Which of the following is not typically associated with PCOS infertility?

• A. Oligo/anovulation
• B. Hyperandrogenism
• C. Polycystic ovaries
• D. Bilateral tubal occlusion

Answer: (D)

Infertility in PCOS is driven by ovulatory dysfunction and androgen excess. In PCOS, many cycles are anovulatory (oligo/anovulation), so ovulation doesn’t occur regularly, which makes conception difficult. Elevated androgens contribute to the clinical signs of hyperandrogenism and reflect the hormonal imbalance seen in PCOS. The ovaries often have a polycystic appearance on ultrasound due to numerous immature follicles, yet these follicles fail to mature and ovulate. Bilateral tubal occlusion, on the other hand, is a tubal-factor infertility where the fallopian tubes are blocked, preventing sperm from reaching the egg or the egg from meeting sperm, and this is not a typical feature of PCOS. Therefore, bilaterally occluded tubes are not associated with the infertility pattern seen in PCOS.