BEYOND ONLY THE BASICS: What PCOS really means for fertility, pregnancy, & long-term health
Polycystic Ovary Syndrome (PCOS) is often discussed in terms of irregular periods, acne, and difficulty conceiving—but these surface-level symptoms only scratch the surface of what is, in truth, a complex and evolving condition. PCOS isn't just about ovulation. It's a lifelong endocrine and metabolic syndrome that can impact everything from fertility to cardiovascular health, insulin sensitivity, and even mental well-being. And understanding how it changes over time is essential for women trying to conceive—especially those in their late 30s and 40s.
PCOS is not one size fits all
The first thing to know: PCOS is a syndrome, not a disease. That means it's a collection of symptoms with multiple possible causes and presentations. Most clinicians still recognize four distinct phenotypes (A through D), but more recent genomic research suggests there may be just two truly distinct subtypes—one more classically "androgenic," and one more "hypo-androgenic" that is especially relevant to older patients.
Women in their teens and 20s with PCOS often experience excess androgens (male hormones like testosterone), irregular periods, and difficulty ovulating. But for some women—particularly those in the D phenotype—these androgen levels actually decline as they age. After 35, some PCOS patients may become too low in androgens, which are essential for healthy follicle development and egg quality. These patients may still present with regular cycles and lean body types—making them easy to misdiagnose or overlook entirely.
It's not just about ovulation when it comes to infertility
While PCOS is the most common cause of anovulatory infertility, many women are surprised to learn that the story doesn't end with ovulation induction. In fact, even women who ovulate regularly can struggle with egg quality, implantation, or hormonal imbalances related to PCOS—especially as they approach their late 30s and early 40s.
As ovarian reserve naturally declines with age, PCOS adds another layer of complexity. Certain phenotypes are at increased risk of developing low androgen levels (hypoandrogenism), which can further impair egg quality and IVF outcomes. In these cases, androgen supplementation with DHEA may improve ovarian response—but only when carefully monitored by fertility specialists who understand the nuances of PCOS in older patients.
Rethinking treatment at 35-plus
For women over 35, especially those trying to conceive, treatment must be more targeted. Inositol—often recommended as a blanket supplement for all PCOS patients—can actually lower already-declining androgen levels in PCOS D-phenotype patients, potentially doing more harm than good.
At the Center for Human Reproduction (CHR), we take a personalized approach to PCOS. Our team regularly sees patients who were misdiagnosed or poorly treated by conventional standards because they didn't fit the "typical" PCOS picture. We believe understanding the underlying hormonal and genomic differences is key to guiding smarter, more effective care.
The bottom line
PCOS is more than a reproductive disorder. It's a dynamic condition that can evolve with age—and so should your treatment. Whether you're in your 20s or 40s, understanding your specific PCOS phenotype, hormone profile, and long-term risks can empower you to make better choices for your health and fertility.
If you're navigating PCOS and want a more personalized, evidence-based approach, we invite you to schedule a consultation with our team.
SPONTANEOUS MISCARRIAGES: What you often are not told about recurrent loss of pregnancy & important testing options
When it comes to spontaneous miscarriage, most people are only told part of the story. The emotional toll is widely acknowledged, but the medical complexity—especially when loss happens more than once—is often overlooked or dismissed. For those who've experienced two or more pregnancy losses, the term "recurrent pregnancy loss" (RPL) may finally come into focus. But unfortunately, many are still left without answers.
Recurrent loss is a medical condition that deserves deeper investigation. Yet in standard care, testing for RPL often doesn't begin until after three consecutive miscarriages—and even then, the workup can be incomplete.
What you might not hear at the doctor's office
Many patients are told, "It's just one of those things," or "You're young and healthy—it'll happen next time." While those statements might be intended to reassure, they can minimize very real grief and delay critical testing. And for those in their late 30s or 40s, delaying answers also delays time—an incredibly important factor in fertility.
What you're often not told is that pregnancy loss can have a wide range of underlying causes: hormonal imbalances, autoimmune dysfunction, anatomical issues, clotting disorders, infections, and even embryo quality. Most standard OB/GYN panels only screen for a fraction of these. And if IVF is involved, some fertility clinics may suggest donor eggs before truly exploring why the loss is happening in the first place.
