The short answer: Yes, many women with PCOS get pregnant, some naturally and many with help. PCOS (now also called PMOS) makes ovulation irregular, so it can take longer to conceive, and it is a leading cause of infertility worldwide. Healthy lifestyle habits come first, then medicines that help you ovulate, such as letrozole, which the 2023 international guideline recommends as the first-choice tablet. If tablets do not work, injections, minor surgery or IVF are options. See a doctor early if your periods are very irregular, rather than waiting a full year.
How PCOS affects fertility
To get pregnant, an egg needs to be released from an ovary (ovulation) and meet sperm. In PCOS, higher androgen levels and often insulin resistance can stop the ovaries releasing an egg every month. The WHO describes PCOS as the most common cause of anovulation (not ovulating) and a leading cause of infertility.
The key point is that irregular ovulation is not the same as no ovulation. Many women with PCOS ovulate some months and not others. Each cycle without ovulation is simply a missed chance, which is why it can take longer.
Signs you may not be ovulating regularly
- Cycles longer than 35 days, or fewer than 8 periods a year.
- Very unpredictable cycle lengths.
- No period for 3 months or more (and a negative pregnancy test).
- Rarely noticing the clear, stretchy "egg white" discharge that often comes before ovulation.
Some women with PCOS have fairly regular cycles but still do not ovulate every month. A doctor can check with a blood test for progesterone in the second half of your cycle, or with ultrasound scans.
Tracking your fertile days with PCOS
Fertility apps that assume a 28-day cycle are often wrong when cycles are irregular. These methods work better:
- Watch your discharge. Clear, slippery, stretchy discharge usually means ovulation is near.
- Have regular sex. Every 2 to 3 days through the cycle covers your fertile window without needing to predict it exactly.
- Use ovulation test kits with care. Some women with PCOS have high LH levels, which can give misleading positive results.
- Keep a cycle diary. Note bleeding days, discharge and any test results. It helps your doctor plan treatment.
Our guide on managing unpredictable PCOS periods explains how to track an irregular cycle.
Getting ready for pregnancy
Before you start trying, or as soon as you can, the 2023 guideline and general pregnancy advice suggest:
- A pre-pregnancy check-up. The guideline recommends a glucose tolerance test and a blood pressure check when planning pregnancy, because women with PCOS have a higher risk of diabetes in pregnancy and high blood pressure.
- Folic acid. Start a daily folic acid supplement before trying to conceive. Your doctor will tell you the right dose.
- Healthy eating and activity. These improve insulin resistance and general health. If you are above a healthy weight, even modest weight loss can help ovulation return for some women. Our PCOS and PCOD diet guide has practical Indian meal ideas.
- Stop smoking and limit alcohol, for both partners.
- Check your partner too. Male factor problems are common, so a semen test is part of a standard fertility check.
Fertility treatment options for PCOS
Treatment usually follows a step-by-step plan. This summary is based on the 2023 international guideline.
| Step | Treatment | How it works | Worth knowing |
|---|---|---|---|
| First line | Letrozole tablets | Helps the ovaries release an egg | Recommended as the first-choice ovulation tablet for PCOS; taken for a few days early in the cycle under a doctor's care |
| Alternative | Clomifene tablets, sometimes with metformin | Also stimulates ovulation | Letrozole is now preferred, but clomifene is still used; metformin can be added |
| Add-on | Metformin | Improves insulin resistance | Can help on its own, but ovulation tablets work better |
| Second line | Gonadotrophin injections | Hormone injections that stimulate the ovaries | Needs close scan monitoring because of a higher chance of twins or more |
| Second line | Laparoscopic ovarian surgery (ovarian drilling) | Keyhole surgery that can help ovulation return | Considered when tablets have not worked |
| Third line | IVF | Eggs are collected and fertilised in a lab | Offered if other treatments have not worked or there are other fertility factors |
Ovulation medicines should only be taken under a doctor's supervision, with monitoring. Taking them without advice can lead to multiple pregnancy or overstimulated ovaries.
How long treatment usually takes
Fertility treatment for PCOS is usually a step-by-step process, not a single appointment. A common path looks like this:
- Getting ready (a few weeks to a few months): tests for both partners, healthy lifestyle changes, folic acid, and checks of blood sugar and blood pressure.
- Ovulation tablets (several cycles): letrozole or clomifene for a few days each cycle, with monitoring to check that you ovulate. Doctors usually try several cycles before moving on if it is not working.
- Second-line options: injections or ovarian surgery if tablets have not helped.
- IVF: if other treatments have not worked, or there are other fertility factors.
Your specialist will tailor the plan to your age, your test results and how long you have been trying. Ask at the start how long each step is likely to take, so you can plan work, travel and family commitments around appointments.
When to see a doctor
General advice is to see a doctor after a year of trying, or after 6 months if you are 35 or older. With PCOS, it is sensible to go earlier:
- if your periods are very irregular, or you have gone more than 3 months without one
- if you already know you have PCOS and want to plan
- if you have other fertility concerns, such as endometriosis or previous pelvic infections
A gynaecologist or fertility specialist will usually check your hormones, do an ultrasound, check that your fallopian tubes are open, and arrange a semen test for your partner.
Tests to expect at a fertility appointment
Knowing what is coming makes the first visit less daunting. A typical work-up for a couple where the woman has PCOS includes:
- Blood tests for hormones such as testosterone, thyroid hormones and prolactin, and sometimes a progesterone test in the second half of a cycle to see whether you ovulated.
