Gynaecological Health Archives

PCOS and fertility: what you need to know about getting pregnant with Polycystic Ovary Syndrome

We looked at the role endometriosis plays in fertility last month, and now we’re focusing on Polycystic ovary syndrome (PCOS), one of the most common hormonal conditions affecting women of reproductive age in the UK, with around one in ten women thought to be living with it. For many, a diagnosis brings relief after years of unexplained symptoms.

For those hoping to start a family, it can also raise a great many questions. The good news is that PCOS does not mean infertility, and with the right support and treatment, pregnancy is absolutely achievable for the majority of women with this condition.

What is PCOS?

PCOS is an endocrine disorder, meaning it affects the body’s hormone production. Women with PCOS typically have higher-than-normal levels of androgens (often called male hormones) and a hormone called luteinising hormone (LH), which plays a key role in the menstrual cycle.

The ovaries may also contain multiple small follicles, visible on ultrasound, that have started to develop but have not fully matured or released an egg.

A diagnosis is typically confirmed when a woman meets two of the following three criteria: irregular or absent periods, elevated androgen levels (which can cause symptoms such as acne or unwanted hair growth), or polycystic-appearing ovaries on ultrasound.

Blood tests to check hormone and insulin levels are also an important part of the diagnostic process.

How PCOS affects ovulation and fertility

The primary way in which PCOS affects fertility is by disrupting ovulation. Because LH levels are already elevated in women with PCOS, the usual hormonal signal to release a mature egg is impaired. As a result, many women with PCOS ovulate infrequently or not at all, which makes it considerably harder to conceive naturally.

Insulin resistance, which is common in PCOS, adds another layer of complexity. When the body does not respond efficiently to insulin, glucose-triggered spikes in insulin can further increase testosterone and LH production, compounding the disruption to ovulation. This is why blood sugar management is such a central part of treating PCOS.

Anti-Müllerian hormone has emerged as a unique biomarker reflecting both ovarian reserve and possibly playing a significant role as a neuroactive hormone in the development of PCOS. Women with PCOS typically have markedly elevated AMH levels, reflecting a high antral follicle count, though this abundance of follicles does not translate into higher quality ovulation.

The role of lifestyle in managing PCOS

Before moving to medical treatment, lifestyle changes can make a meaningful difference to both PCOS symptoms and fertility. Achieving or maintaining a healthy weight through balanced nutrition and regular physical activity can improve insulin sensitivity, which, in turn, can support more regular ovulation.

Dietary choices matter too. A low glycaemic, lower carbohydrate approach to eating helps to keep blood sugar levels stable, reducing the insulin spikes that can worsen hormonal imbalance. Vitamin D deficiency is also particularly common in women with PCOS and can affect fertility, so it is worth having levels checked and supplementing if needed.

Women with PCOS are sometimes advised to take supplements such as inositol, which has been shown in research to support ovarian function and hormone balance. Nutritional advice should always be tailored to the individual, and a specialist fertility dietitian can provide personalised guidance.

When to seek treatment

If you have been trying to conceive for twelve months without success, or for six months if you are over 35, it is advisable to seek specialist advice. For women who are already aware of a PCOS diagnosis, it is sensible to seek a consultation earlier, as irregular ovulation means that the usual guidance around timing does not always apply in the same way.

At Aria Fertility, our consultant gynaecologists have specialist expertise in PCOS and other gynaecological conditions. They will carry out a full assessment, including a physical examination, ovarian ultrasound, and hormone blood tests. This allows a clear picture of your individual situation to be established before any treatment decisions are made.

Treatment options at Aria

For many women with PCOS, the first line of treatment is ovulation induction. Fertility medication is used to gently stimulate the ovaries to develop and release a mature egg.

Once ovulation is confirmed, conception can be attempted naturally or timed alongside intrauterine insemination (IUI), where prepared sperm is placed directly into the uterus to maximise the chances of fertilisation.

Where ovulation induction is not successful, or where other fertility factors are also present, in vitro fertilisation (IVF) is an excellent option for women with PCOS. IVF success rates for PCOS-related infertility are generally very good, as the ovaries typically respond well to stimulation.

