HEALTH & FERTILITY

When health changes the fertility conversation.

Some diagnoses and treatments make timing more important. Pearl helps you understand what may affect fertility, what can wait, and what deserves a conversation now.

HORMONAL HEALTH

PCOS

PCOS can affect ovulation, but it doesn't write one fixed fertility story. What matters is your own reserve, your age, and your plans, read together.

1 IN 10 WOMENAFFECTS OVULATIONMOST CONCEIVE NATURALLY
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THE SIMPLE VERSION

PCOS is the most common hormonal condition that affects fertility. Its main effect is on ovulation, whether a mature egg develops and releases each month. It isn't about having fewer eggs. PCOS ovaries often carry more, which is why AMH tends to read high.

COMMON QUESTIONS

Does PCOS mean I'll need IVF?

No. Most women with PCOS conceive naturally or with simple ovulation support such as letrozole. IVF sits at the far end of that path, not the start of it.

Is egg freezing better or worse for me with PCOS?

Often better on numbers, since more follicles usually means more eggs collected in a cycle. Quality still tracks with age, so acting earlier still helps.

What is OHSS, and should I worry about it?

It's when the ovaries over-respond to stimulation, a known PCOS risk. It's manageable, and at Zoi our rate is under 1%. Worth understanding, not fearing.

Start with an AMH test. A consultation with Dr. Yashodhara reads it against your cycle and your plans.

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REPRODUCTIVE HEALTH

Endometriosis

Endometriosis isn't a fertility verdict. It can change the timing conversation, particularly when ovarian reserve, cysts, or surgery are involved.

ROUGHLY 1 IN 10CAN LOWER AMHNOT A DEAD END
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Endometriosis can form cysts on the ovaries that gradually replace healthy tissue, which often shows up as a lower AMH than you'd expect for your age. Unlike most planning, where age is the main variable, endometriosis is active and tends to progress over time.

COMMON QUESTIONS

Will endometriosis stop me getting pregnant?

Not for most women. Many conceive with endometriosis. It can make it take longer, which is exactly why knowing your reserve early is useful.

Does surgery affect my egg count?

It can. Removing endometriomas sometimes reduces reserve, so it's worth understanding your numbers before and after any surgery.

My AMH came back low. Is that the endo?

Possibly. Suppression medication can also lower the reading temporarily, so the number needs reading in context rather than on its own.

An AMH number means the most alongside your stage, your medication, and your surgical history. That's what a consultation with Dr. Yashodhara brings together.

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HORMONAL HEALTH

Thyroid

Your thyroid sets the pace for a lot of your hormones, ovulation included. When it's off balance, your cycle often is too, and that's usually very treatable.

SIMPLE BLOOD TESTAFFECTS YOUR CYCLEUSUALLY TREATABLE
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The thyroid is a small gland that helps regulate your hormones. Too much or too little thyroid hormone can disrupt ovulation and make periods irregular. It's one of the more common hormonal reasons behind cycle changes, and one of the most straightforward to check, with a simple blood test.

COMMON QUESTIONS

Can a thyroid problem really affect my fertility?

Yes. An under-active or over-active thyroid can interfere with regular ovulation. The reassuring part is that treating it often brings cycles back on track.

Should I get my thyroid checked before freezing or trying?

It's a simple, worthwhile test. Knowing your thyroid status helps everything else be read correctly.

Does my thyroid affect my egg reserve?

There's some evidence that thyroid antibodies track with a slightly lower AMH, but the clearer, bigger effect is on ovulation and your cycle.

A thyroid check is a simple blood test, and it pairs naturally with AMH. A consultation with Dr. Yashodhara reads them together.

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REPRODUCTIVE HEALTH

Fibroids

Fibroids are common, and most don't affect fertility at all. Whether yours matter comes down to their size and where they sit.

VERY COMMONOFTEN HARMLESSSIZE & SITE MATTER
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Fibroids are non-cancerous growths in or on the uterus. They're very common, and in India they're increasingly found in women in their late 20s and early 30s. Many cause no trouble at all. The ones that can affect fertility are those that change the shape of the uterine cavity or block the fallopian tubes.

COMMON QUESTIONS

Do fibroids mean I can't get pregnant?

Usually not. Most fibroids don't affect fertility. It's mainly the ones inside the uterine cavity that can interfere with implantation.

I'm in my early 30s. Why do I have these?

They're being found earlier than they used to be, across women in their 20s, 30s, and 40s. Finding one isn't a cause for alarm. It's a reason to understand it.

Does egg freezing have anything to do with fibroids?

Freezing preserves your eggs regardless of fibroids. If surgery for a fibroid is ahead, knowing where your fertility stands first helps you plan around it.

A scan and an AMH test together give you the full picture. A consultation with Dr. Yashodhara walks you through what, if anything, needs attention.

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OVARIAN HEALTH

Low Ovarian Reserve

If your periods have changed before 40, or your AMH is low for your age, or early menopause runs in your family, it's worth understanding sooner. A lower reserve is not an empty one.

~1 IN 100 UNDER 40OFTEN RUNS IN FAMILIESOPTIONS REMAIN
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Ovarian reserve is the pool of eggs you have left. It declines for everyone with age, but for some women it declines earlier. When ovarian function drops before 40, which affects roughly 1 in 100 women, a low AMH for your age is often the first sign.

COMMON QUESTIONS

My AMH is low. Does that mean I can't have children?

