The most important things to know about fertility and PMOS at a glance:

• About 5-10% of women of reproductive age are affected by PMOS.
• PMOS leads to increased male hormones (androgens) and disrupts the female cycle.
• Genetics, hormones, and environmental factors likely play a role together.
• Common symptoms include irregular cycles, acne, excess body hair, hair loss, weight problems, and insulin resistance.
• A healthy diet, exercise, and weight loss can improve the chances of getting pregnant.

How to get pregnant with PMOS

Polyendocrine metabolic Ovarian Syndrome (PMOS) is a common hormonal disorder that significantly affects fertility and can make it difficult to get pregnant or fulfill the desire to have children. Women affected by PMOS often experience infertility due to the lack of regular ovulation.

Despite the challenges that come with PMOS, there are now numerous evidence-based approaches that can help reduce the impact of PMOS on fertility and improve the chances of pregnancy. Fertility clinics offer specialized fertility treatments, ranging from hormone therapy to assisted reproduction, such as intrauterine insemination (IUI) or in-vitro fertilization (IVF).

Learn everything important about the most common causes and diagnosis of PMOS, as well as proven therapy approaches. We also provide valuable tips on how to improve your chances of getting pregnant.

What is Polyendocrine Metabolic Ovarian Syndrome (PMOS) and why is it no longer called PCOS?

PMO syndrome (Polyendocrine Metabolic Ovarian Syndrome, also known as PMOS) is a complex metabolic disorder (endocrine disease) characterized by numerous symptoms. It is considered the most common hormonal disorder in women and affects approximately one in eight women of childbearing age, or about 170 million women worldwide.

In polyendocrine metabolic ovarian syndrome, the body produces increased levels of male sex hormones (androgens). This leads to inadequate regulation of the menstrual cycle. The follicles in the ovaries do not mature properly, which is why women with PMOS often do not ovulate regularly. The failure of the eggs to mature and be released impairs fertility in affected women.

One aspect of PMOS may be the presence of polycystic ovaries. This means that many small, fluid-filled cysts form in the ovaries, which are visible on ultrasound. However, polycystic ovary syndrome is a complex hormonal disorder that goes beyond these cysts. In the past, the presence of polycystic ovaries was considered an important criterion for PMOS (or, as it was previously known, PCOS). It is now clear that polycystic ovaries are no more common in women with PMOS than in other women.

In addition to ovarian issues, those affected experience a wide range of metabolic, psychological, reproductive, and skin-related changes. Women with PMOS therefore often suffer from effects that affect the entire body. For this reason, a new name has been under discussion for some time and has now been adopted. The name PMOS is intended to shift the focus away from the possible presence of polycystic ovaries and toward the rest of the condition. Many women went undiagnosed with PCOS (or PMOS) for a relatively long time because their ovaries appeared normal. The new name PMOS is intended not only to prevent this but also to reduce the stigma surrounding the disease and accurately reflect its true scope and effects: “Polyendocrine” is meant to indicate that multiple hormonal systems in the body are affected—and not just that the sex hormones are out of balance. “Metabolic” refers to the increased risk of metabolic diseases such as diabetes or cardiovascular diseases like hypertension, i.e., high blood pressure. “Ovarian syndrome” is the only component carried over from the old term PCOS and continues to establish the link to ovulation and fertility disorders.

Incidentally, the new name was very carefully considered: the process of choosing the name spanned over 10 years and involved 22,000 people—including thousands of those affected!

Diagnosis of PMOS

The diagnosis of polyendocrin metabolic ovary syndrome (PMOS) is made through a combination of blood tests to check hormone levels, ultrasound scans, and medical consultations about the presence of certain symptoms. To get a comprehensive diagnosis and treatment, you should schedule an appointment with your gynecologist or a fertility clinic.

The key steps in diagnosing PMOS include:

1. Blood tests A blood test helps check the hormones in the blood and establish hormone levels. Key hormones include:

   • Androgens: Elevated androgen levels in the blood (hyperandrogenemia), such as testosterone and dihydrotestosterone (DHT), can be an indicator of PMOS.
   • Testosterone: >70 ng/dl is elevated, >100 ng/dl is highly elevated.
   • Dihydrotestosterone (DHT): >150 ng/dl.
   • Luteinizing hormone (LH) and follicle-stimulating hormone (FSH): A common pattern in PMOS is an increased ratio of luteinizing hormone to follicle-stimulating hormone. While LH is often elevated, FSH levels may be normal or low. A ratio of LH to FSH of 2:1 or higher may indicate a hormonal imbalance.
   • Progesterone and estrogen: In PMOS, the ratio of progesterone to estrogen is often disrupted. Many cases show estrogen dominance. This doesn’t necessarily mean the estrogen level is absolutely elevated, but there is an imbalance compared to progesterone. Due to the often irregular or absent ovulation in PMOS, too little progesterone (a progestogen) is produced in the second half of the cycle.
   • Insulin: Since many women with PMOS have insulin resistance, insulin levels can also be elevated. Elevated fasting insulin or impaired glucose metabolism can indicate insulin resistance.
   • SHBG (Sex hormone-binding globulin): In PMOS, SHBG levels are often too low. SHBG binds testosterone and other androgens, and lower levels can lead to higher free androgen levels in the blood.