Women with PCOS do have a slightly higher risk of ovarian hyperstimulation syndrome (OHSS), a condition in which the ovaries over-respond to fertility medication, but this is carefully managed by the experienced team at Aria, who are highly skilled in minimising this risk.

A PCOS diagnosis can feel daunting, particularly when you are hoping to grow your family. But with the right clinical support, most women with PCOS can conceive. If you would like to discuss your situation with a specialist, the team at Aria Fertility is here to help.

13 April 2026/by CLINIC TEAM

Aria expert talks everything endometriosis and fertility

Clinic Updates, Egg Freezing, Fertility Preservation, Gynaecological Health, News

Endometriosis can raise a lot of questions, especially when it comes to fertility. Recently, Carla Cressy of The Endometriosis Foundation sat down with Aria Fertility’s Ms Srividya Seshadri to discuss the link between endometriosis and fertility.

WATCH OUR ENDO FAQ VIDEOS IN FULL

Carla: We’re sitting down with gynaecologist and fertility specialist, Ms Srividya Seshadri at Aria, where we’ll be talking openly and honestly about what endometriosis really means for reproductive health. We’ll cover everything from lifestyle and early testing to fertility preservation treatments and planning a pregnancy so that you can feel informed, supported and empowered to make decisions that are right for you at the right time. Before we talk about medical treatments or fertility preservation. I wanted to start with something a little more fundamental, like the everyday things that people can do to support their fertility.

How do nutrition, stress and sleep play a role in long -term fertility, especially for those with endometriosis?

Vidya: You’ve highlighted two very important factors that could affect fertility. Recently, there has been a focus on PFAS, or forever chemicals, and their potential effects on egg and even sperm quality.

I’m a big believer that nutrition should be in pristine health, at least before any fertility treatment is contemplated. This can range from diet, what triggers to avoid, or curbing excessive caffeine or alcohol intake

Vitamins are also important for fertility, especially folic acid. Folic acid is paramount for egg quality and early pregnancy development, especially the central nervous system development of the baby. Vitamin D also plays a powerful anti-inflammatory role, and we should really be taking it year-round.

One of our government’s guidelines is that all of us who live in the UK must take a daily dose of 10 micrograms of vitamin D. It’s not only helpful during the Winter, but it’s also very good for symptoms of endometriosis and improving egg quality.

However, anything taken in excess is also not great for egg quality. Vitamin E is thought to be good for the eyes and the skin. But it’s a fat-soluble vitamin and so is stored in our fat deposits for a considerable length of time. Also, taking too much vitamin A in early pregnancy is not conducive to embryonic growth and could be quite toxic for early embryo development. So, I would say avoid vitamin A if you’re trying to conceive.

Sleep is also very important, and we often underestimate its effect on egg quality. There have been some observational studies in the US that looked at how sleep quality affects egg quality, and I’m a firm believer that we need everything in balance to achieve an optimum outcome.

Carla: What fertility tests are available for someone with endometriosis, even if they’re not trying to conceive yet?

Vidya: The fertility investigations would include a blood test that checks our Anti-Mullerian Hormone level. It’s a hormone secreted by small cells lining the follicle, or fluid bubble, that contains our eggs.

It gives us a rough indication of our egg reserve at a given point in time compared to that of a woman of our age. But it does not often predict your future fertility.

So, if you’re an individual wanting to exercise your reproductive choice or even have underlying endometriosis and considering fertility preservation, then doing that test may be valuable because then you can ascertain if you want to do an IVF cycle for egg freezing before embarking on endometriosis treatment.

The test is not dependent on your cycle, so it can be done at any point in your menstrual cycle. The second test is a transvaginal or internal scan.

For individuals with endometriosis, this scan will be very important because endometriosis often causes scarring due to inflammatory deposits or adhesions. A transvaginal scan will also ascertain the position of the ovaries and the number of follicles.

As I alluded to earlier, follicles are the bubbles that contain eggs, so they represent the number of eggs recruited from the federal egg bank reserve each month.

Those are the two tests I would initially offer. But doing tests just for the sake of checking things without wanting to do anything about them is not advisable. But I tell any patient, it is valuable to ensure that our diet, exercise, nutrition, and supplements are in order. Those are the parameters I would look for or try to optimise before we start thinking about reproduction.