No. A lower reserve means fewer eggs to work with, not a closed door. It's a reason to act while there's reserve to preserve.

Early menopause runs in my family. Does that affect me?

It can. It tends to run in families, so testing earlier gives you more room to plan.

Is it too late to freeze if my reserve is already low?

Often not. A single cycle may yield fewer eggs, and sometimes more than one is suggested, but the point of testing now is to use the reserve you have.

An AMH test shows where your reserve stands today. A consultation with Dr. Yashodhara tells you what that means for your timeline.

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GENETIC HEALTH

Genetic & Hereditary Risk

If you carry a BRCA mutation, or a genetic condition that affects the ovaries, preserving before any risk-reducing surgery or decline often makes sense. Knowing early is the advantage.

PLAN BEFORE SURGERY~50% INHERITANCEEMBRYOS CAN BE SCREENED
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Some genetic patterns affect your fertility timeline. A BRCA mutation raises the risk of breast and ovarian cancer, and the usual way to lower that ovarian risk is removing the ovaries and tubes, generally between 35 and 40, which ends natural fertility. Other conditions such as Turner syndrome and Fragile X are linked to earlier loss of ovarian function.

COMMON QUESTIONS

I'm a BRCA carrier but healthy. Should I freeze now?

It's worth a conversation. Freezing before risk-reducing surgery preserves the option of a biological child afterwards, and some carriers have a slightly lower reserve for their age.

Will I pass the mutation on?

If it's inherited, there's roughly a 50% chance. Eggs frozen now can later be fertilised and the embryos screened for that specific mutation.

It runs in my family, but I haven't been tested. What now?

A consultation, alongside a genetic counsellor, is the right place to map out testing and timing.

A consultation with Dr. Yashodhara, with your genetic counsellor or oncologist, maps what to preserve and when.

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CANCER CARE

Cancer, Before Treatment

If you've been diagnosed and treatment hasn't started yet, this is the window that matters most for your fertility. It's usually possible to preserve without delaying your care.

START WITHIN DAYS10 TO 14 DAY CYCLEONCOLOGIST COORDINATED
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There's usually a gap between diagnosis and the start of chemotherapy or radiation. A collection cycle takes around 10 to 14 days, and acting in that gap protects options that may not be available once treatment begins. We can start within days, and we coordinate directly with your oncologist.

COMMON QUESTIONS

Will freezing delay my cancer treatment?

Usually not. In most cases a cycle fits inside the window before treatment, and we move quickly.

My cancer is hormone-sensitive. Can I still freeze?

Yes. There are stimulation protocols designed for exactly this, coordinated with your oncologist. It's manageable, not a barrier.

Should I freeze eggs or embryos?

If you have a partner, embryo freezing is an option. If you'd rather keep the decision yours, eggs do that. Dr. Yashodhara will talk both through with you.

We handle the coordination with your oncology team so you don't have to. A consultation with Dr. Yashodhara starts it.

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CANCER CARE

Cancer, During & After Treatment

Whether you're in active treatment or in remission, the starting point is the same: finding out where your reserve stands today. From there, the options become clear.

START WITH AMHA TEAM DECISIONHONEST ANSWERS
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In active treatment, whether preservation is possible depends on your protocol. Sometimes there's a window between cycles, sometimes there isn't. In remission, treatment may have lowered your AMH. For some women it recovers over time, for others it's been reduced further.

COMMON QUESTIONS

I'm in treatment now. Is it too late?

Not necessarily. It depends on your specific protocol, and it's a decision made with Dr. Yashodhara and your oncology team together, never in isolation.

I'm in remission. Can I still freeze?

Often yes. An AMH test gives you the number, and a consultation tells you what that number actually means for your options.

What if my reserve is too low to freeze?

Then we'll tell you honestly, and walk through the other paths open to you. A clear, honest conversation is what we can promise.

A consultation with Dr. Yashodhara begins with AMH testing. If you're in active treatment, we coordinate with your oncology team before any next step.

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GENDER-AFFIRMING CARE

Gender-Affirming Care

Freezing eggs is worth thinking about before gender-affirming care begins, and sometimes alongside it. It keeps the option of a biological child open, on your terms.

FREEZE BEFORE HORMONESPAUSE & COLLECTWE COORDINATE CARE
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Testosterone suppresses ovulation and, over time, can reduce or remove the ability to produce eggs. Surgeries such as hysterectomy or oophorectomy remove the organs needed to collect them. The most flexibility comes from freezing before those steps.

COMMON QUESTIONS

I'm already on testosterone. Have I missed the window?

Often not. Freezing is usually still possible. It typically means pausing hormone therapy for a few weeks around the collection cycle, coordinated with your provider.

How long does it take?

The collection cycle is around 10 to 14 days, and it can usually fit within a transition timeline.

Will I have to manage the coordination myself?

No. We work directly with your endocrinologist or care provider so the cycle fits your plan rather than disrupting it.

A consultation with Dr. Yashodhara starts the conversation. If you haven't had your AMH tested, that's part of the process. You're welcome here, and your care is handled with the same privacy and rigour we bring to every member of Pearl.

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Not sure which of these is you?

If your situation is not listed, or sits across more than one condition, that is exactly what a consultation is for. An AMH test can show where your reserve stands today. Dr Yashodhara can then read that number in the context of your health, history, and plans.

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EVERY PEARL PLAN IS BUILT AROUND YOUR SITUATION, NOT A TEMPLATE. YOUR BODY. YOUR TIMELINE.

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