What testing should include
If you've experienced recurrent miscarriage—whether natural or via IVF—you have the right to ask for a full workup. That should include:
Hormonal testing, including thyroid function, prolactin, and luteal phase support
Immune testing, such as antiphospholipid antibodies, and other autoimmune markers
Anatomical evaluations, including hysterosalpingogram (HSG), saline sonograms, or hysteroscopy
Metabolic and nutritional panels, including Vitamin D, insulin resistance, and inflammatory markers
This is not an exhaustive list, but it highlights just how multifaceted pregnancy loss can be. A one-size-fits-all approach doesn't work—and yet, many patients are given exactly that.
Moving beyond the "unexplained"
One of the most frustrating experiences is being told your losses are "unexplained." While it's true that not every answer can be found, many unexplained cases are actually just underexplored. There are specialists and clinics that go deeper—like the CHR—that focus on complex or "last-resort" cases. If you feel unheard or dismissed, consider a second opinion from a clinic that prioritizes individualized diagnostics.
You deserve more than reassurance
Miscarriage is more than an emotional event—it's a medical one. If you've experienced more than one—and/or even if it is only one, but a so-called later miscarriage (after a positive fetal heart)—it may not only be just bad luck, and it's not something you should have to endure without answers. You deserve to understand what's happening in your body and what can be done to support a healthier outcome moving forward.
Recurrent loss is a diagnosis that deserves compassion, care, and comprehensive investigation. Don't settle for anything less. We can help you. Reach out to our team to schedule a consultation!
PREGNANT AT 40-PLUS: What's different, what matters, & what's possible
In recent years, more women are choosing to start or grow their families in their 40s—and for good reason. With more access to fertility care, better health awareness, and shifting life priorities, the idea that 40 is "too late" for pregnancy is finally being challenged.
Still, pregnancy over 40 does look and feel different, physically, emotionally, and medically. Whether you're already expecting or considering pregnancy, here's what you need to know about navigating this chapter with confidence.
What's different after 40?
(i) Fertility is naturally declining—but is not gone
It's true that egg quantity and quality decline with age. By 40, most women have significantly fewer eggs left in their ovaries than they did in their 20s, and a higher percentage may be chromosomally abnormal. But that doesn't mean pregnancy is impossible. Many women still conceive naturally—or with fertility support—using their own eggs. Taking care of women in their 40s is our bread and butter at the CHR!
(ii) Higher risk doesn't usually mean very high risk and/or no chance
Pregnancy over 40 is considered higher risk, but by no means necessarily very high risk. This, in principle, just means that you'll be monitored more closely. However, with good prenatal care and proactive health management, the vast majority of women end up having healthy pregnancies and deliveries.
(iii) You may be taken less seriously
Unfortunately, age bias still exists. Some fertility providers may rush to recommend donor eggs or discourage you from trying at all. That's why choosing the right care team matters—especially one with p experience working with patients in their 40s (and sometimes these days even in their 50s).
What matters most
(i) Individualized care
There is no one-size-fits-all protocol for pregnancy after 40. A clinic or OB-GYN that considers your unique hormone levels, ovarian reserve, immune health, and medical history is essential.
(ii) Preconception prep
Eggs mature over a 2–3 month window before ovulation. That means what you do before conception—nutrition, sleep, supplements, and stress management—can impact the quality of your eggs and overall outcomes.
(iii) Emotional resilience
Whether this is your first pregnancy or the result of a long fertility journey, being pregnant at 40 can stir up a range of emotions: excitement, fear, gratitude, even disbelief. Finding a support network—through therapy, patient communities, or trusted providers—can help you stay grounded through the ups and downs.
What's possible
New patients at the Center for Human Reproduction (CHR) often were told by other clinics that they've "run out of time." But time isn't the only factor in fertility. We've helped many women in their 40s—and even early 50s—conceive and carry healthy pregnancies, often using their own eggs. Our oldest patients who conceived and delivered babies with the use of their own eggs were around 47 to 48. And we are continuing to try to get better. With the use of donor eggs, pregnancies and deliveries in the 50s are no longer unusual. When no one believes in you, we do.
Success is possible when the approach is thoughtful, evidence-based, and tailored to you. If you're over 40 and trying to get pregnant, don't, therefore, let outdated statistics or dismissive opinions dictate your path.
You deserve to be seen, heard, and supported every step of the way