How to Get Pregnant With PCOS

Receiving a diagnosis of polycystic ovary syndrome (PCOS) can feel like a heavy weight, especially if you are dreaming of starting a family. It is completely normal to feel overwhelmed or worried about what this means for your fertility.

The good news is that PCOS does not mean you cannot get pregnant. In fact, most women with this condition can and do have healthy babies.

We are here to help you navigate this journey. We will break down exactly what PCOS is, how to manage the symptoms through lifestyle changes, and the latest medical treatments available to help you conceive. Whether you are just starting to wonder about your symptoms or are ready to explore fertility treatments, we have the information you need to move forward with confidence.

What Is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal condition where the ovaries may develop small fluid-filled sacs (follicles) and fail to release eggs regularly. It is driven by an imbalance of reproductive hormones, creating problems in the ovaries. It is one of the most common causes of female infertility, affecting nearly 5 million women of reproductive age in the US ⁽¹⁾.

Common Symptoms of PCOS

Because PCOS is a spectrum, symptoms can vary wildly from person to person. Some women discover they have it after trying unsuccessfully to conceive, while others notice physical changes much earlier.

If you suspect you might have PCOS, look out for these common indicators:

• Irregular periods: This is the most common sign. You might have fewer than nine periods a year, cycles that are longer than 35 days, or unpredictably heavy bleeding.
• Weight gain: Up to 80% of women with PCOS are obese or overweight. This weight often accumulates around the abdomen and is difficult to lose due to insulin resistance.
• Hirsutism: This refers to excess hair growth on the face, chin, or parts of the body where men usually have hair. It affects up to 70% of women with PCOS.
• Acne and oily skin: High androgen levels can cause severe acne, particularly along the jawline, chest, and upper back.
• Thinning hair: You might notice hair loss on the scalp, similar to male-pattern baldness ⁽²⁾.
• Skin darkening: Dark patches of skin can form in creases like the neck, groin, and under the breasts. This is a sign of insulin resistance.

If these symptoms sound familiar, schedule a visit with your doctor. A diagnosis is the first step toward managing the condition effectively.

Can You Get Pregnant With PCOS?

Yes, you absolutely can. The misconception that a PCOS diagnosis equals sterility is outdated and incorrect. While it may require a bit more planning and medical assistance, the majority of women with PCOS are able to conceive ⁽³⁾.

The primary hurdle is usually ovulation. If you do not ovulate, you cannot get pregnant. However, through diet, exercise, and medication, ovulation can often be restored.

Why Does PCOS Impact Fertility?

PCOS affects fertility by disrupting the delicate hormonal balance required for ovulation.

In a typical cycle, hormones trigger a follicle to grow and release an egg. In women with PCOS, high levels of androgens (male hormones) interfere with this signal. The egg may not develop fully or isn’t released at all. Without the release of an egg, fertilization cannot occur. Furthermore, hormonal imbalances can sometimes affect the lining of the uterus, making implantation more difficult ⁽⁴⁾.

3 Home Treatments to Boost Fertility

Before jumping into medical interventions, many doctors recommend starting with lifestyle changes. For some women, these changes alone are enough to restart ovulation.

Here are three effective ways to manage PCOS from home:

1. Diet and Weight Management

Insulin resistance plays a huge role in PCOS. When your body doesn’t use insulin effectively, it pumps out more insulin, which triggers the ovaries to produce more androgens.

Adopting a low-glycemic index (GI) diet can help balance blood sugar levels. Focusing on whole grains, lean proteins, and plenty of vegetables helps reduce insulin spikes. If you are overweight, losing just 5% to 10% of your body weight can restore regular periods and improve ovulation rates significantly.

Remember that the basis behind many cases of PCOS is insulin resistance. For this reason, losing 5-10% of your body weight can reduce insulin resistance and improve irregular menstrual cycles. By improving the way your body produces insulin and responds to glucose, you can improve your likelihood of becoming pregnant.

Editor's Note:

Caitlin Goodwin, MSN, RN, CNM

2. Track Your Cycle (With Caution)

Understanding your body’s rhythm is crucial. However, standard tracking methods can be tricky with PCOS.

Standard ovulation predictor kits (OPKs) measure Luteinizing Hormone (LH). Because many women with PCOS have persistently high LH levels, these kits can give false positives. Instead, try tracking your basal body temperature (BBT) or monitoring cervical mucus changes. These methods can confirm if ovulation has actually occurred.

Having a cycle every month does not mean you are releasing eggs every month. It is important to look to other signs to ensure your body is following the proper steps to becoming pregnant.

Editor's Note:

Caitlin Goodwin, MSN, RN, CNM

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3. Strategic Supplementation

Certain vitamins and minerals can support hormone balance.

Myo-Inositol is a standout supplement for PCOS; studies suggest it can improve insulin sensitivity and restore ovulation frequency. Additionally, Vitamin D deficiency is common in women with PCOS and is linked to insulin resistance, so adding a quality supplement can be beneficial. Always speak to your doctor before starting a new regimen.

