PCOS, Obesity, and Infertility: Understanding the Interconnection and Key Insights from Experts

PCOS and obesity are interconnected with fertility challenges as they both lead to irregular ovulation, thereby contributing to infertility.

PCOS, a hormonal condition impacting the ovaries, can result in obesity and subsequently lead to infertility issues. The connection between PCOS and obesity lies in their shared tendency to cause irregular ovulation, thereby contributing to fertility challenges. Consequently, it is crucial to recognize the symptoms of PCOS in order to proactively manage one’s health and mitigate potential complications such as obesity and infertility. We had the opportunity to speak with Dr. Pruthviraj MO, Consultant in Obstetrics and Gynaecology at Manipal Hospital, Varthur and Whitefield, who provided insights into the correlation between PCOS, obesity, and infertility, as well as strategies for effective management.


“Polycystic Ovarian Syndrome, commonly referred to as PCOS, is the most prevalent endocrine disorder among women of reproductive age. It encompasses a cluster of symptoms, including elevated levels of androgens (male hormones), ovarian dysfunction, and a polycystic appearance of the ovaries on ultrasound scans,” explained Dr. Pruthviraj.

PCOS, Obesity, And Infertility: Expert Explains Their Connection And What You Should Know

An increase in male hormones can cause: 

  • Male pattern hair growth over face, chest, abdomen, or back
  • Recurrent episodes of acne
  • Irregularity in periods (delayed or absent periods or rarely frequent periods followed by a few months of missed periods)

Ovarian Dysfunction:

  • No ovulation or infrequent ovulation 
  • Inability to conceive naturally 

Polycystic appearance of ovaries:

  • The polycystic appearance of ovaries refers to the presence of multiple fluid-filled sacs
  • “Patients often become concerned upon hearing the term “cyst.” Typically, cysts in the ovary are defined when fluid-filled sacs exceed 3cms in size and periods remain regular. In PCOS, cyst sizes range from 2-9mmâ€, added Dr Pruthviraj.

How To Know Who Has PCOS

As per Rotterdam criteria, any two of the following three features should be present:

  1. Clinical or biochemical increased androgen levels.
  2. Absence of periods or infrequent periods (more than 35 days cycle ) 
  3. Ultrasound criteria: Polycystic appearance of ovaries: more than 12 in each ovary of size 2-9mm or increased ovarian volume >10cc 

Risk Factors Associated With PCOS


  • Inability to conceive naturally with irregular periods 
  • Risk of diabetes in pregnancy 
  • Endometrial hyperplasia, endometrial cancer 
  • Diabetes with advanced age 
  • Cardiovascular disease 
  • Hypertension 
  • Increased cholesterol levels

Link Between PCOS, Obesity, Infertility


According to the World Health Organization (WHO), being overweight is defined as having a Body Mass Index (BMI) above 25, while obesity is characterized by a BMI above 30. Although many obese women may experience regular menstrual cycles, a small percentage may encounter irregular patterns of bleeding.

Obesity is associated with various health risks, including:

1. Difficulty achieving pregnancy naturally: Obesity can disrupt hormone levels and menstrual cycles, leading to difficulties in conceiving.

2. Diabetes: Obesity is a major risk factor for type 2 diabetes due to insulin resistance and impaired glucose metabolism.

3. Hypertension: Obesity increases the risk of high blood pressure, which can lead to cardiovascular complications.

4. Increased risk of malignancy: Obesity is linked to an elevated risk of developing certain types of cancer, including breast, endometrial, and colon cancer.

5. Metabolic syndrome: Obesity is a key component of metabolic syndrome, a cluster of conditions including high blood pressure, high blood sugar, abnormal cholesterol levels, and excess abdominal fat, which collectively increase the risk of heart disease, stroke, and diabetes.

Addressing obesity through lifestyle modifications, such as adopting a healthy diet, regular physical activity, and weight management, is crucial for reducing these associated health risks and improving overall well-being.

Obesity And PCOS Causing Infertility

Obesity is a prevalent factor in nearly 50% of PCOS cases. Excessive accumulation of body fat, particularly in the central region, increases the waist-to-hip ratio. This, in turn, triggers the peripheral conversion of androgens to estrogen. Such hormonal shifts disrupt the delicate balance necessary for the production of high-quality oocytes essential for successful pregnancy, as emphasized by Pruthviraj.

Furthermore, the impairment of the hypothalamic-pituitary-ovarian axis exacerbates the situation. This disruption compromises egg quality and reduces the receptiveness of the uterine lining to pregnancy. As a result, irregular menstrual cycles, often lacking ovulation, become common. This irregularity makes it challenging to predict ovulation timing accurately, ultimately leading to infertility.

According to research published in the Journal of Clinical Endocrinology and Metabolism, numerous studies have revealed a strong association between PCOS and metabolic syndrome. The prevalence of metabolic syndrome among women with PCOS ranges from 33% to 46%, indicating a significant overlap between these conditions.

How To Overcome PCOS 

How To Overcome PCOS 


  • Obesity is one of the risk factors for developing PCOS, hence keep yourself active with moderate exercise 20-30 mins 3-4 days a week. If not exercising, do whatever suits you, including cycling, jogging, walking, swimming, sports, Zumba, aerobics etc 
  • Follow a low carbohydrate diet with high-fibre foods, such as whole grain, fruits, vegetables
  • Avoid high-sugar carbs like soda, white rice 
  • Consume fruits and vegetables with low glycemic index, such as asparagus, broccoli, carrots, cauliflower, apple, berries, grapes
  • Have small, healthy meals and snacks throughout the day

When To Consult A Doctor

  • You should consult with your doctor in the following cases:
  • If you have less than eight menstrual cycles in a year
  • Failing to conceive despite trying for a year

Treatment Options

  • Regularise periods if unmarried or married but do not want pregnancy
  • Treatment for fertility by ovulation induction