1. Transvaginal ultrasound An ultrasound of the ovaries is performed to check for the presence of numerous small egg sacs in the ovaries. This is a characteristic but not sufficient feature for diagnosing PMOS.

2. Medical consultation (Anamnesis) Based on your blood values and the ultrasound, your doctor can gain a better understanding of your cycle and provide an assessment. In a consultation with a specialist, you will be asked about the following symptoms of PMOS:

   • Irregular menstrual cycles: Infrequent menstruation (oligomenorrhea) or absence of menstruation (amenorrhea).
   • Excess body hair (hirsutism).
   • Acne.
   • Hair loss.
   • Medical/family predisposition.

The diagnosis of PMOS is usually based on the following criteria. At least two of the following three criteria must be met:

1. Irregular menstruation 
2. Elevated androgen levels
3. The presence of polycystic ovaries or elaborated AMH-levels

Causes of PMOS

The exact cause of polyendocrine metabolic ovary syndrome (PMOS) is not fully understood. It is believed that a combination of genetic, hormonal, and environmental factors plays a role.

A possible trigger for PMOS could be a malfunction of an enzyme that normally regulates the production of male hormones. This malfunction leads to an elevated level of androgens, or male hormones, in the body. Such an increase can contribute to the typical symptoms of PMOS, such as irregular menstrual cycles and excessive hair growth.

Symptoms of PMOS

Women with polyendocrine metabolic ovary syndrome (PMOS) may experience a wide range of symptoms. The most common include:

• Irregular menstrual cycles: Very long and irregular cycles or absent periods are a common symptom.
• Ovulation disorders: Lack of regular maturation and release of eggs. This can lead to fertility problems.
• Elevated androgen levels: This can manifest as acne, excessive hair growth (hirsutism), hair loss on the head, or oily skin.
• Weight gain: Women with PMOS often have difficulty controlling their weight or are more prone to weight gain.
• Insulin resistance: PMOS can result in insulin resistance, leading to higher blood sugar levels and an increased risk of developing type 2 diabetes.
• Metabolic syndrome: Women with PMOS are at a higher risk for metabolic syndrome, which is characterized by a combination of insulin resistance, overweight, high blood pressure, and elevated blood fat levels. Metabolic syndrome increases the risk of cardiovascular disease and diabetes. A healthy lifestyle with a balanced diet and regular exercise is especially important for women with PMOS.
• Psychological stress: Studies have found that women with PMOS are more likely to suffer from mild to severe depression than women without PMOS. They are also more likely to experience moderate anxiety and stress. (Sulaiman, 2017).

The severity of these symptoms can vary, and not all women with PMOS experience all of these complaints.

Treatment options for PMOS for women trying to conceive

For women with PMOS who are having difficulty getting pregnant, several treatment options are available, aimed at regulating hormone levels.

1. Hormonal stimulation for egg maturation and ovulation induction

   • Clomiphene: Stimulates the ovaries to mature eggs and is often used to induce ovulation (ovulation induction) and improve fertility. (Elkhateeb RR. et al, 2017).
   • Gonadotropins (LH, FSH, and combination of LH and FSH): Hormones typically used for hormonal stimulation of ovulation in women with polyendocrine metabolic ovary syndrome (PMOS), especially when other treatments like clomiphene citrate are not successful.

2. Supporting measures to improve insulin resistance and metabolism

   • Metformin: A medication primarily used to treat type 2 diabetes but can also help improve insulin sensitivity and regulate the menstrual cycle in women with PMOS. However, it's important to note that metformin does not replace the need for lifestyle changes in overweight and obese women with PMOS. (Lashen H. et al, 2018).
   • Myo-Inositol: Improves insulin sensitivity and supports normal ovarian function, which can help regulate the menstrual cycle. (Unfer V. et al, 2017).