4 Medical Treatments for PCOS Infertility

If lifestyle changes haven’t resulted in a pregnancy after a few months, medical intervention is the next logical step. These treatments are highly effective for inducing ovulation.

1. Letrozole (Femara) and Clomid

For years, Clomid was the go-to drug for PCOS. However, recent research suggests that Letrozole (Femara) may actually be more effective for women with PCOS, resulting in higher live birth rates ⁽⁵⁾.

Both medications work by blocking estrogen production, which tricks your brain into producing more follicle-stimulating hormone (FSH) to trigger ovulation. Your doctor will help decide which is right for you.

2. Metformin

Metformin is an insulin-sensitizing drug originally used for diabetes. Because insulin resistance drives PCOS symptoms, Metformin can help lower insulin levels and androgen levels.

While not a fertility drug per se, it is often prescribed alongside Clomid or Letrozole to help restart regular menstrual cycles and improve the odds of ovulation.

3. Gonadotropins (Injections)

If oral medications fail to induce ovulation, your doctor may suggest gonadotropins. These are injectable hormones (FSH and LH) that directly stimulate the ovaries to produce eggs.

Because this treatment is potent, it requires frequent monitoring via ultrasound and blood work to ensure you don’t release too many eggs at once or develop Ovarian Hyperstimulation Syndrome (OHSS) ⁽⁶⁾.

4. IVF (In Vitro Fertilization)

If ovulation induction and other treatments haven’t worked, IVF is the next option.

In this process, eggs are retrieved from the ovaries and fertilized with sperm in a lab. The resulting embryo is then transferred to the uterus. IVF has high success rates for women with PCOS because it completely bypasses the ovulation hurdles ⁽⁷⁾.

Does PCOS Increase Miscarriage Risk?

Women with PCOS do have a statistically higher rate of miscarriage than the general population. Factors contributing to this include hormonal imbalances, high insulin levels, and potential egg quality issues.

However, many of these risks can be managed. By optimizing your health before conception, treating thyroid issues, and managing blood sugar levels, you can help support a sticky pregnancy. Early and frequent prenatal care is essential.

Pregnancy Risks to Be Aware Of

Once you are pregnant, your care team will likely monitor you a bit more closely. PCOS is associated with a higher risk of certain complications during pregnancy.

These potential risks include:

• Gestational Diabetes: Due to underlying insulin resistance, you may be more prone to developing high blood sugar during pregnancy ⁽⁸⁾.
• Preeclampsia: This is a condition characterized by high blood pressure starting after 20 weeks of pregnancy.
• Preterm Birth: Babies born to mothers with PCOS have a slightly higher chance of being born before 37 weeks.

Do not let this list scare you. Knowing these risks allows your doctor to monitor you proactively, ensuring the best outcome for you and your baby.

Looking Ahead: Growing Your Family

The journey to parenthood with PCOS might look different than you expected. It may involve more doctor visits, temperature tracking, and patience. But the destination remains the same.

Remember that you are your own best advocate. If you feel something isn’t right or you aren’t getting the answers you need, seek a second opinion. With the right support and treatment plan, your dream of holding your baby is entirely within reach.

Getting Pregnant With PCOS FAQs

Can I Get Pregnant With PCOS Naturally?

Yes, many women with PCOS conceive naturally without medical intervention. Lifestyle changes such as weight loss, a low-glycemic diet, and exercise can often restore regular ovulation on their own.

What Age Is Best to Get Pregnant With PCOS?

While fertility naturally declines with age for all women, those with PCOS should ideally try to conceive before age 35 to maximize egg quality. However, women with PCOS sometimes have a higher ovarian reserve (more eggs) than average, which can be an advantage later in life.

How Many Days Do You Ovulate With PCOS?

If you are ovulating, the fertile window is the same as anyone else (about 6 days). The challenge with PCOS is that ovulation may not happen every month, or it may happen irregularly, making it harder to predict that window.

Are You More Likely to Have a Boy or Girl With PCOS?

There is no scientific evidence that PCOS influences the gender of your baby. Your chances of having a boy or a girl remain roughly 50/50.

Can PCOS Cause Birth Defects?

PCOS itself does not cause birth defects. However, unmanaged comorbidities often associated with PCOS, such as obesity or type 2 diabetes, can increase certain risks, which is why preconception health is so important.

What Should I Avoid When Trying to Get Pregnant With PCOS?

Try to avoid processed foods high in sugar, simple carbohydrates, and excessive stress. It is also wise to limit endocrine-disrupting chemicals found in some plastics and personal care products.

Is Letrozole Better Than Clomid for PCOS?

Recent studies suggest that Letrozole (Femara) results in higher ovulation and live birth rates for women with PCOS compared to Clomid. Many fertility specialists now use Letrozole as the first line of treatment.