PCOS and Getting Pregnant: What You Need to Know

Medically reviewed content. Last updated: April 2026.

Polycystic ovary syndrome (PCOS) is one of the most common causes of irregular ovulation, but having PCOS does not mean you cannot get pregnant. With the right support and treatment, most people with PCOS conceive successfully. This guide covers how PCOS affects fertility, what treatment options are available, and what you can do to improve your chances.

What is PCOS?

PCOS is a hormonal condition that affects how the ovaries work. It is estimated to affect around 1 in 10 women and people with ovaries in the UK, making it one of the most common reproductive health conditions.

PCOS is characterised by three features, and you need at least two of the three for a diagnosis (known as the Rotterdam criteria):

• Irregular or absent periods. This indicates that ovulation is not happening regularly.
• Excess androgens. Higher than normal levels of male hormones (testosterone), which can cause acne, excess hair growth, or thinning hair.
• Polycystic ovaries on ultrasound. The ovaries contain a large number of small, fluid-filled sacs (follicles) that surround the eggs. These are not actually cysts but underdeveloped follicles that have not matured enough to trigger ovulation.

Not everyone with PCOS has all three features, and symptoms can range from mild to severe.

How does PCOS affect fertility?

The main way PCOS affects fertility is through irregular or absent ovulation. If you do not ovulate regularly, there are fewer opportunities for an egg to be fertilised each year. Some people with PCOS ovulate occasionally but unpredictably, while others rarely ovulate at all without treatment.

It is important to understand that PCOS does not mean you are infertile. Many people with PCOS conceive naturally, especially with lifestyle adjustments. For those who need additional help, effective treatments are available.

Other PCOS-related factors that can affect fertility include:

• Insulin resistance. Around 70% of people with PCOS have some degree of insulin resistance, where the body produces more insulin to compensate. High insulin levels can disrupt ovulation and increase androgen production.
• Weight. While PCOS affects people of all sizes, around 40 to 60% of those with PCOS are overweight or obese. Excess weight can worsen insulin resistance and make ovulation less likely.
• Inflammation. Chronic low-grade inflammation is common in PCOS and may affect egg quality and implantation.

What can you do to improve your chances?

Lifestyle changes

NICE guidelines emphasise lifestyle changes as the first-line approach for improving fertility in PCOS. Even modest changes can restore ovulation in many cases.

Weight management. If your BMI is above 30, losing even 5 to 10% of your body weight can significantly improve ovulation rates. A study in Human Reproduction found that a 5% weight loss restored regular ovulation in around 40% of people with PCOS. Weight loss improves insulin sensitivity, lowers androgen levels, and makes the body more responsive to fertility treatment if needed.

This does not mean you need to reach a "normal" BMI before trying to conceive. The focus should be on gradual, sustainable changes rather than restrictive dieting, which can be counterproductive.

Diet. There is no single "PCOS diet," but research supports a balanced eating pattern that helps manage blood sugar levels. Useful approaches include:

• Choosing lower glycaemic index (GI) foods such as whole grains, legumes, and vegetables
• Including protein with every meal to slow blood sugar spikes
• Eating regular meals and avoiding long gaps without food
• Reducing refined carbohydrates and sugary foods
• Including healthy fats from sources like olive oil, avocados, nuts, and oily fish

Exercise. Regular physical activity improves insulin sensitivity independently of weight loss. Aim for at least 150 minutes of moderate exercise per week. A combination of aerobic exercise (walking, swimming, cycling) and resistance training is particularly effective for PCOS.

Reduce stress. Chronic stress can worsen hormonal imbalances. Finding sustainable ways to manage stress, whether through exercise, mindfulness, social support, or professional help, is worthwhile.

Supplements

• Folic acid (400mcg daily). Recommended for everyone trying to conceive.
• Vitamin D (10mcg daily). Many people with PCOS are vitamin D deficient, and supplementation may improve insulin sensitivity and ovulation.
• Inositol. Myo-inositol and D-chiro-inositol have been studied for PCOS and may improve insulin sensitivity and ovulation rates. The evidence is promising but not yet strong enough for NHS recommendation. If you are interested, discuss it with your GP.

