PCOS Fertility Guide

PCOS and Pregnancy

Getting pregnant with PCOS is absolutely possible — here's everything you need to know about improving fertility, managing pregnancy risks, and what to expect every step of the way.

Last reviewed: June 25, 2025

H

HerPCOS Editorial Team

Evidence-based health content for women with PCOS

Last reviewed

June 25, 2025

Evidence-based

This content is for general informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.

PCOS and Fertility: The Honest Picture

PCOS is the most common cause of ovulatory infertility in women of reproductive age, accounting for approximately 70% of ovulatory infertility cases. But it's important to separate two very different realities:

What PCOS does cause

Irregular or absent ovulation, which makes timing conception difficult and reduces the monthly chance of pregnancy.

What PCOS does NOT cause

Permanent infertility. Most women with PCOS can and do have children — often with relatively simple interventions.

Many PCOS-related fertility challenges are very responsive to treatment. Before exploring fertility medications, understanding where you are in your cycle is helpful — our irregular periods guide covers how to track your cycle when it's unpredictable.

How to Improve Fertility With PCOS

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Optimise Diet First

A low-GI, anti-inflammatory diet improves insulin sensitivity, which can restore ovulation. Research shows women with PCOS who improve their diet see menstrual cycle improvements within 2–3 months.

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Regular Exercise

Even 30 minutes of moderate exercise 4–5 days per week significantly improves insulin sensitivity and can restore ovulation in PCOS. Resistance training and aerobic exercise are both beneficial.

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5–10% Weight Loss (If Overweight)

In women with PCOS who are overweight, losing as little as 5–10% of body weight significantly improves ovulation rates, hormone levels, and fertility. You don't need to reach an 'ideal' weight.

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Inositol Supplementation

Myo-inositol + D-chiro-inositol (40:1 ratio) improves ovulation rates in women with PCOS. Clinical trials show 65% of women restore ovulation within 3 months, compared to 15% with placebo.

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Ovulation Tracking

Because PCOS cycles are irregular, standard 28-day tracking doesn't work. Use basal body temperature tracking and LH surge ovulation predictor kits to identify when you actually ovulate.

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Seek Specialist Care Early

If you haven't conceived after 6 months of trying (or 3 months if over 35), see a reproductive endocrinologist. Many women with PCOS respond well to first-line fertility medications like letrozole.

Medical Fertility Treatments for PCOS

If lifestyle changes haven't restored ovulation, a reproductive endocrinologist can guide you through a stepwise treatment approach. PCOS typically responds well to first-line treatments.

Letrozole (Femara)

First-line

The current first-line ovulation induction medication for PCOS. It temporarily blocks estrogen, triggering the body to release FSH and stimulate egg growth. More effective than Clomid in PCOS with fewer side effects.

Clomiphene Citrate (Clomid)

Second-line

An older ovulation induction medication, now considered second-line in PCOS. Stimulates ovulation in 70–80% of women with PCOS, but pregnancy rates per cycle are lower than letrozole.

Metformin + Letrozole

Combination

Adding Metformin to letrozole may improve ovulation and pregnancy rates, particularly in women with high insulin or BMI over 30. Often used for 4–6 months before moving to more intensive treatments.

Injectable Gonadotropins (FSH/LH)

Second-line

Powerful hormone injections that directly stimulate egg development. Used when oral medications fail. Require careful monitoring to prevent multiple pregnancies and ovarian hyperstimulation syndrome (OHSS).

IVF (In Vitro Fertilisation)

Advanced

Used when other treatments have failed or there are additional fertility factors. Women with PCOS have good IVF outcomes but are at higher risk of OHSS. Frozen embryo transfer cycles can reduce OHSS risk.

Pregnancy Risks in PCOS

PCOS pregnancies have higher rates of certain complications — but awareness and monitoring significantly reduce their impact. Being informed helps you advocate for appropriate care.

Gestational Diabetes

High risk

Women with PCOS have 3× higher risk of developing gestational diabetes. Early glucose screening (before 28 weeks) is recommended. A low-GI diet, appropriate weight gain, and regular exercise significantly reduce risk.

Preeclampsia

Elevated risk

High blood pressure during pregnancy is more common in PCOS due to underlying insulin resistance and inflammation. Regular blood pressure monitoring throughout pregnancy is essential.

Preterm Birth

Elevated risk

PCOS is associated with a modestly increased risk of preterm delivery (before 37 weeks). Risk is higher in pregnancies conceived with fertility treatments. Regular prenatal monitoring helps detect issues early.

