Polycystic Ovarian Syndrome (PCOS) affects five to ten percent of women who are childbearing age in the United States.
Polycystic Ovarian Syndrome (PCOS) affects five to ten percent of women who are childbearing age in the United States. That's roughly five million women.

But it doesn't look the same in everyone, which makes it tough to diagnose. Here are some things you can look out for.

When I was 26, my husband and I decided it was time to try and build our family. My entire family was as fertile as they come, but I'd always had some little voice in my head tell me it wouldn't be so easy. That voice was not wrong. Over the course of the next 13 years, I'd undergo eight artificial inseminations, two laparoscopies, 7 fresh IVF cycles, three frozen IVF cycles, two domestic and one international adoption failures and the death of two sons.

Related: A Mother's Story About Finding Hope After Tragic Loss

Why? At best, the answer was poor egg quality. But mostly? I'd been diagnosed with PCOS. Many women know the main symptoms of PCOS - irregular periods, heavier weights, acne, more hair, tell-tale 'strand of pearl' appearance when looking at ovaries on ultrasound...but did you know that many of us with PCOS have few, if any of those symptoms?

In fact, the only thing that my doctors would, without question, pin my PCOS on was my LH: FSH ratio (lutenizing hormone: follicle stimulating hormone ratio). A woman with PCOS will typically have an LH: FSH ratio that is 3:1, vs. a more typical 1:1, and I did. That said, those women with elevated ratios will also typically have higher levels of testosterone, and I most certainly did not. I am of slight build, had clear skin, was hypoglycemic...and still got that frustrating diagnosis.

And I share because I know I was not alone. PCOS is sometimes called the 'garbage can' diagnosis of infertility because there are so many different 'categories' that it can fall under. Lean women can still have insulin resistance (or none, but still have PCOS). Women with high levels of estrogen can still have PCOS. Women who have no issue with getting pregnant can still have PCOS. Women who have no acne or are particularly extra 'hairy' or even women with no polycystic ovaries can still have PCOS.

Related: The Hidden Pain of Secondary Infertility

This is important to know because PCOS is evolving. Obviously, a main factor disorder when it comes to infertility, women need to know that it has other inherent issues to be on the lookout for. PCOS is now viewed as a metabolic disorder, and has cardiac and metabolic risk factors involved that women need to know about.

A number of health disorders, which include type-2 diabetes and cardiovascular and cerebrovascular diseases, have been linked to PCOS diagnosis, and signs can offer insight as to whether you should talk to your doctor more. If you have any indication of insulin resistance or glucose intolerance, high blood pressure, high cholesterol or clotting issues, you need to talk to your doctor about whether PCOS can be at play.

Because when it comes to PCOS, looks can most definitely be deceiving.