Carla: When should someone with endometriosis consider having fertility preservation?

Vidya: If they have been diagnosed with stage 3 to stage 4 endometriosis, and they’ve done their AMH level, and it is borderline.

I feel strongly that the number doesn’t always matter because I have seen individuals with severe endometriosis with a very good AMH value, but I still would encourage them to consider egg or embryo freezing because of the nature of the condition.

The reason for that is that endometriosis is a very difficult condition to predict. Unfortunately, we cannot map out the reproductive cycle and tell an individual how many months they have before their AMH or egg reserve drops. And with endometriosis, that drop could be quite sudden, from a very good egg reserve to negligible.

So, a blood test should not explicitly dictate what an individual should do.

Carla: At what point should someone with endometriosis who is actively trying to get pregnant seek help?

Vidya: I believe that after three to six months of trying naturally, if there is no natural conception, they should seek medical investigations and further intervention.

Now, saying that, not all women with endometriosis have difficulty conceiving. There have been many anecdotal cases where women have had severe endometriosis and have fallen pregnant naturally and have had a wonderful pregnancy and child delivery.

So, I don’t think we need to sort of compartmentalise based on the severity of the diagnosis, but it would depend on the individual’s symptoms, what stage they are at in their life, and their individual circumstances before they make that decision.

Carla: How do you help patients to understand results without any unnecessary fear or anxiety?

Vidya: That is a very important question because, as a clinician, conveying a test result without causing undue anxiety for the patient is paramount. And often it’s difficult because what they take home from the discussion about the results may be completely different from what the clinician discussed with them.

I discuss their results with them, give them time to reflect on the discussion and, if they want, have a follow-up appointment so they can ask any questions that have been left unanswered or help with any ambiguity in their decision-making.

Carla: One of the most common and often kind of frightening beliefs around endometriosis is that it automatically means infertility. What is the real link between endometriosis and infertility?

Vidya: Very good question. The link between endometriosis and infertility is not clearly defined, but up to nearly 50 % of women with endometriosis have problems conceiving. It is a lot, but again, we must bear in mind the other side of the coin that the majority have no problem conceiving.

But endometriosis is an inflammatory condition; those deposits, as they travel through the tubes, can cause scarring and therefore tubal blockage, preventing the egg from fertilising the sperm. Or it could mean that these deposits sit in the ovaries and are akin to rust on metal.

And this inflammation of the ovaries can mean that egg numbers and egg quality can rapidly deteriorate.

Carla: And what do the actual statistics tell us versus the myths that we often hear?

Vidya: The myth we often hear is that if you’ve got endometriosis, you can’t conceive, and you’re doomed for infertility, or you can only conceive through IVF treatment, and the answer is no, because most women with endometriosis have no problem conceiving.

Another myth is that if you get pregnant, be it through natural conception or IVF, your endometriosis will improve. That is a myth that’s been busted. Some women can have a smooth pregnancy, but quite often symptoms will return shortly after birth; for others, their pain just exacerbates during pregnancy.

What I don’t want is for everyone to panic about being diagnosed with endometriosis, because number one, we have so much more information compared to 25 years ago.

For more advice on how we treat patients with endometriosis, please arrange an initial consultation with one of our fertility experts.

16 March 2026/by CLINIC TEAM

Managing the endometriosis patient through their fertility journey

Gynaecological Health, IVF, News

In the UK, it is estimated that one in 10 women of reproductive age is affected by endometriosis, translating to roughly 1.5 million women. Trustee of The Endometriosis Foundation and executive committee member of the British Fertility Society, Ms Srividya Seshadri has recently co-authored an exploration of endometriosis management for IVF patients.

Published in the specialist journal The Obstetrician and Gynaecologist, this seemed an opportune moment to give a more patient-focused rundown on the intricacies of fertility treatment for endometriosis patients.

Endometriosis and fertility

Endometriosis is a painful condition that is characterised by the growth of womb-like tissue outside of the uterus. Because this tissue cannot exit the body in the usual way – through menstrual bleeding – this leads to the formation of scar tissue, causing obstruction and pain in the pelvic region.

