I am the mother of a 37-year-old son diagnosed with autism and Crohn’s disease. He also has serious intellectual and developmental disabilities (IDD), requiring round-the-clock care and support. I also have a medical history of PCOS (polycystic ovary syndrome) and took fertility medication to conceive him. For years, I have watched the autism diagnosis rate climb while public discourse remained fixated on single causes or stigmatizing narratives. But we are missing something deeper and more systemic.

PCOS is a hormonal disorder that affects millions of women. It is often accompanied by insulin resistance and elevated testosterone levels, factors that can create a challenging environment for fetal development. Research has shown that women with PCOS are significantly more likely to have children diagnosed with autism, and that risk increases when PCOS is paired with obesity. But this is just one possible factor among many. Autism is a complex condition with diverse causes: genetic, environmental, immunological, and metabolic. No single explanation will ever fit every family’s story.

Still, we need to ask better questions. The metabolic crisis we are facing (driven by high sugar intake, processed foods, and sedentary lifestyles) is making PCOS more severe and more common. Fertility treatments may help women with PCOS conceive, but they do not necessarily correct the hormonal environment in the womb. We may be enabling pregnancies in bodies that are not hormonally prepared to support optimal neurodevelopment. That is not a judgment; it is a public health concern.

I have lived through this intersection firsthand. My fertility journey was filled with hope, but also uncertainty. I was grateful for the chance to become a mother, but I now wonder whether my hormonal and metabolic health played a role in my son’s neurodevelopmental and autoimmune challenges. These are difficult questions, and they deserve thoughtful, compassionate exploration, not blame or shame.

This is not about vilifying fertility treatments. It is about asking better questions. If we want to understand the rise in autism diagnoses, we need to look upstream: at maternal health, nutrition, and the systems that normalize metabolic dysfunction. We need to support women with PCOS not just in conceiving, but in optimizing their health before and during pregnancy.

My son’s autism is not a quirky personality trait; it is a severe disability that affects every aspect of his life. He requires intensive care, and the cost (financial, emotional, and systemic) is staggering. Families like mine are often left navigating fragmented services, long waitlists, and bureaucratic indifference. The burden is real, it is unaddressed, and it is growing.

Women seeking fertility treatment should be fully informed of potential risks, not to discourage them, but to empower them with knowledge and options for improving their health before conception. And we need to invest in lifelong care for those with serious autism and IDD.

I am not a scientist. I am a mother, an advocate, and someone who has lived this story. It is time we broaden the conversation and bring maternal metabolic health into the spotlight, not as the sole cause of autism, but as one of many factors worth exploring. Our children deserve nothing less.

Irene Tanzman is a patient advocate and author of Abie and Arlene’s Autism War.