How does PCOS affect my fertility hormones?

Polycystic ovary syndrome (PCOS) can affect ovulation and hormones, both of which can impact your fertility.

If you’re diagnosed with PCOS and struggling to conceive, this article is for you. We’ll explore how different hormones may be affecting your chances, as well as some lifestyle changes that may help.

We discuss:

• How does PCOS affect fertility?
• Can blood testing help increase ovulation with PCOS?
• Best hormones to check for PCOS and fertility
• Can anything else affect my fertility with PCOS?
• How can I improve my fertility if I have PCOS?

How does PCOS affect fertility?
 

Although PCOS affects every woman differently, the main way PCOS causes fertility issues stems from hormone imbalances [1]. Many women find they have high levels of androgens (hormones that are typically higher in men), such as testosterone, which disrupt your menstrual cycle and can prevent ovulation. A symptom of this is irregular or absent periods.

But if this is something you’re experiencing, don’t worry. Many people with PCOS go on to have successful pregnancies.

Can blood testing help increase ovulation with PCOS?
 

Blood testing can provide insights about your hormones and reproductive health with PCOS. Although it can’t directly increase your fertility or ovulation, it can help you understand your hormone levels.

PCOS presents a high probability of hormone imbalance.

Blood testing may help you:

• Identify hormone imbalances
• Understand why ovulation might not be happening
• Monitor your hormone levels over time
• Give additional insights and support for any discussions with a GP or fertility specialist

It's also important to note that while a Polycystic Ovary Syndrome Blood Test can’t diagnose PCOS, but it can help establish whether you meet one of the three criteria for PCOS (raised androgen levels).

You can learn more about the three criteria for PCOS in our signs and symptoms of PCOS blog.

Best hormones to check for PCOS and fertility
 

There are several hormones worth testing if you are having trouble conceiving with PCOS [2].

The hormones are:

• Testosterone
• Luteinising hormone 
• Follicle-stimulating hormone
• Prolactin

Additionally, you might want to check your Anti-Müllerian hormone (AMH) and progesterone levels.

Testosterone

Your androgen levels are important when it comes to PCOS and ovulation. Women with PCOS may produce higher amounts of testosterone in the ovaries.

High levels of androgens may affect fertility by causing:

• Irregular ovulation
• Irregular periods
• Decreased egg production and development

A blood test measuring testosterone can help confirm whether androgen excess is playing a role in your troubles conceiving.

It is possible to have regular cycles but still not be ovulating regularly – so if you have been trying to conceive for over 12 months then it may be best to seek medical advice.

It may be a good idea to measure your androgens and the proteins that bind to testosterone, namely sex hormone-binding globulin (SHBG) and albumin.

As most testosterone is bound to SHBG and albumin, it’s not available to interact with the body's tissues. Measuring testosterone, SHBG, and albumin together, can give a good idea to the levels of free testosterone in the body.

You may notice lower levels of SHBG with PCOS, which means there is more free testosterone (FT) in the body as there is less to bind to.

Free androgen index (FAI) indicates how much free testosterone you have circulating in the body, more sensitive measurement as if T levels are normal or low-upper levels.

LH:FSH ratio

Women with PCOS may have an elevated LH:FSH ratio, which can prevent ovulation from happening [3].

• Luteinising hormone (LH) is the hormone that governs your menstrual cycle. It usually reaches its highest levels just before ovulation and is the trigger for releasing an egg.
• The follicle-stimulating hormone (FSH) helps to stimulate the growth of ovarian follicles which in turn increases oestradiol levels.

If you have PCOS, your LH levels may be high or out of balance with your follicle-stimulating hormone (FSH), which may be normal or low. This imbalance may prevent your ovaries from releasing eggs [3,4].

While the LH:FSH ratio isn’t used as a diagnostic criterion for PCOS, it does give a good insight into potential other causes of infertility.

Prolactin

Prolactin is a hormone involved in lactation, but if your levels are imbalanced, it can also disrupt ovulation.

Prolactin isn’t a diagnosis for PCOS and infertility, but up to 40% of women with PCOS have been found to have mildly elevated prolactin levels [5,6].

Your levels of prolactin likely won’t be drastically high, but they may be slightly elevated or at the upper end of the range.