Although there is some association between endometriosis and fertility problems, the condition does not necessarily cause infertility, and some women with very severe endometriosis have been able to conceive naturally. However, studies have suggested that roughly 25% to 50% of infertile women have endometriosis, and about 30% to 50% of women with endometriosis are infertile.

The exact reason for this is not yet fully understood, but in some cases, it may be linked to the formation of scar tissue, causing distortion of the abdominal organs, or even creating a blockage in the fallopian tubes, preventing eggs from being released. Other possible reasons are that the associated inflammation reduces egg quality or disrupts implantation.

Can IVF help with fertility issues related to endometriosis?

The short answer is, yes. By extracting eggs directly from the ovaries, IVF treatment can circumvent many endometriosis-related fertility problems, and success rates among IVF patients with endometriosis are reassuringly high. However, there may be some adjustments to the standard IVF protocol that are necessary for patients with endometriosis.

Pre-IVF evaluation of symptoms

Before undergoing fertility treatment, it is necessary to assess the severity of the endometriosis symptoms and the impact it is having on your reproductive organs and ovarian reserves. This may include MRI or ultrasound scans.

Surgery to remove endometrial lesions

Although there is evidence to show that surgical treatment of endometriosis can be beneficial for the success of IVF, there is a risk that the surgery itself can diminish ovarian reserves, so currently this is only recommended for patients with severe lesions that block access for egg retrieval.

Hormone therapy and GnRH agonists

Historically, patients with endometriosis have been prescribed a prolonged (3-6 month) period of treatment with GnRH agonists and hormone therapy to treat the symptoms of endometriosis before IVF. However, evidence for the benefits of this on the success of fertility treatment is minimal, and it is now only recommended for patients who have undergone surgical removal of lesions, to prevent the recurrence of endometriosis symptoms.

Whilst all technologically assisted fertility treatments are available to patients with endometriosis, IVF has the strongest evidence base to support its use.

Endometriosis and pregnancy

Patients are often concerned about the impact that endometriosis will have on pregnancy, if they can conceive. The good news is that generally, the pain associated with endometriosis improves during pregnancy – although there are some exceptions to this rule, and it is likely to return soon after giving birth.

There are also some increased risks associated with endometriosis in pregnancy – the risk of miscarriage rises from 1 in 5 to 1 in 4, and patients with endometriosis are more than twice as likely to experience an ectopic pregnancy as those without the condition – although the risk is still very minimal.

When you undergo fertility treatment with Aria, we will always offer the treatment with the best evidence base for you, and monitor your fertility journey every step of the way, so you can rest assured you’re in the best possible hands.

For more information, please get in touch with us.

19 August 2025/by CLINIC TEAM

Sorting fibroid myths from the facts

Gynaecological Health, News

Fibroids are estimated to affect up to 50% of women of reproductive age, yet despite being such a common female complaint, there are many misconceptions.

Here are six common myths about fibroids:

Myth #1: Fibroids can be cancerous

Fact: Fortunately, this is untrue, as fibroids are benign growths and are not linked to uterine cancer. Although they can affect quality of life, they are not usually life-threatening.

Myth #2: Fibroids can impact your fertility

Fact: Most women with fibroids have normal fertility and pregnancy outcomes. Depending on size and location, some types of fibroids may impact fertility as they can obstruct the journey of a sperm or fertilised egg. Larger fibroids in the uterus may affect foetal growth. Treatment should be able to improve your chance of preventing conception from occurring and a healthy, successful pregnancy.

Myth #3: Once removed, fibroids can’t come back

Fact: Unfortunately, new fibroids can develop after treatment. If fibroids reoccur, you may need to explore a new treatment option for shrinking or removing your fibroids.

Myth #4: If you have fibroids, you will experience heavy menstrual bleeding and pain

Fact: Heavy or painful periods are a common symptom of fibroids, but not all women experience this or any symptoms.
When symptoms do occur, alongside heavy and painful menstrual bleeding, women may experience pelvic pain, frequent urination, and pain during intercourse. Depending on the size and location, it can cause constipation, and if the fibroid is pressing on a nerve, you may even experience back or leg pain.

Myth #5: Fibroids are genetic

Fact: Although it is not known exactly what causes fibroids, there does seem to be a genetic link. If you have a family history of uterine fibroids, you are three times more likely to develop them yourself.