3. Further measures

   • In-vitro fertilization (IVF): If other treatments have not been successful, fertility treatments can bring you closer to your desired child. During IVF or ICSI, eggs are retrieved, fertilized outside the body, and then implanted into the uterus.
   • Laparoscopic ovarian drilling (LOD): A surgical method where small holes are made in the ovaries to reduce androgen production and promote ovulation.
   • Hormonal contraception: Birth control pills can help regulate hormone levels and alleviate typical PMOS symptoms, such as acne and excessive hair growth. However, it is not a solution for women trying to conceive.

Tips for women with PMOS trying to conceive

For women with polyendocrine metabolic ovary syndrome (PMOS), the path to pregnancy can be challenging, but there are several effective strategies to improve fertility and increase the chances of a successful conception. Here are some comprehensive tips to help mitigate the effects of PMOS on fertility:

Active Lifestyle
Ensure you get at least 150 minutes of moderate physical activity each week, whether it's brisk walking, cycling, or swimming. Regular exercise helps improve insulin resistance and can contribute to stabilizing your menstrual cycle.

Healthy Diet
Focus on a diet rich in fiber, healthy fats, and lean protein. Avoid highly processed foods and sugar, as these can cause insulin spikes. Instead, opt for whole grains, fresh fruits, vegetables, nuts, and seeds. This diet supports not only your hormone balance but also promotes healthy ovarian function.

Micronutrients
Incorporate high-quality micronutrients to support healthy ovarian function with regular menstrual cycles, promote ovulation, and improve egg quality.

Weight Loss
If overweight, even a small weight loss of 5-10% can improve insulin resistance, regulate hormone levels, and increase the chances of ovulation.

Medical Support
Consult your specialist for personalized treatment options to boost your fertility.

Use these tips as a foundation to fulfill your desire for a child. By combining lifestyle changes, targeted micronutrients, and informed medical treatment, you can significantly improve your chances of a successful conception. You can do it – stay persistent and be patient with yourself!

Conclusion: The right treatment helps many women with PMOS achieve their dream of having a child

It’s completely normal to feel overwhelmed when you first receive a PMOS diagnosis—especially when you're trying to have a baby. PMOS is a common hormonal disorder that can affect your fertility, but it doesn't mean the end of your journey to parenthood. With the right treatment and a few changes in your daily life, you can greatly improve your chances of getting pregnant.

It’s best to seek support early on from your gynecologist or a fertility clinic. They can provide information on the treatment options available and what will work best for you.

FAQ:

What are the chances of getting pregnant with PMOS?
The chances of getting pregnant with polyendocrine metabolic ovary syndrome (PMOS) vary significantly depending on several factors, including the severity of the syndrome and individual symptoms.

The spontaneous pregnancy rate (without treatment) in PMOS is indeed lower than in women without PMOS. Studies show that about 20-40% of PMOS patients become pregnant spontaneously within a year, compared to 70-80% in women without PCOS (Teede, 2018).

Women with PMOS who receive medical treatment have significantly better chances. For example, the cumulative pregnancy rate after 6 cycles of treatment with metformin and/or clomiphene is about 40-46% (Legro, 2007).

How long does it usually take for a woman with PMOS to get pregnant?
The time to pregnancy can vary because the menstrual cycle in PMOS is often irregular, making it harder to determine the fertile window. However, with appropriate treatment (e.g., hormonal stimulation combined with cycle monitoring), many women can become pregnant within 12 months, but it depends on individual factors.

Do you have to be overweight to be diagnosed with PMOS?
No, you do not have to be overweight to be diagnosed with polyendocrine metabolic ovary syndrome (PMOS). PMOS can occur in women of all weight categories. While being overweight and obesity are common symptoms of PMOS, especially due to the often associated insulin resistance, this is not the only way the syndrome can manifest.

References

1. Kostroun et al. Impact of updated international diagnostic criteria for the diagnosis of polycystic ovary syndrome. F & Reports. 2022.
2. Elkhateeb RR, Mahran AE, Kamel HH. Long-term use of clomiphene citrate in induction of ovulation in PCO patients with clomiphene citrate resistance. J Gynecol Obstet Hum Reprod. 2017. 
3. Attia GM, Almouteri MM, Alnakhli FT. Role of Metformin in Polycystic Ovary Syndrome (PCOS)-Related Infertility. 2023.
4. Lashen H. Role of metformin in the management of polycystic ovary syndrome. Ther Adv Endocrinol Metab. 2010.
5. Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocr Connect. 2017. 
6. Teede et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility, 2018.
7. Legro et al. Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome. The New England Journal of Medicine, 2007.
8. Sulaiman et. al. Psychological burden among women with polycystic ovarian syndrome in Oman: a case–control study. International Journal of Women's Health, 2017.