaries compared with normal ovaries, suggesting that women with polycystic ovaries may actually be endowed with a larger ovarian reserve at birth[ii]” That means that as we age, we have more eggs left over than women without PCOS.  This increased ovarian reserve, together with other factors (discussed below) mean older women with PCOS have a better chance of pregnancy than their age matching non-PCOS counterparts[iii].

Second, ovarian aging naturally results in follicle loss.

This bodes well for women with PCOS since the major cause of infertility in women with the syndrome is that they have greater numbers of follicles or cysts on their ovaries than healthy women. As a result, they ovulate less frequently because these extra follicles interfere with their hormonal activity and prevent just a few healthy follicles from maturing. When aging naturally reduces the number of follicles, the hormonal problems should lessen (if not disappear). This may explain the normalized menstruation cycles reported by some older women with PCOS[iv]^,[v] .

In addition, the study concludes that, “Thus, in women with PCOS, this age-dependent reduction in the pool of resting follicles may eventually lead to more cycles becoming ovulatory and a catch-up of fecundity.”

Translation? As women with PCOS age (and women without PCOS become infertile because they are running out of eggs and losing follicles they need to ovulate), women with PCOS still have eggs remaining and have a more optimal number of follicles than in their youth.

Finally, the study showed that the rate of miscarriages was not increased in PCOS patients.

These findings are contrary to previous studies[vi]^{,[vii],[viii]}. Researchers think the difference is that, in other studies, infertile PCOS patients undergoing assisted reproduction were the only patients studied, whereas the Swedish study included PCOS patients seeking help for other PCOS symptoms such as oligomenorrhoea, hirsutism or infertility.

The study suggests that “factors other than the PCOS diagnosis might contribute to the increased risk of miscarriage reported in prior studies, such as obesity, fertility treatment^v or smoking[ix]. Indeed, in women with polycystic ovaries, but not a full syndrome, miscarriage rates have been reported to be normal[x].

This all comes together as very hopeful news.  It is possible that with a reduction in other factors (like obesity and insulin resistance) that our bodies will naturally come to a “normal” ovulation cycle- just much later than women without PCOS.

Could it be that two perceived negatives (aging and PCOS) can turn out to be a blessing?  Self-care plus Mother Nature may just equal PCOS fertility.

Amy Medling, best-selling author of Healing PCOS and certified health coach, specializes in working with women with Polycystic Ovary Syndrome (PCOS), who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill, and live with their symptoms. In response, Amy founded PCOS Diva and developed a proven protocol of supplements, diet, and lifestyle programs that offer women tools to help gain control of their PCOS and regain their fertility, femininity, health, and happiness.  

Resources:

[i] Hudecova, M., J. Holte, M. Olovsson, and I. Sundström Poromaa. “Long-term Follow-up of Patients with Polycystic Ovary Syndrome: Reproductive Outcome and Ovarian Reserve.” Human Reproduction. Oxford University Press, 24 Jan. 2009. Web

[ii] Webber LJ, Stubbs S, Stark J, Trew GH, Margara R, Hardy K, Franks S (2003)Formation and early development of follicles in the polycystic ovary. Lancet362:1017–1021.

[iii] Nikolaou D, Gilling-Smith C (2004) Early ovarian ageing: are women with polycystic ovaries protected? Hum Reprod 19:2175–2179.

[iv] Dahlgren E, Johansson S, Lindstedt G, Knutsson F, Oden A, Janson PO, MattsonLA, Crona N, Lundberg PA (1992) Women with polycystic ovary syndrome wedge resected in 1956 to 1965: a long-term follow-up focusing on natural history and circulating hormones. Fertil Steril 57:505–513.

[v] Elting MW, Korsen TJ, Rekers-Mombarg LT, Schoemaker J (2000) Women with polycystic ovary syndrome gain regular menstrual cycles when ageing. Hum Reprod15:24–28.

[vi] Wang JX, Davies MJ, Norman RJ (2001) Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment. Hum Reprod 16:2606–2609.

[vii] Legro RS (2007) Pregnancy considerations in women with polycystic ovary syndrome. Clin Obstet Gynecol 50:295–304.

[viii] Boomsma CM, Fauser BC, Macklon N  (2008) Pregnancy complications in women with polycystic ovary syndrome. Semin Reprod Med 26:72–84.

[ix] George L, Granath F, Johansson AL, Anneren G, Cnattingius S (2006)Environmental tobacco smoke and risk of spontaneous abortion. Epidemiology17:500–505.

[x]Koivunen R, Pouta A, Franks S, Martikainen H, Sovio U, Hartikainen AL, McCarthyMI, Ruokonen A, Bloigu A, Jarvelin MR, et al. (2008) Fecundability and spontaneous abortions in women with self-reported oligo-amenorrhea and/or hirsutism: Northern Finland Birth Cohort 1966 Study. Hum Reprod 23:2134–2139.