Fibroids are also linked to the hormones produced by the ovaries, oestrogen and progesterone. They usually develop and grow as long as the ovaries produce these hormones and tend to shrink when hormone levels fall, such as after menopause.

Myth #6: If fibroids are untreated, they will continue to grow.

Fact: Not all fibroids get bigger if left untreated. Many women have small fibroids that do not grow or cause any symptoms or may stop growing when they reach a certain size.

If your fibroids are causing significant symptoms, Aria Fertility gynaecologist Miss Amanda Tozer can advise women on a range of tailored treatment options, including lifestyle changes, medications, hormone treatments and, if required, minimally invasive gynaecological surgery.

Call +44 (0) 203 263 6025 or email admin@ariafertility.co.uk to arrange a consultation.

22 July 2024/by CLINIC TEAM

Can I still get pregnant if I have endometriosis?

FAQs, Fertility Health, Gynaecological Health, Infertility, News

The good news is that if you’re suffering from endometriosis, it is still possible to conceive without intervention. It is estimated that 60 to 70% of women with mild to moderate endometriosis can get pregnant spontaneously. However, there is a link between endometriosis and infertility although it is not clear exactly why women with this condition may have a harder time becoming pregnant.

What is endometriosis?

Endometriosis is a very common, chronic gynaecological condition. The endometrium is the lining of the inner uterine wall and sometimes it can grow outside of the uterus. The most common places affected are the ovaries and fallopian tubes, but it can also affect the pelvis, bladder and intestines.

Even outside of the uterus, these abnormal tissue growths respond to the hormonal changes that occur during your menstrual cycle. This means that in women of a reproductive age, the growths thicken and then break down. As the tissue cannot leave the body in the normal way, pain and scarring occurs.

Reasons why you may have difficulty conceiving

Although the exact cause has not been identified, there are several reasons why approximately 40% of women with infertility have endometriosis:

Scarring can make it harder for the ovary to release an egg or block the egg from reaching the fallopian tube to be fertilised
Ovarian endometriosis can affect ovulation and the number of mature eggs that are released
Inflammation creates an inhospitable environment that affects both the egg and sperm, making fertilisation and subsequent implantation more challenging

Endometriosis and infertility: your next steps

Endometriosis can affect women of any age and can present from very early on. If you have been diagnosed with endometriosis, seeing a fertility specialist is recommended even if you’re not considering getting pregnant at that point.

A fertility specialist can assess the quantity and quality of your viable eggs, known as your ovarian reserve, as well as check the condition of your fallopian tubes or tubal patency. They will also assess your uterine cavity. This combined with the severity of your symptoms and your age, will be critical in determining the best treatment option.

These include laparoscopic endometriosis surgery, but this can reduce your ovarian reserve. When ready to start trying to conceive, IVF is often recommended although the success rates of IVF for those with endometriosis is about half that for those with other fertility issues.

Egg freezing is also an important treatment option to consider if you want to start a family in the future as endometriosis often gets progressively worse coupled with a natural decrease in fertility as you age.

If you’re worried about endometriosis and infertility, call +44 (0) 203 263 6025 to arrange a consultation with one of fertility experts. Consultant gynaecologist, Dr Amanda Tozer leads the Aria Women’s health clinic and provides bespoke gynae services. She has spent more than 20 years assisting couples experiencing infertility and trouble conceiving.

20 March 2024/by CLINIC TEAM

How does PCOS affect your fertility?

Fertility Health, Gynaecological Health, Infertility, News

Polycystic Ovarian Syndrome is a common, although often underdiagnosed, condition affecting women in the UK. It is thought to affect more than one in 10 women, and those suffering from PCOS often have concerns about whether they can successfully have a family.

In September, we focus on PCOS, aiming to raise awareness of this often-distressing metabolic disease, which can cause many symptoms, including difficulties conceiving and complications while pregnant.

PCOS and fertility

Symptoms vary from person to person and in severity, but they can include:

Menstrual problems
Difficulty conceiving
Increased body and facial hair caused by high levels of male hormones
Weight gain
Thinning hair
Acne

It affects your ability to get pregnant in several ways. Your ovaries are typically enlarged, with many follicles containing immature eggs that fail to mature and release an egg, meaning many women have irregular periods or no periods.