Anti-Mullerian hormone (AMH)

It’s not a diagnostic hormone for PCOS, but your AMH levels can provide insights into ovarian function [7]. AMH is a marker of ovarian reserve. You can read all about what this means in our blog, “What is AMH?”, but basically, it’s a measure of how many eggs you have.

One study showed that over 70% of women with PCOS had elevated levels of AMH. We don’t know exactly why AMH is raised in PCOS, but it’s worth knowing that if you have PCOS, your AMH levels may often higher than average [8,9].

Progesterone

A progesterone blood test can help you figure out if you’re ovulating or not, the latter being common in women with PCOS. If your levels are low, it could show you’re not ovulating regularly.

Again, this isn’t used as diagnostic criteria for PCOS, but just an additional way to get insights into how your body is working.

Can anything else affect my fertility with PCOS?
 

There are a few additional factors which affect your fertility, that go hand in hand with PCOS.

These include:

• High BMI
• Insulin resistance
• Psychosexual dysfunction (a fancy word for sex issues caused by your mental wellbeing)

We’ve written a helpful fertility blood test guide, that might help you decide if blood testing for fertility is for you. Remember, blood testing can’t diagnose you with PCOS or specific fertility issues, but can give useful insights for next steps you could take.

How can I improve my fertility with PCOS?
 

Besides using blood testing to investigate your fertility, you can improve your chances of conceiving with PCOS in other ways. A good place to start is taking a look at your lifestyle, and seeing where you can make some changes.

Things to consider:

• Eating a balanced diet – the Mediterranean diet is a great place to start and can help regulate insulin resistance
• Exercising regularly – a simple lunchtime walk can be an easy way to build movement into your day
• Reduce your stress – mindfulness, meditation, or a walk outside in nature
• Increasing your quality of sleep – try cutting out screens two hours before bed
• Reduce caffeine and alcohol intake – try zero- or low-alcohol options
• Quitting smoking and vaping – there’s lots of help out there for quitting
• Check your nutrient levels – vitamin D, magnesium, iron – get your body as healthy as can be
• Track your cycle – if you want to take fertility or ovulation blood tests, it’s important to know where you are in your cycle
• Consider medical intervention – including ovulation induction, insulin lowering medications, and assisted conception such as IVF

Trying to conceive with PCOS can feel isolating – your cycle feels unpredictable, it feels like your body is out of your control. Don’t be afraid to talk to your friends, find online communities, and reach out to your GP if you’re struggling.

And remember, more research into PCOS and women’s health is happening and many women with PCOS go on to have a baby.

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References

1. Symptoms of PCOS. In: Verity - The UK PCOS Charity [Internet]. [cited 18 Feb 2026]. 
2. What causes PCOS. In: Verity - The UK PCOS Charity [Internet]. [cited 18 Feb 2026]. 
3. Saadia Z. Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non- Obese Women. Med Arch. 2020;74: 289–293. doi:10.5455/medarh.2020.74.289-293
4. Polycystic ovary syndrome - Causes. In: nhs.uk [Internet]. 20 Oct 2017 [cited 18 Feb 2026]. 
5. Polycystic ovary syndrome | Right Decisions. [cited 18 Feb 2026]. 
6. Davoudi Z, Araghi F, Vahedi M, Mokhtari N, Gheisari M. Prolactin Level in Polycystic Ovary Syndrome (PCOS): An approach to the diagnosis and management. Acta Biomed. 2021;92: e2021291. doi:10.23750/abm.v92i5.9866
7. Grynnerup AG, Lindhard A, Sørensen S. The role of anti-Müllerian hormone in female fertility and infertility – an overview. Acta Obstetricia et Gynecologica Scandinavica. 2012;91: 1252–1260. doi:10.1111/j.1600-0412.2012.01471.x
8. Elevated Anti-Müllerian Hormone as a Prognostic Factor for Poor Outcomes of In Vitro Fertilization in Women with Polycystic Ovary Syndrome - PMC. [cited 18 Feb 2026]. 
9. Butt MS, Saleem J, Aiman S, Zakar R, Sadique I, Fischer F. Serum anti-Müllerian hormone as a predictor of polycystic ovarian syndrome among women of reproductive age. BMC Womens Health. 2022;22: 199. doi:10.1186/s12905-022-01782-2