Does PCOS affect egg quality?

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age, and a leading cause of female infertility. But does PCOS affect egg quality, and can you do anything about it? 

PCOS typically affects fertility by stopping ovulation, the process by which the ovaries release an egg each month. This leads to irregular periods and difficulty conceiving. What is not commonly known is that it can also negatively affect egg quality. For some women with PCOS, this can mean that even if they ovulate, the chances of the egg being fertilized and developing into a healthy embryo are also reduced. 

In this article, we’ll explore how PCOS can impact egg quality and what steps you can take to support egg health and your fertility.

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What is egg quality and why does it matter? 

When it comes to female fertility, two key factors play a role: the number of eggs remaining in the ovaries (known as ovarian reserve) and how healthy those eggs are, often referred to as egg quality. Egg quality reflects how viable your eggs are, not how many you have. Both egg quality and ovarian reserve influence your ability to conceive, and both can be affected by age, certain health conditions, and lifestyle factors. 

Egg quality not only affects whether or not you can conceive naturally, but also how effective assisted reproductive technologies, like IVF, might be. We know that egg quality tends to decline with age, particularly after the age of 35, but for women with PCOS, there may be additional concerns. 

How PCOS might affect egg quality 

The hormonal imbalances in PCOS can interfere with normal ovulation and egg development. Here’s a closer look at how:

• Insulin resistance: A 2014 study found that women with obese PCOS and insulin resistance had higher levels of certain free fatty acids (FFAs) in both their blood and in the fluid surrounding the eggs (follicular fluid). Increased concentrations of these FFAs were linked to poorer egg quality. Researchers suggested that this could help to explain why some women with PCOS have poorer IVF outcomes. 
• Changes in follicular fluid: The follicular fluid (FF) microenvironment plays a key role in oocyte (egg) development. Several studies have found a difference in the makeup of FF in women with PCOS. A 2024 review published in the journal Endocrinology found that in women with PCOS, FF tends to have higher lipid levels, more inflammatory cells, signs of increased oxidative stress, and imbalances in both hormone and metabolic activity. Together, this could impair healthy egg development and impact chances of conceiving both naturally and when using assisted reproductive technologies like IVF. ‍
• Elevated androgens (male hormones): Women with PCOS often have higher-than-normal levels of androgens, which may disrupt egg maturation within the ovaries.

Does PCOS always mean poor egg quality? 

The short answer is: no. The link between PCOS and egg quality is complex and not yet fully understood. Because PCOS symptoms and hormone levels can vary widely from woman to woman, how the condition impacts egg quality is likely to differ as well. 

Some women with PCOS may have excellent egg quality and conceive naturally, while others may need support to improve it. 

The specific type of PCOS also matters. For instance: 

• Women with insulin-resistant PCOS may be more likely to experience egg quality issues due to inflammation and blood sugar imbalances. 
• Those with “lean” PCOS, who are not overweight or insulin resistant, may have less impact on egg health. 

Other factors—such as age, lifestyle, and coexisting conditions—also influence egg quality. So, while PCOS can be a risk factor, it doesn’t guarantee poor outcomes. 

How to improve egg quality with PCOS 

If you’re concerned about your egg quality or simply want to optimize your fertility, there are several different strategies you can take to help improve egg quality in PCOS. Let’s take a closer look.

Nutrition and supplements 

Eating to support hormone balance and reduce inflammation is key: 

• Focus on a low-glycemic, anti-inflammatory diet that is rich in fibre, lean protein, healthy fats, and antioxidant-rich fruits and vegetables. 
• Avoid foods high in sugar, saturated fats and simple carbohydrates to help reduce insulin resistance. 
• Consider supplements like inositol, Coq10, and omega-3 fatty acids to help regulate insulin production, reduce chronic inflammation and support reproductive health. Always speak to your healthcare provider before starting a new supplement to make sure it’s the right fit for you first. 

Exercise and weight management

Exercise improves insulin sensitivity and can help to restore ovulation in women with PCOS. Maintaining a healthy BMI can also help to regulate hormonal imbalances and improve the symptoms of PCOS. 

• Aim for 150 minutes a week of moderate to vigorous intensity exercise, including two sessions of strength training. If you’re new or returning to exercise, then start slowly with activities like walking or swimming as you build up your cardio-respiratory fitness. 
• In women with PCOS and a raised BMI, even a modest weight loss of 5-10% can improve ovulation and fertility. 

Other lifestyle adjustments 

• Poor sleep and chronic stress can disrupt hormones, worsen insulin resistance and impact fertility. Prioritizing your emotional well-being and practicing good sleep hygiene are important lifestyle changes you can make to help manage PCOS symptoms. 
• Smoking and alcohol can each negatively affect egg development and ovulation. Where possible, making lifestyle changes to reduce or eliminate these factors can help support and optimize your fertility. 

Medical and fertility treatment 

• Metformin is a medication commonly prescribed to women with PCOS to improve insulin sensitivity. Talk to your healthcare provider about whether this medication would be suitable for you.
• Assisted reproductive technology like IVF may be useful for some women with PCOS and infertility that doesn’t respond to the use of ovulation medication.
• Ovulation medications like letrozole and clomiphene can stimulate egg development and trigger ovulation.

When to see a specialist 

If you’re under 35 and have been trying to conceive for 12 months without success, or over 35 and have been trying for at least 6 months, then it’s time to reach out to a fertility specialist. They will be able to use blood tests and scans to review your fertility, including how many eggs you have and their likely quality. However, if you're not ovulating regularly, it's important not to wait the full 6–12 months before seeking help. Irregular or absent ovulation significantly reduces your chances of conceiving naturally, so getting an earlier evaluation can make a big difference.

Even if you’re not trying to get pregnant but have irregular cycles, signs of insulin resistance, or symptoms of raised androgens, then speak to your healthcare provider. If you have PCOS, the earlier you’re diagnosed, the earlier you can start to manage your condition. 

Key takeaways 

• PCOS may affect egg quality through hormonal imbalances, changes to the follicular fluid that impact egg growth and insulin resistance, but it will vary from woman to woman. 
• Many people with PCOS can improve their egg quality through nutrition, lifestyle changes, and with medical support. 
• Early intervention and working with a fertility specialist can increase the chances of a healthy pregnancy. 
• Having PCOS doesn’t always mean poor fertility, but it’s important to understand your body and support it in the right ways.

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