What medical treatments are available?

If lifestyle changes alone do not restore regular ovulation, your GP or fertility specialist can offer medical treatment.

Letrozole

NICE updated its guidelines in 2024 to recommend letrozole as the first-line medical treatment for ovulation induction in PCOS. Letrozole works by temporarily lowering oestrogen levels, which stimulates the brain to produce more follicle-stimulating hormone (FSH) and trigger ovulation. Studies show it is more effective than clomifene for PCOS, with higher ovulation and live birth rates.

Clomifene citrate

Previously the standard first-line treatment, clomifene stimulates the ovaries to produce eggs. It is taken as a tablet for five days early in your cycle, and ovulation is monitored with ultrasound. Up to six cycles are usually offered. Success rates are good, with around 70 to 80% of people with PCOS ovulating on clomifene and around 30 to 40% conceiving within six cycles.

Metformin

Metformin is a diabetes medication that improves insulin sensitivity. In PCOS, it can help restore ovulation, particularly in people with insulin resistance. It is sometimes used alongside letrozole or clomifene. Side effects can include nausea and digestive upset, which usually improve over time.

Gonadotrophin injections

If oral medications do not work, injectable hormones (FSH and LH) can be used to stimulate the ovaries. This requires closer monitoring with regular ultrasound scans because of a higher risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. OHSS is a particular concern in PCOS because the ovaries are already sensitive.

Ovarian drilling

A surgical option where small holes are made in the surface of the ovary using a laser or needle (laparoscopic ovarian drilling). This can restore regular ovulation for a period of time. It is less commonly used now that letrozole is available as a highly effective first-line option.

IVF

If other treatments have not been successful, IVF may be recommended. People with PCOS often respond well to IVF because they tend to produce a good number of eggs. However, careful dose management is essential to reduce the risk of OHSS. Your specialist will use protocols specifically designed for PCOS.

What happens during pregnancy with PCOS?

Once you are pregnant, PCOS does carry some additional risks that your care team will monitor:

• Gestational diabetes. People with PCOS are at higher risk and will usually be offered a glucose tolerance test.
• Pre-eclampsia. Slightly increased risk. Your blood pressure will be monitored closely.
• Premature birth. A slightly higher risk has been observed in some studies.

These risks are manageable with good antenatal care, and most people with PCOS have healthy pregnancies and babies.

When should you see a GP?

See your GP if:

• Your periods are irregular (cycles longer than 35 days or fewer than 8 periods per year)
• You have been trying to conceive for 6 to 12 months without success
• You have symptoms of PCOS (excess hair growth, acne, weight gain) even if you are not yet trying to conceive

Early investigation and diagnosis give you the best chance of timely treatment. Your GP can arrange blood tests (hormone levels, glucose, and insulin) and an ultrasound to assess your ovaries.

Key takeaways

• PCOS is common, affecting around 1 in 10 people with ovaries, and is one of the most treatable causes of fertility difficulties
• The main impact on fertility is through irregular or absent ovulation
• Lifestyle changes, particularly weight management and exercise, are the first-line approach and can restore ovulation in many cases
• Letrozole is now the recommended first-line medical treatment for ovulation induction in PCOS
• Clomifene, metformin, and injectable hormones are also effective options
• IVF is available if other treatments do not work, and people with PCOS often respond well
• Most people with PCOS conceive successfully with the right support

Sources

• NHS. Polycystic ovary syndrome. nhs.uk
• NICE Clinical Guideline CG156. Fertility problems: assessment and treatment. 2013, updated 2024
• RCOG. Polycystic ovary syndrome: what it means for your long-term health. Patient information. 2023
• Teede HJ et al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. 2023
• Legro RS et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. New England Journal of Medicine. 2014
• Kiddy DS et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Human Reproduction. 1992