PCOS and fertility: what it means for getting pregnant

Trying to conceive · Updated July 2026 · All articles

Finding out you have PCOS when you are trying for a baby can feel like a blow. The word "syndrome" alone sounds serious, and when you are already anxious about getting pregnant, a new diagnosis can feel like a wall between you and the family you want.

So here is the most important thing first: PCOS is the most common cause of ovulation-related fertility problems, and yet the vast majority of people with PCOS do become parents. Most will conceive either naturally or with treatment. You are not facing an impossible situation, and there is a lot that can help.

What is PCOS?

PCOS stands for polycystic ovary syndrome. It is a hormonal condition that affects roughly one in ten women of reproductive age. Despite the name, many people with PCOS do not actually have cysts on their ovaries in the traditional sense. The "cysts" are small, immature follicles (fluid-filled sacs that each contain an egg) that have started to develop but have not fully matured or released.

To receive a PCOS diagnosis, you need at least two of the following three features, known as the Rotterdam criteria:

• Irregular or infrequent periods, which indicate that ovulation is not happening regularly
• Signs of excess androgens (male hormones), such as acne, excess facial or body hair (hirsutism), or hair thinning on the scalp
• Polycystic ovaries on ultrasound scan, typically 12 or more follicles in each ovary, or enlarged ovaries overall

PCOS affects hormone levels in a complex way. Levels of LH (luteinising hormone) and insulin are often raised, which disrupts the normal ovulatory cycle. Many people with PCOS also have some degree of insulin resistance, where the body's cells do not respond to insulin as efficiently as they should. This is relevant both to understanding symptoms and to choosing the right treatment.

How PCOS affects ovulation

In a typical menstrual cycle, one follicle grows to maturity and releases an egg. With PCOS, the hormonal disruption means this process often stalls. Follicles start to develop but do not reach the point of releasing an egg. Because ovulation does not happen, or happens only occasionally, periods become irregular or stop altogether.

This unpredictability is what makes trying to conceive with PCOS particularly challenging. If you do not know when, or whether, you are ovulating, timing sex to coincide with your fertile window becomes genuinely difficult. Cycles can range from 35 days to several months, and some people go many months without a period.

That said, irregular cycles do not mean ovulation never happens. Many people with PCOS do ovulate sometimes, just not reliably. You may notice that some months feel almost normal while others are much longer or absent entirely. The unpredictability itself is the core challenge, not a complete absence of fertility.

PCOS and your chances of conceiving

Here is something that often gets lost in the anxiety of a new diagnosis: PCOS is strongly associated with fertility challenges, but it is not the same as permanent infertility.

The NHS and NICE are both clear that the majority of people with PCOS who want to conceive will do so. Many conceive naturally, particularly those with milder symptoms or who have some regular cycles. Others need support to prompt ovulation, but once ovulation is restored, the chances of pregnancy are broadly similar to those of the wider population.

The path to parenthood with PCOS may need a little more support, but it is a well-mapped and well-travelled path. Ovulation-related infertility is the most treatable form of fertility difficulty, and the treatments available are effective.

Lifestyle changes that can really help

Before any medical treatment, lifestyle changes are the first and most evidence-backed step for people with PCOS who have a raised BMI. Losing as little as five to ten per cent of your body weight can restore regular ovulation in many women with PCOS. This is not about reaching a particular ideal weight or fitting a certain body shape. Even a modest, sustainable change can make a genuine hormonal difference.

A lower glycaemic index (GI) diet is particularly relevant with PCOS. Because many people with PCOS have some degree of insulin resistance, eating in a way that avoids sharp blood sugar spikes can improve insulin sensitivity and, in turn, support more regular ovulation. In practice this means choosing wholegrains, legumes, vegetables and fruit more often than refined carbohydrates and sugary foods. You do not need to cut anything out entirely; small consistent shifts matter more than perfection.

Regular exercise helps too, both by improving insulin sensitivity and by supporting mood during what can be a stressful and emotionally demanding time. You do not need intensive training. Brisk walking most days, swimming, yoga, or any activity you genuinely enjoy can make a real difference over time.

If your weight is not a factor, these dietary and exercise principles can still support hormonal balance and overall wellbeing. They are worth doing regardless of where you are starting from.

Tracking ovulation when you have PCOS

Standard ovulation predictor kits (OPKs) detect the LH surge that triggers ovulation. These can be less reliable if you have PCOS because LH levels are often elevated throughout the cycle, which means you may see multiple "positive" readings that do not correspond to actual ovulation. This can be confusing and disheartening, especially if you do not realise it is expected.

Basal body temperature (BBT) tracking can be more useful. Your BBT rises slightly (by around 0.2°C) after ovulation and stays elevated until your period arrives. Tracking this over several months can help you identify whether and roughly when ovulation is occurring, though it confirms ovulation after the fact rather than predicting it in advance.

A few other things worth knowing about tracking with PCOS:

• If your cycles are long (say, 40 to 60 days), ovulation will probably happen much later in your cycle than the standard day 14. It could be day 25, 30 or even later. Do not assume you have missed your window if you are only a couple of weeks in.
• Combining OPKs, BBT and changes in cervical mucus can give a fuller picture than any one method alone.
• If tracking feels stressful or confusing, having regular sex across the middle stretch of a longer cycle is a perfectly reasonable approach rather than trying to pinpoint an exact day. For very long or absent cycles, medical support to induce ovulation may ultimately be more useful than tracking alone.

Medical treatments for ovulation induction

If lifestyle changes have not led to regular ovulation within a reasonable time, or if your periods are very infrequent or absent, your GP can refer you to a fertility clinic for ovulation induction. The NICE fertility guideline (CG156) sets out the main treatment options.

