PMOS, endometriosis and male-factor infertility deserve attention before pregnancy becomes urgent
Too many people discover an important reproductive diagnosis only after they begin trying to conceive.
They may have spent years living with irregular periods, severe menstrual pain, or other symptoms they were told were “normal.” Meanwhile, the male partner may not be assessed until months—or even years—into the fertility investigation.
By then, couples can feel that they have lost valuable time.
After more than 35 years as an OBGYN, I believe we need to begin these conversations earlier. Recognizing a possible health concern does not mean assuming that someone will experience infertility. It means listening to the body, asking appropriate questions and investigating symptoms when they arise.
Three areas deserve particular attention: polyendocrine metabolic ovarian syndrome, endometriosis and male-factor infertility.
1. PMOS: more than irregular periods
Polyendocrine metabolic ovarian syndrome, or PMOS, is the newer, more descriptive name for the condition traditionally called polycystic ovary syndrome, or PCOS. You may still see PCOS used by many healthcare professionals and medical organizations.
The newer name reflects an important reality: this is not simply a condition involving “cysts” on the ovaries. It is a complex hormonal and metabolic condition that can affect ovulation, insulin regulation, cardiovascular risk, emotional health, and fertility.
PMOS is one of the most common hormonal conditions affecting reproductive-aged women, yet many remain undiagnosed for years.
Possible signs include:
- Irregular, widely spaced or absent menstrual periods
- Difficulty predicting ovulation
- Persistent acne
- Excess facial or body hair
- Hair thinning from the scalp
- Insulin resistance or difficulty regulating blood sugar
- Unexplained difficulty conceiving
Not everyone with PMOS has every symptom. A person does not need to be overweight to have PMOS, and the condition is not diagnosed simply by finding polycystic-appearing ovaries on an ultrasound.
Current international guidance recommends considering PMOS when menstrual cycles remain irregular. In adults, this may include cycles shorter than 21 days, longer than 35 days, or fewer than eight menstrual cycles per year. Other causes of irregular cycles must also be considered.
PMOS is not only a fertility diagnosis. It can be associated with an increased risk of impaired glucose regulation, type 2 diabetes, sleep apnea, endometrial problems, and psychological concerns. Recognizing it earlier creates an opportunity to support both reproductive and long-term health.
When to ask for help
Speak with a healthcare professional if your periods are persistently irregular or absent, or if you have symptoms such as significant acne, excess hair growth, or other signs of increased androgens.
You do not need to wait until you are trying to become pregnant.
2. Endometriosis: severe period pain should not be dismissed
Many people are taught that painful periods are simply part of being a woman. Menstrual discomfort is common, but pain that regularly disrupts school, work, exercise, sleep or daily life deserves assessment.
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. Symptoms can include:
- Severe menstrual pain
- Chronic pelvic pain
- Pain during or after intercourse
- Pain with bowel movements or urination, particularly during a period
- Heavy menstrual bleeding
- Fatigue
- Difficulty conceiving
Symptoms vary widely. Some people have extensive disease with relatively little pain, while others experience significant pain without obvious findings on routine imaging.
A normal pelvic examination or ultrasound does not necessarily exclude endometriosis, particularly superficial disease. Current guidance also recognizes that surgery is not always required before treatment or a working diagnosis can be considered. The right approach depends on symptoms, examination findings, imaging, pregnancy plans, and individual preferences.
The important message is that persistent, life-altering pain should not simply be normalized.
When to ask for help
Seek an assessment if period pain causes you to miss activities, requires frequent or escalating pain medication, wakes you from sleep, or is accompanied by pain during intercourse, bowel movements, or urination.
Keeping a symptom and menstrual-cycle diary can help you show your healthcare professional when the pain occurs and how it affects your life.
3. Male-factor infertility: not an afterthought
Fertility is not solely a female issue.
Yet the woman frequently undergoes numerous tests before anyone orders a basic semen analysis for her partner. This can delay diagnosis and place an unfair physical and emotional burden on one person.
Male reproductive health can be affected by:
- Previous testicular injury, surgery or infection
- Undescended testicles
- Varicocele
- Hormonal or genetic conditions
- Certain medications
- Testosterone or anabolic-steroid use
- Smoking, cannabis and excessive alcohol
- Excessive heat exposure
- Metabolic health concerns
- Workplace or environmental exposures
Sometimes there are no obvious symptoms.
A semen analysis is generally an important early part of a fertility assessment. It provides information about sperm concentration, movement and shape, although one result does not tell the entire story. Abnormal findings may need confirmation and interpretation alongside the man’s medical, reproductive, and medication history.
Professional guidelines recommend assessing both partners concurrently when investigating infertility. Do not evaluate the male partner only after every female test is complete.
When to ask for help
Ask about earlier male evaluation when there is a history of testicular problems, sexual or ejaculatory difficulties, chemotherapy, pelvic surgery, testosterone use or other known risk factors.
When a couple is having difficulty conceiving, assessment should usually begin with both partners.
When should a fertility investigation begin?
For people having regular unprotected intercourse without known risk factors, fertility evaluation is generally recommended after:
- 12 months when the female partner is younger than 35
- 6 months when the female partner is 35 or older
- More immediate discussion when the female partner is over 40
But these timelines are not rules requiring everyone to wait.
Earlier evaluation may be appropriate when there are irregular or absent periods, suspected endometriosis, previous pelvic infection or surgery, recurrent pregnancy loss, sexual difficulties, known male risk factors or another medical concern that could affect reproduction.
Notice, ask and act
Earlier recognition begins with three simple steps:
Notice
Pay attention to menstrual patterns, pain, sexual symptoms and changes in reproductive or general health.
Ask
Bring these concerns to a healthcare professional. If symptoms are significantly affecting your life, it is reasonable to ask what conditions have been considered and whether further assessment is appropriate.
Act
Follow through with an individualized evaluation. This does not mean that everyone needs extensive fertility testing. It means choosing the right assessment for the symptoms, history and stage of life.
Earlier knowledge does not create certainty, but it can create choices.
Before the positive test
The goal of preconception education is not to make people anxious or to suggest that every fertility problem is preventable. It is to reduce unnecessary delays and help people understand their reproductive health before decisions become urgent.
Pain deserves to be heard. Irregular cycles deserve to be assessed. Male fertility deserves equal attention.
These conversations should not begin only after someone has struggled to conceive.
This is part of my Before the Positive Test series leading up to my presentation at the National Women’s Show in Ottawa on October 18. Next week, I will share a practical checklist of what I wish every patient knew before trying to conceive—and announce the final giveaway of two pairs of tickets to the show.
Follow the series, share this article with someone who may need it, and learn more in my book, Optimize Your Fertility Naturally: A Holistic Guide to Achieving a Healthy Pregnancy.
This article provides general education and is not a substitute for individualized medical advice, diagnosis or treatment.
Dr Marina OBGYN
References
- International PCOS Network. “Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.” Fertility and Sterility, 2023. ASRM guideline
- European Society of Human Reproduction and Embryology. ESHRE Guideline: Endometriosis. 2022. ESHRE guideline
- American Urological Association and American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Published 2020; amended 2024. AUA/ASRM guideline
- American Society for Reproductive Medicine. “Definition of Infertility: A Committee Opinion.” 2023. ASRM committee opinion
