How does Accutane work to clear skin?

I have polycystic ovaries so my skin has moderate acne that no cream or topical stuff will touch. My dermatologist recommended Accutane. How does this medication work to clear acne? Are the side effects as bad as people say? And how long do I have to be off of it before I can get pregnant? My dermatologist said that 50% of people who take accutane do not have acne problems after discontinuing use. I am 28 and I would like to try it because I have tried everything else and I do not want to be on antibiotics the rest of my life. Please only answer if you are a doctor or have taken accutane.

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