Could polycystic ovaries explain infertility despite regular ovulation and periods?

[HeartyPearlSeal]

Hi all,

I’m on my TTC journey for a year now , I’m 28, partner 29 and no children .

have hypothyroidism and have had raised prolactin which are now balanced since March 2026 thanks to levothyroxine .

However, I had a ultrasound with the NHS and it has shown the below :

Enlarged Size: Both of your ovaries are larger than average (the right is 15ml and the left is 10ml).
Multiple Small Follicles: The scan noted a high number of tiny, resting egg sacs (follicles) arranged around the outer edges of your ovaries. This specific "string of pearls" pattern is the classic visual sign of polycystic ovarian changes.

i ovulate every month confirmed by BBT and have a period every month and my FSH and LH are balanced on my day 3 bloods ,

does this mean I could benefit from letrozole or Clomid ?

im confused if this means I have PCOS?

You need a doctor to interpret any test results, so presumably you will get a follow up appointment to discuss them? I think it's best to wait to see a professional, rather than rely on unverifiable info on the Internet.
When I was diagnosed with PCOS 25 years ago, I was given an analogy of a greengrocer's about to shut up shop, with just a few tomatoes remaining - I guess it would be a bit more scientific these days 😂

Thank you for your reply ,

Ive been booked in for 3 weeks time to discuss with the Dr but was just seeking any advice / experiences as I am considering going to see a gynaecologist privately to get a more indepth opinion as I’ve been worrying about this a lot and not sure if my Dr’s will do anything considering I’m having regular periods etc

From the little I know, you can have polysistic ovaries and not have the syndrome, theres a few symptoms that youd need to have for it to be PCOS, I think !
High androgens is one that I remember (Testosterone)

we’ve been ttc for over 10yrs. We’ve fallen pregnant 4 times but all ended in MC. Finally got a doctor to listen to us and all indications are PCOS but I’ve not had my ultrasound yet. But like you I have regular periods but some are extremely heavy and painful. My current diagnosis is PCOS but I’m still baffled by it tbh

PCOS is primarily a hormonal imbalance. Hormonal imbalance can impair egg quality, even when periods are regular and ovulation occurs. This is one of the main reasons why PCOS can affect fertility.

PCOS is primarily a hormonal imbalance characterised by elevated AMH and testosterone levels. High testosterone (an androgen) disrupts normal egg development, causing many follicles to arrest at an early stage. As a result, the ovaries contain large numbers of small, immature follicles that fail to mature and ovulate normally. This is the main reason PCOS can reduce fertility.

Women with PCOS can find it easier to conceive during perimenopause. This is because your hormones start to drop off and become more “normal”. I conceived at 35 after being diagnosed with PCOS in my early 20s. I also am the only one of my friends who lost weight during menopause. This I’m told is because my hormones stopped being wildly out of sync and the associated issues I had, migraines, pre diabetes etc all sorted themselves out naturally.

While your experience is undeniable, the explanation lacks a clear scientific basis. Perimenopause begins when hormone levels start to become disrupted, not more normal. It progresses towards menopause, where hormonal changes become even more pronounced, leading to the cessation of ovulation and, ultimately, the absence of menstrual periods.

Thank you .

I do seem to ovulate monthly as confirmed by day 21 progesterone test and monthly BBT monitoring showing temperature rising.

Ovulation simply means that an egg is released from the ovary. But releasing an egg is only part of the story. A successful pregnancy also depends on that egg being of good quality.
In PCOS, ovulation may still occur, but the eggs are more likely to be of poorer quality because their development has been disrupted by hormonal imbalance.
Think of it like an apple tree in your garden. To make a good apple pie, it is not enough for the tree to produce apples—it also has to produce good apples. In the same way, fertility depends not only on producing an egg, but on producing a healthy, high-quality egg.

Yes that makes total sense , thank you.

could possibly having a history of high TSH, low T4 and prolactin of 700 have caused this hormonal imbalance and causing multiple follicles and contributing to bad egg quality ?

I have balanced the prolactin and TSH since April 2026 because of levothyroxine,

I have been taking COQ10 for a few months aswell but wondering if I would benefit from a small dose of letrozole or Clomid to help me conceive?

my blood sugar is also balanced HBA1C 32 mmol
testosterone 1.9 nmol

PCOS is typically characterised by elevated AMH and elevated testosterone. In fact, these are two of the three Rotterdam diagnostic criteria used to diagnose PCOS. Your testosterone level appears to be particularly high.
Our published research demonstrated that current AMH reference ranges are inflated because women with PCOS were included in the reference populations. This means that many women with genuinely elevated AMH are incorrectly reported as being "normal", contributing to the substantial underdiagnosis and under-recognition of PCOS. Around 70% of women with PCOS remain undiagnosed. The same concern is likely to apply to testosterone, although this has yet to be formally investigated.
Hormones function as an integrated system rather than as isolated actors, so other hormones may also be affected. Your prolactin appears to be towards the higher end of the normal range, and thyroid function can also influence the overall hormonal balance.
Letrozole is primarily an ovulation-induction medication. It can help an egg to be released, but it does not correct the underlying hormonal imbalance that characterises PCOS. In other words, it is mainly a temporary treatment to induce ovulation rather than to restore hormonal balance.
Whatever treatment, supplement, lifestyle change, or complementary therapy you decide to try, the most objective way to assess whether it is helping is to measure your AMH and testosterone before treatment and then repeat the same tests at regular intervals. This allows you to monitor whether your hormonal balance is improving rather than relying solely on symptoms or expectation.