- Blood sugar and cholesterol checks, because insulin resistance is common with PCOS.
- A pelvic ultrasound to look at the ovaries and the lining of the womb.
- A test of the fallopian tubes, usually before injections or IVF, to check they are open.
- A semen analysis for your partner.
Questions worth asking your doctor
- Am I ovulating at all, and how will we know if treatment is working?
- Which treatment do you suggest first, and how many cycles will we try before moving on?
- How will I be monitored, and how many scans will I need?
- What is the chance of twins with this treatment?
- What should I change in my diet, activity or medicines before we start?
Bringing your cycle diary and a list of current medicines saves time and helps your doctor plan.
PCOS and pregnancy
Once you are pregnant, most women with PCOS have healthy pregnancies and babies. The 2023 guideline notes some risks are higher, including:
- miscarriage
- diabetes in pregnancy (gestational diabetes)
- high blood pressure and pre-eclampsia
- a baby who is smaller than expected, and early birth
- needing a caesarean section
Tell your doctor you have PCOS at your first antenatal visit. The guideline recommends a glucose tolerance test early in pregnancy if it was not done before, and again at 24 to 28 weeks. Our guide on bleeding in pregnancy explains which symptoms need urgent attention.
Understanding the risks of treatment
Fertility treatment is generally safe when properly monitored, but it is worth knowing about two risks that are more common in women with PCOS:
- Multiple pregnancy. Ovulation medicines, especially injections, can release more than one egg, which raises the chance of twins or more. Twin pregnancies carry higher risks for mother and babies. This is why scans are used to count developing follicles, and why a cycle may be cancelled if too many are growing. In IVF, transferring a single embryo lowers the risk.
- Ovarian hyperstimulation syndrome (OHSS). The ovaries over-respond to fertility drugs and become swollen. Mild OHSS causes bloating and discomfort; severe OHSS is rare but serious. Women with PCOS are at higher risk, so clinics adjust doses and use protocols designed to reduce it.
Your partner's role
Fertility is a shared journey. Male factors contribute to many couples' difficulty conceiving, so your partner should have a semen analysis early on. Healthy habits help men too: stopping smoking, limiting alcohol, staying active and keeping a healthy weight can all improve sperm health. Going to appointments together also means you both hear the plan and can share decisions.
Your periods during fertility treatment
Treatment can change your bleeding pattern. Some medicines are started after a bleed brought on by a short course of progestogen. Spotting can happen around ovulation or after procedures. A late period during treatment should always be checked with a pregnancy test before you take any more medicine. Keep a note of every bleed and share it with your clinic.
Looking after yourself while trying
Trying to conceive with PCOS can be emotionally hard, especially with irregular cycles and well-meaning questions from family. The 2023 guideline recognises that infertility affects mood and relationships. Talk openly with your partner, share the load of appointments, and consider counselling if it starts to feel overwhelming. Our guide PCOS and Mental Health has more support ideas.
On a practical note, unpredictable bleeding during fertility treatment is common. A panty liner or a pair of period panties covers spotting and surprise periods without fuss.
Common myths about PCOS and fertility
"Women with PCOS cannot get pregnant." Many do, naturally or with treatment.
"If my periods are irregular, I don't need contraception." You can still ovulate and get pregnant. Use contraception if you do not want to conceive.
"I must lose a lot of weight first." For women above a healthy weight, even modest weight loss can help. Healthy habits help at any weight.
"IVF is the only option." Most women with PCOS who need help start with tablets, which work for many.
See a doctor if
- you have PCOS and are planning a pregnancy, for a pre-pregnancy check
- you have been trying for 6 to 12 months, or sooner if your periods are very irregular
- you have not had a period for 3 months and your pregnancy test is negative
Get urgent help if
Call 112 or go to the nearest emergency department if you could be pregnant and have severe tummy pain, pain on one side, shoulder-tip pain, heavy bleeding or you feel faint. These can be signs of an ectopic pregnancy. If you are having fertility treatment and develop severe tummy swelling, pain or breathlessness, contact your clinic straight away.
Frequently asked questions
Can I get pregnant naturally with PCOS? Yes. Many women with PCOS conceive without treatment, though it may take longer.
What is the best fertility treatment for PCOS? The 2023 guideline recommends letrozole as the first-choice ovulation medicine, together with healthy lifestyle habits.
Does metformin help me get pregnant? It can help a little on its own, but ovulation tablets such as letrozole work better.
Is PCOS pregnancy high risk? Some complications are more common, so your doctor will monitor blood sugar and blood pressure closely. Most women with PCOS have healthy babies.
How many cycles of letrozole should I try? Your doctor will decide, based on whether you ovulate and your other test results. If you are ovulating but not getting pregnant after several cycles, they will usually review the plan.
Does age matter with PCOS? Yes. As with all women, fertility gradually declines with age, especially after 35. Many women with PCOS find their cycles become more regular as they get older, but it is still wise not to delay seeking help if you want to conceive.
Does PCOS get better after pregnancy? Some women find their cycles become more regular after having a baby, but PCOS does not go away.
Related reading
- PCOS Explained: Symptoms, Diagnosis and Treatment
- Managing Unpredictable PCOS Periods
- Can You Have a Period While Pregnant?
- Endometriosis: Symptoms, Diagnosis and Treatment
This article is for general information and doesn't replace advice from your doctor or fertility specialist.
Sources: International evidence-based guideline for PCOS (2023), summary, WHO: Polycystic ovary syndrome, NHS: PMOS