PCOS management at Fertility Plus

At Fertility Plus, we recognise that polycystic ovary syndrome (PCOS) is a complex, lifelong condition that affects both health and fertility, and that its impact differs from woman to woman. Our approach is strongly evidence-based, drawing on research and clinical experience from the UK and the Indian subcontinent, and tailored to each patient rather than using a "one-size-fits-all" model.

What is PCOS?

PCOS is a hormonal condition where the ovaries often appear "polycystic" on scan, with many small follicles that have not matured and released an egg. Rather than being just about cysts, PCOS involves a combination of ovulatory problems, higher androgen (male-type hormone) levels and metabolic changes such as insulin resistance.

PCOS phenotypes

Not all women with PCOS look the same clinically, and we take this into account when planning treatment. Common patterns include:

1

Women with higher BMI, irregular periods, excess hair/acne and polycystic ovaries on scan.

2

Women of normal or low BMI with irregular periods and polycystic ovaries, who may still have androgen excess or metabolic risk.

3

Women whose main issue is menstrual irregularity and subfertility, with milder or minimal cosmetic symptoms.

Understanding your specific phenotype helps us individualise lifestyle advice, choice of drugs, and decisions about when to move to IVF.

Symptoms and causes

PCOS can present with:

  • Irregular or absent periods.
  • Difficulty conceiving due to irregular or absent ovulation.
  • Excess hair growth (hirsutism), acne or hair loss related to higher androgen levels.
  • Weight gain and difficulty losing weight in some women, though PCOS also affects many women with a healthy BMI.

PCOS is driven by hormonal imbalance, particularly increased androgens and often insulin resistance. There is usually a genetic component, and it may be seen in several women in the same family.

How PCOS affects fertility

PCOS commonly causes irregular ovulation (or anovulation), so eggs are released less predictably or not at all, making it harder to conceive naturally. Hormonal and metabolic factors can also affect egg quality and the environment in which implantation occurs. With the right treatment, however, most women with PCOS can achieve pregnancy, either with ovulation induction or, where needed, IVF.

What to expect at a PCOS consultation

When you attend Fertility Plus for PCOS, you will be seen by clinicians with extensive experience in PCOS management and research, including published work in both UK and Indian populations. Your consultation typically includes:

A detailed history of your cycles, symptoms, weight pattern, family history and previous treatments.
An ultrasound scan to assess the ovaries and endometrium.
Blood tests to evaluate hormones (including androgens) and metabolic markers such as glucose and lipids, where appropriate.

Using this information, we build a personalised, evidence-based management plan that takes into account your phenotype, fertility goals and long-term health.

Evidence-based treatment at Fertility Plus

Our management is grounded in high-quality research and international guidance, adapted to the needs of diverse populations.

For women trying to conceive, ovulation induction is often the first-line treatment:

We use oral agents such as letrozole or clomifene, chosen and dosed according to the latest evidence and your individual profile.
Where needed, we may use low-dose gonadotrophin injections under careful ultrasound monitoring to reduce the risk of multiple pregnancy and ovarian hyper-stimulation.
Cycle monitoring helps us confirm whether ovulation has occurred and optimise timing of intercourse or intrauterine insemination (IUI) if indicated.

Pregnancy and long-term health

PCOS can be associated with higher risks of miscarriage, gestational diabetes and hypertensive disorders in pregnancy. At Fertility Plus, we:

Optimise pre-conception health and weight where possible.
Work closely with obstetrician/gynecologist to provide appropriate screening and follow-up during pregnancy.

We also consider long-term health, including diabetes and cardiovascular risk, and provide guidance on ongoing monitoring and lifestyle strategies beyond fertility treatment.

Our philosophy

At Fertility Plus, PCOS management is:

Individualised

based on your phenotype, symptoms, fertility goals and background.

Evidence-based

guided by robust research and international clinical experience.

Fertility-focused

using a structured progression from lifestyle optimisation and ovulation induction through to IVF where appropriate.

Positive and supportive

aiming not only to help you conceive, but also to improve your overall health and wellbeing in the long term.

We are committed to offering comprehensive, research-backed care for women with PCOS, and our extensive experience means that outcomes for our patients are consistently encouraging.

Endometriosis

Endometriosis

Endometriosis: fertility-focused care at Fertility Plus

Endometriosis is a complex condition where tissue similar to the lining of the womb (endometrium) grows outside the uterus, most often on the ovaries, fallopian tubes, pelvic lining, bladder or bowel. It is benign (non-cancerous) but can cause significant pain, inflammation, scarring and adhesions, and is a major cause of subfertility.

How endometriosis affects fertility

Endometriosis can reduce fertility in several ways: it can distort pelvic anatomy, affect egg quality, interfere with tubal function and create an inflammatory environment around the ovaries and uterus. Many women with endometriosis do conceive, but it may take longer and they are more likely to need help such as IUI or IVF. Once pregnancy is established, most pregnancies progress normally, although individual risks are assessed and monitored.

Our approach at Fertility Plus

Endometriosis care at Fertility Plus is structured, individualised and grounded in high-quality evidence. We focus on:

Careful assessment of symptoms, pelvic imaging and ovarian reserve to understand the extent of endometriosis and its impact on fertility.
Aligning treatment choices with your reproductive goals (trying to conceive now, preserving fertility for later, or managing pain as a priority).
Minimising unnecessary interventions that could harm ovarian reserve, while using surgery strategically when it is likely to improve pain, function or fertility.
We have extensive experience supporting women with all stages of endometriosis, from mild to severe—including deep infiltrating endometriosis and endometriomas. When needed, we work closely with expert laparoscopic surgeons and other specialists to ensure you receive comprehensive, coordinated care.

Preparing the endometrium for transfer

To support implantation, we pay particular attention to the endometrium and pelvic environment:

Hormone-replacement frozen cycles

We can carefully control oestrogen and progesterone levels to prepare the womb lining, rather than relying on the stimulated fresh cycle environment.

Natural or modified-natural frozen cycles

For suitable women, we may use a cycle based on the woman's own ovulation, which can be helpful where hormone sensitivity or side-effects are a concern.

Additional treatments where appropriate

Depending on your history and prior outcomes, we may consider measures such as treating hydrosalpinges, managing adenomyosis, or addressing suspected inflammation or infection before transfer. Any additional interventions are discussed in the context of available evidence and your previous treatment history.

Why choose Fertility Plus for endometriosis and fertility?

Specialist expertise

Our clinicians have many years of experience caring for women with endometriosis-related infertility, from mild to complex endometriosis.

Evidence-based, fertility-focused decisions

We base our recommendations on robust research and guidelines, carefully balancing pain control, preservation of ovarian reserve, and the need to achieve pregnancy.

Integrated use of medical treatment and assisted conception

We don't rely on a single strategy. Instead, we combine tailored medical management with egg or embryo freezing where appropriate, and ongoing monitoring to adapt your plan as things progress.

Personalised, long-term view

Our aim is not only to help you conceive, but also to protect your future fertility and overall pelvic health as far as possible.

When surgery could be considered

Surgery is not automatic for every woman with endometriosis who wants to conceive. We weigh up:

1

Severity of pain and impact on quality of life.

2

Size and location of endometriomas and deep lesions.

3

Age, ovarian reserve and previous surgeries.

4

Whether surgery is likely to improve spontaneous conception or IVF outcomes in your specific situation.

We are cautious about repeated ovarian surgery, as this can reduce egg reserve. Where surgery is indicated (for example, for severe pain, large cysts, or distorted anatomy), we discuss timing in relation to fertility treatment and may recommend egg or embryo freezing beforehand to safeguard future options.