PCOS can also cause weight gain and a high BMI, making it more difficult to conceive. However, a diagnosis of Polycystic Ovarian Syndrome does not mean you cannot have a baby.

Whether you’re trying to conceive naturally or contemplating fertility treatment, there are steps you can take to improve your chances of success.

PCOS and nutrition

One of the first steps is to try and achieve hormonal balance by addressing diet. Fertility nutritionist Melanie Brown is particularly interested in endometriosis and PCOS and the effect of nutrition on ameliorating their adverse impact on fertility.

“First and foremost, PCOS is a challenging condition for women to live with, and it is also very tough to treat,” Mel explains. “Often the advice when you’re first diagnosed is to go on the pill which masks many symptoms. Many PCOS sufferers come off the pill when they want to start a family and find that their periods might not come back, whereas symptoms such as acne or facial hair return with a vengeance.

“Whether you’re trying to conceive naturally or about to undergo IVF, it’s ideal to prepare your body and improve egg quality. It is also good to reduce abdominal fat, which is often an issue for those suffering from polycystic ovaries, without crash dieting, which is not good for your fertility.”

Melanie explains that her approach to treating PCOS patients is similar to all her fertility patients but emphasises controlling blood sugar. Although the cause of PCOS is not entirely understood, it is believed that abnormal levels of the luteinising hormone (LH) and high levels of male hormones interfere with the normal function of the ovaries.

LH is released at a certain point in your menstrual cycle to stimulate the ovarian follicles to mature and release an egg. PCOS sufferers already have high levels of LH, which means they fail to ovulate normally. We also know that glucose-induced insulin spikes further increase the production of testosterone and LH.

“The basis is always a low glycaemic, low carb diet. As well as its impact on our hormones, a dysregulated blood sugar mechanism means that insulin no longer packages up glucose neatly and delivers it to the liver. Instead, it panics and stores it in your fat cells, particularly around your abdomen.

I always check vitamin D levels as many people, particularly those with a higher BMI, are deficient in it without realising it, and it’s important for fertility. As well as a high dose of vitamin D, I recommend supplements that control blood sugar and inflammation and balance hormones such as Inofolic to my PCOS patients.

“Weight gain is a common symptom of PCOS, and many of my patients have been living with this issue for many years. Often, I have to override the messages we’ve been fed by the diet and food industry for decades and explain that peanut butter on rye toast, avocados and full-fat humus are far better for you than Special K, diet coke and low-fat yoghurt.

“Education is always critical. If patients understand what’s happening in their bodies, brains and biome, they can make positive and informed choices.”

PCOS fertility treatments at Aria Fertility

Consultant gynaecologist Miss Amanda Tozer at Aria Fertility is an expert in general gynaecology and women’s health. She has a comprehensive knowledge of menstrual disorders, including endometriosis, PCOS and fibroids. She will investigate symptoms with a physical exam and complete a medical history check.

She can perform ultrasound imaging to check for cysts in the ovaries. You may also need a blood test to check your hormone and insulin levels.

Miss Tozer can offer advice on potential treatments depending on your symptoms and needs, including lifestyle advice, supplements, hormonal control and possible fertility treatments.

Treatment options include induction of ovulation, where fertility medication is used to gently stimulate your ovaries to produce and release a mature egg. You can then either attempt to conceive naturally or through intrauterine insemination (IUI). In general, IVF success rates are excellent for cases of infertility caused by PCOS. Women with POCS may be at higher risk of developing ovarian hyperstimulation syndrome (OHSS), but our experienced fertility doctors are highly skilled in treating PCOS patients and will take every precaution to prevent and manage OHSS.

For more advice on anything fertility and nutrition-related, see Mel’s website: melaniebrownnutrition.com. Call +44 (0) 203 263 6025 or email us at admin@ariafertility.co.uk for advice on preparing for IVF.

For more information on the individual practitioners and organisations offering support, advice, and information to those undergoing fertility treatment, please visit our Support Hub. To discuss your fertility options with one of our specialists, call xxx.

26 September 2023/by CLINIC TEAM