Miscarriage

Elevated risk

Women with PCOS have approximately 2–3× higher miscarriage rates, particularly in the first trimester. Elevated LH, high androgens, and insulin resistance are thought to contribute. Metformin and inositol may help reduce this risk.

Caesarean Section

Elevated risk

C-section rates are higher in PCOS pregnancies, partly due to gestational diabetes, larger babies, and other complications. Choosing an experienced obstetric team is important.

Managing PCOS During Pregnancy

Proactive management reduces complications and gives you and your baby the best possible outcome:

  • ✓Schedule an early preconception appointment to review medications and optimise health
  • ✓Discuss with your doctor whether to continue Metformin during pregnancy (often recommended through the first trimester)
  • ✓Take folic acid (at least 400–800 mcg daily) for 3 months before conception and through the first trimester
  • ✓Get tested for gestational diabetes at 16–18 weeks, not just at 26–28 weeks as standard
  • ✓Monitor blood pressure at every prenatal appointment and at home if advised
  • ✓Maintain a low-GI diet throughout pregnancy to manage insulin and reduce gestational diabetes risk
  • ✓Attend all recommended prenatal appointments — PCOS pregnancies benefit from closer monitoring
  • ✓Discuss postpartum PCOS management plans with your doctor before delivery

Frequently Asked Questions

Can women with PCOS get pregnant naturally?+
Yes — many women with PCOS conceive naturally, especially when PCOS is well-managed through diet, lifestyle, and supplements. PCOS causes irregular ovulation, not permanent infertility. Women who do ovulate, even irregularly, can and do conceive without medical intervention. Lifestyle changes often restore regular ovulation.
Does PCOS get better or worse during pregnancy?+
Some PCOS symptoms actually improve during pregnancy as progesterone and estrogen naturally rise and androgen levels often decrease. However, the metabolic risks (gestational diabetes, preeclampsia) increase. After delivery, PCOS symptoms typically return — some women notice temporary improvement in cycles postpartum.
Should I keep taking Metformin during pregnancy?+
This is a nuanced decision best made with your doctor. Many reproductive endocrinologists recommend continuing Metformin through the first trimester in women with PCOS, particularly to reduce miscarriage risk. Evidence for benefit beyond the first trimester is more mixed. Never stop or start Metformin during pregnancy without medical guidance.
Does PCOS affect my baby's health?+
Babies born to mothers with PCOS generally have good outcomes. There is some research suggesting a slightly increased risk of being large for gestational age (macrosomia) and a higher rate of NICU admission — largely linked to gestational diabetes complications. Daughters of women with PCOS have a higher genetic likelihood of developing PCOS themselves.
What is OHSS and am I at risk?+
Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to fertility medications, where the ovaries become swollen and fluid leaks into the abdomen. Women with PCOS are at significantly higher risk because they have more follicles. Symptoms include bloating, abdominal pain, nausea, and rapid weight gain. Mild OHSS is manageable at home; severe OHSS requires hospitalisation. Your fertility doctor will monitor carefully to prevent it.
Will losing weight before pregnancy improve my chances?+
For women with PCOS who are overweight, even a 5–10% weight loss before pregnancy significantly improves ovulation rates, reduces miscarriage risk, and lowers gestational diabetes risk. However, weight is not the only factor — lean women with PCOS also face fertility challenges. Focus on metabolic health (insulin sensitivity, androgen levels) rather than weight alone.
Does breastfeeding affect PCOS?+
Breastfeeding may help by suppressing ovulation temporarily and improving insulin sensitivity. Some women find PCOS symptoms are milder while breastfeeding. However, symptoms typically return after weaning. There is no evidence that breastfeeding 'cures' or permanently improves PCOS.

Medical References

  1. [1]Joham AE, et al. (2014). Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome. Fertil Steril. 102(5):1487–1493.
  2. [2]Legro RS, et al. (2014). Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome. NEJM. 371(2):119–129.
  3. [3]Qin JZ, et al. (2013). Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol. 11:56.
  4. [4]Morin-Papunen L, et al. (2012). Metformin reduces pregnancy complications without affecting androgen levels in pregnant PCOS women. Hum Reprod. 27(5):1295–1302.
  5. [5]Teede HJ, et al. (2018). International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 33(9):1602–1618.

This content is for informational purposes only and does not constitute medical advice. Fertility treatment and pregnancy management should always be guided by a qualified healthcare provider.

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