If you've been diagnosed with PCOS and want to have a baby, you're not alone. PCOS affects 6-12% of women of reproductive age, making it one of the most common hormonal disorders—and the leading cause of anovulatory infertility.
But here's the good news: PCOS-related infertility responds well to treatment. Let's understand what's happening and what can help.
What Is PCOS?
Polycystic ovary syndrome is a hormonal disorder characterized by:
- Irregular or absent ovulation—the primary fertility concern
- Elevated androgens (male hormones)—causing acne, excess hair growth
- Polycystic ovaries—multiple small follicles visible on ultrasound
- Insulin resistance—present in many (not all) women with PCOS
The core problem for fertility is anovulation or irregular ovulation. Without regular ovulation, there's no egg to fertilize. Even when ovulation occurs, it may be unpredictable, making timing intercourse difficult.
Rotterdam Diagnostic Criteria
PCOS is diagnosed when 2 of these 3 criteria are present:
Irregular Cycles
Cycles longer than 35 days, fewer than 8 periods per year, or no periods
High Androgens
Elevated testosterone on bloodwork OR clinical signs (acne, hirsutism)
Polycystic Ovaries
12+ follicles per ovary or ovarian volume >10mL on ultrasound
Other causes of these symptoms must be ruled out first.
How PCOS Affects Fertility
Irregular ovulation: The main issue. Many women with PCOS don't ovulate regularly, or ovulate unpredictably. Without ovulation, pregnancy can't occur naturally.
Hormonal imbalances: Elevated LH, androgens, and insulin can interfere with follicle development and egg maturation, even when ovulation does occur.
Higher miscarriage risk: Some studies suggest women with PCOS have slightly higher miscarriage rates, possibly related to egg quality, hormonal factors, or metabolic issues. This risk decreases with treatment.
Longer time to conceive: Even with treatment, it may take longer than average to conceive due to the underlying hormonal complexity.
"PCOS doesn't mean you can't get pregnant—it means you may need help ovulating. Once ovulation happens, your chances of conceiving that cycle are similar to women without PCOS."
Treatment Options: Step by Step
Treatment for PCOS-related infertility typically follows a stepwise approach, starting with the least invasive options:
For women who are overweight, losing just 5-10% of body weight can restore ovulation in many cases. Even without weight loss, improving diet quality and exercise habits can help regulate cycles and improve treatment response.
Now the preferred first-line medication for PCOS ovulation induction (per ASRM guidelines). An aromatase inhibitor that lowers estrogen, signaling the brain to produce more FSH and stimulate ovulation. Taken cycle days 3-7.
A selective estrogen receptor modulator (SERM) that's been used for decades. Blocks estrogen receptors in the brain, triggering FSH release and ovulation. Taken cycle days 3-7 or 5-9.
An insulin-sensitizing medication that can help restore ovulation in women with PCOS and insulin resistance. Often used alongside Letrozole or Clomid. Also helps with weight management and may reduce miscarriage risk.
Injectable hormones that directly stimulate the ovaries. More powerful than oral medications. Used when Letrozole/Clomid don't work, but requires careful monitoring due to higher risk of multiple pregnancies and ovarian hyperstimulation.
Reserved for cases where other treatments fail or other factors are present. Eggs are retrieved, fertilized in the lab, and embryos transferred. Very effective, but more invasive, expensive, and requires careful management to prevent ovarian hyperstimulation.
The landmark PPCOS II trial showed Letrozole produces higher ovulation rates and live birth rates than Clomid in women with PCOS. It also has fewer side effects and lower risk of multiple pregnancies. Most fertility specialists now use Letrozole as the first-line medication for PCOS.
Lifestyle Changes That Help
Regardless of whether you use medication, lifestyle modifications can significantly improve PCOS symptoms and fertility:
Weight Management
If overweight, losing 5-10% of body weight can restore ovulation. Focus on sustainable changes rather than crash diets. Even without weight loss, improving body composition helps.
Low-Glycemic Diet
Reduce refined carbs and sugar. Emphasize whole grains, vegetables, lean proteins, and healthy fats. This helps manage insulin resistance, a key driver of PCOS symptoms.
Regular Exercise
Both cardio and strength training improve insulin sensitivity. Aim for 150+ minutes of moderate activity weekly. Even walking helps. Don't over-exercise—extreme training can disrupt cycles.
Stress Management
Chronic stress elevates cortisol, which can worsen hormonal imbalances. Practice stress-reduction techniques: yoga, meditation, adequate sleep, therapy if needed.
Supplements for PCOS
Several supplements have evidence supporting their use in PCOS:
Monitoring Ovulation with PCOS
Tracking ovulation is trickier with PCOS because cycles are irregular. Here's what works:
OPKs (Ovulation Predictor Kits): Can work but may give false positives if you have consistently elevated LH (common in PCOS). Look for a surge rather than always-positive tests.
BBT charting: Still useful for confirming ovulation occurred (temperature shift), but won't predict it in advance when cycles are irregular.
Cervical mucus: Look for egg-white cervical mucus as a sign of approaching ovulation. One of the most reliable natural signs.
Ultrasound monitoring: Your doctor may use ultrasound to track follicle development during treatment cycles—the most accurate method.
Where Are You in Your PCOS Journey?
Our quiz can help identify the right resources and next steps for your situation.
Take the Fertility Quiz →The Bottom Line
PCOS is one of the most treatable causes of infertility. Key takeaways:
- Most women with PCOS can get pregnant with appropriate treatment
- Lifestyle changes are powerful—5-10% weight loss can restore ovulation
- Letrozole is now first-line treatment (better than Clomid for PCOS)
- Inositol (Ovasitol) has strong evidence for improving PCOS fertility
- Treatment is usually successful—70-80% of women conceive with treatment
- Patience is needed—it may take several cycles to find what works
Don't let a PCOS diagnosis discourage you. With the right approach, the majority of women with PCOS achieve their goal of pregnancy. Work with a reproductive endocrinologist if your OB-GYN's initial treatments aren't successful.