Letrozole

Letrozole is now the preferred first-line treatment for ovulation induction in PCOS, following the 2023 NICE guidance update. It is an aromatase inhibitor, originally developed as a breast cancer drug, that temporarily lowers oestrogen levels. This prompts the brain to send stronger signals to the ovaries to stimulate follicle development and, in turn, ovulation. It is taken for five days at the start of the cycle. Live birth rates with letrozole are at least as good as, and in many studies better than, those with clomiphene, and it carries a lower risk of multiple pregnancy.

Clomiphene citrate

Clomiphene (sometimes called Clomid) was the standard first-line treatment for many years and remains widely used. It works by blocking oestrogen receptors in the brain, which triggers a stronger hormonal signal to the ovaries to develop a follicle. It is effective at inducing ovulation in around 70 to 80 per cent of people with PCOS and leads to pregnancy in roughly 40 to 45 per cent over several cycles. It is taken for five days early in the cycle and is typically prescribed for up to six cycles.

Metformin

Metformin is a medication primarily used for type 2 diabetes that works by improving insulin sensitivity. In PCOS, it can help regulate cycles and improve the response to ovulation-inducing drugs. It is often used alongside letrozole or clomiphene rather than on its own, particularly for people who show signs of insulin resistance.

Gonadotrophins

Gonadotrophins are injectable hormones, usually FSH (follicle-stimulating hormone), that stimulate the ovaries directly. They are used when tablet-based treatments have not worked. Because they require careful monitoring via blood tests and ultrasound scans to reduce the risk of over-stimulating the ovaries, they are usually only offered by a fertility clinic with specialist supervision.

IVF with PCOS

If ovulation induction has not resulted in pregnancy, or if IVF is recommended for other reasons, having PCOS does not reduce your chances of it working. Success rates for IVF in people with PCOS are generally comparable to, and in some studies better than, those in the wider population. This is partly because PCOS is typically associated with a good number of eggs being available at retrieval.

The main consideration to discuss with your clinic is the risk of ovarian hyperstimulation syndrome (OHSS). This is a reaction to the hormone stimulation used in IVF, where the ovaries become swollen and can cause pain, bloating and nausea. Mild OHSS is uncomfortable but manageable at home. Severe OHSS is rare but serious and requires medical care. Because PCOS means the ovaries contain many small follicles, they can sometimes over-respond to stimulation drugs.

Modern IVF protocols have significantly reduced this risk. Your clinic is likely to recommend a freeze-all approach (freezing all embryos and transferring them in a later, unstimulated cycle) or an antagonist protocol, both of which lower the risk of OHSS considerably. If you have PCOS and are considering IVF, make sure to have this conversation with your clinic early so they can design your protocol with this in mind from the start.

When to see your GP or a fertility specialist

General guidance is to see your GP if you have been trying to conceive for 12 months without success (if you are under 35) or six months (if you are 35 or older). However, if you have PCOS with very irregular or absent periods, you do not need to wait that long before asking for help.

NICE guideline CG156 recommends that referral to a fertility clinic after six months is appropriate for people with known ovulatory dysfunction, which includes most people with PCOS who have infrequent or absent periods. You do not need to spend a year trying first before anyone will take your concern seriously.

When you see your GP, they will typically:

• Review your PCOS diagnosis and any recent blood test or scan results
• Discuss lifestyle factors and whether any changes might help
• Refer you to a gynaecologist or fertility clinic if appropriate
• Arrange initial fertility investigations for you and your partner, including a sperm analysis and a check that your fallopian tubes are open

Please do not feel you are going too soon or making a fuss. Seeking advice earlier means earlier access to support. Your fertility team will not think you are being impatient; this is exactly what they are there for.

PCOS during pregnancy

If you conceive with PCOS, making sure your care team knows about it from the very start is important. PCOS is associated with a somewhat higher risk of gestational diabetes (diabetes that develops during pregnancy) and pre-eclampsia (high blood pressure in pregnancy). Both conditions are routinely screened for during antenatal care, but disclosing your PCOS to your midwife and GP at the start of pregnancy means they can flag you for enhanced monitoring from the beginning.

Mention your PCOS at your booking appointment, which usually happens around eight to ten weeks of pregnancy. Your midwife can then ensure you are offered the right glucose screening and keep a closer watch on your blood pressure throughout. With good antenatal care, most people with PCOS have healthy pregnancies and healthy babies.

PCOS and your mental health

Research consistently shows that people with PCOS have higher rates of anxiety and depression than the general population. The reasons are layered and include hormonal factors, the emotional weight of managing an unpredictable condition, concerns about body image and changes in appearance, and the ongoing stress of a fertility journey that does not always follow a clear timeline.

If you are finding the diagnosis difficult, or if trying to conceive is taking a toll on how you feel day to day, that response is completely valid. You do not need to feel stoic or to keep it to yourself. Talking to your GP about how you are feeling is a good starting point, and they can refer you to appropriate support.

Verity, the UK PCOS charity at verity-pcos.org.uk, also runs a peer support community and forum. Many people find it genuinely helpful to connect with others who understand what living with PCOS feels like, particularly around fertility.

Being kind to yourself through this process is not a luxury. It is part of taking care of your health, and it matters just as much as any treatment or lifestyle change.

Common questions about PCOS and fertility

Related articles

• Is my cycle normal? Understanding what regular periods look like
• Understanding your fertility: how cycles, ovulation and timing work
• The two-week wait: symptoms, what you might feel and how to cope