Why do women with pcos have trouble with their cycle and fertility?

Complicated. Syndrome is due to high Insulin levels. Patients have the type ii diabetes gene expression. Early in dmii, Insulin levels are high. Insulin in the ovary creates higher male hormone (androgen) production that thwarts follicle (egg) development. Thus ovulation problems and longer menstrual cycles. Anything over 30 days is abnormal. Fertility is decreased and miscarriage increased.