Is Fertility Reduced in Ovulatory Women With Polycystic Ovary Syndrome?

An Opinion Paper

Stefano Palomba


Hum Reprod. 2021;36(9):2421-2428. 

In This Article

Abstract and Introduction


Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility; however, whether women with PCOS and spontaneous or drug-induced ovulatory cycles have the same reproductive potential as non-PCOS controls is a matter of debate. In the present opinion paper, the author takes the opportunity to summarize the collective evidence supporting the hypothesis of reduced fertility potential in women with PCOS, regardless of ovulatory status, and speculate that reduced reproductive potential may be caused by altered oocytes, embryo and endometrial competence, and infertility-related co-morbidities as well as an increased risk of pregnancy complications.


Polycystic ovary syndrome (PCOS) is a common multifaceted condition that is often associated with reproductive compromise (Dumesic et al., 2015) and, in particular, anovulatory infertility (Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2008; Legro et al., 2013). A wide range of effective interventions have been suggested for improving ovulation rates (Balen et al., 2016; Teede et al., 2018; Costello et al., 2019), even though the proportion of infertile patients with PCOS who undergo IVF is very high (Roos et al., 2011; Hart and Doherty, 2015; Rees et al., 2016; Mills et al., 2020). This discrepancy suggests other abnormalities that influence fertility among patients with PCOS, independent of ovulation. In addition, whether women with PCOS and normal ovulatory cycles, i.e. the ovulatory PCOS phenotype (Rotterdam ESHRE/ASRM-Sponsored PCOS consensus Workshop Group, 2004), have the same fertility of matched controls without PCOS is a matter of debate.

Based on these considerations, the author presents his opinion about the complex relationship between PCOS and fertility, regardless of ovulatory function, to address gaps in understanding and consider future research priorities.