Can You Get Pregnant with PCOS? Understanding Your Fertility Options

If you have PCOS, you're not alone – it affects up to 13% of women of childbearing age.1,2  That's roughly 1 in 8 women, making it one of the most common hormonal conditions affecting fertility.1 But here's the important truth: PCOS is treatable, and pregnancy is usually possible with the right approach and support.3,4

You might be wondering how to get pregnant with PCOS. This guide will walk you through some important things you should know about PCOS and fertility, from understanding how the condition affects your body to exploring your treatment options. Most importantly, you'll learn why a PCOS diagnosis doesn't mean giving up on your dreams of having children – many women with PCOS successfully conceive with proper treatment.3,5

Understanding PCOS: The Basics Every Woman Should Know

The Science Behind PCOS

PCOS stands for Polycystic Ovary Syndrome – a hormonal condition that affects how your ovaries work.1,3 Think of it as your body's hormone system being a bit out of balance, which creates a ripple effect throughout your reproductive system.3,5

Here's what makes PCOS unique:

• High levels of male hormones (androgens): While all women produce small amounts of male hormones, women with PCOS produce too much. This hormone imbalance is at the root of many PCOS symptoms5,6

• Small fluid-filled sacs on ovaries: These aren't actually cysts (despite the name), but rather immature egg follicles that haven't developed properly due to the hormone imbalance.5,6

• Thickened outer shell of ovaries: The ovary's outer layer becomes thicker, making it harder for eggs to be released during ovulation.5,6

• High insulin levels in blood: Many women with PCOS have insulin resistance, meaning their bodies need more insulin to keep blood sugar levels normal.5,6

Why PCOS Disrupts Your Cycle

When your hormones are out of balance, they interfere with ovulation – the monthly process where your ovary releases a mature egg.4

 In a typical cycle, hormones work together like a well-orchestrated dance. But with PCOS, it's more like everyone's dancing to different music.6

The connection between irregular periods and fertility problems is straightforward: if you're not ovulating regularly (or at all), it's much harder to get pregnant. The high insulin levels common in PCOS make this worse by affecting how your ovaries respond to other hormones.4

PCOS and Fertility: Why Getting Pregnant Can Be Challenging

The Main Problem: Ovulation Issues

Approximately 70-80% of women with PCOS experience fertility challenges.6,7 But before you panic, remember that "challenging" doesn't mean impossible – it just means you might need some extra help.

The primary issue is something called anovulation, which simply means "lack of ovulation."1 In a healthy reproductive system, your ovaries release a mature egg every month. With PCOS, this process can be irregular or might not happen at all.3

Regular ovulation is essential for pregnancy because that's when the egg is available to meet sperm.3  No ovulation = no egg = no pregnancy. It's that straightforward.

What PCOS Changes About Your Fertility 

Ovulation Problems

Irregular or absent ovulation is the biggest hurdle. This affects timing conception – it's hard to plan when you don't know when (or if) you're ovulating. Even tracking methods like temperature charting become unreliable.1,3,6

Pregnancy and Gestation Issues 

Women with PCOS face some additional challenges during pregnancy:

• Increased risk of miscarriage in early pregnancy4,5

• Higher chance of gestational diabetes3,4

• Greater likelihood of pregnancy complications like high blood pressure3

While there are real risks, it's important to remember that many women with PCOS do have babies. With proper medical care and monitoring, risks can usually be managed effectively?3,6

 

PCOS Infertility Diagnosis: Why It's Not Permanent

What Does "Infertility" Actually Mean?

Let's clear up a common misconception. When doctors use the term "infertility," they're describing your current situation – not making a permanent judgment about your future.

The medical definition of infertility is simple: inability to conceive after one year of trying (or six months if you're over 35). It's basically a timeline marker that tells your doctor it's time to investigate and potentially intervene.8,9

Here's the crucial point: an infertility diagnosis describes where you are right now, not where you'll always be. Whether it's treatable depends on the underlying cause, and for PCOS specifically, most cases are treatable – though some women may have additional factors to address.9

Think of it as identifying a problem that may have solutions, not receiving a final verdict on your reproductive future.

Infertility vs. Subfertility: The Key Differences

• Infertility: Current difficulty conceiving that typically requires medical help to overcome.8

• Subfertility: Reduced fertility, but you may still conceive naturally with time and the right conditions.8

Most PCOS-related fertility challenges are treatable with proper medical care. Many women who initially had "infertility" diagnoses go on to have successful pregnancies.3,6

Actually, many women with PCOS seek help earlier than the typical one-year recommendation because they recognize obvious ovulation problems – irregular periods, absent periods, or other clear signs that something's not quite right with their cycles. This is a great approach. If you have PCOS and are thinking of starting a family, talk to your doctor sooner rather than later. 

Fertility Treatments for PCOS; What Works Best

Starting Your Treatment Journey

Weight, Hormones, & Sleep

First things first, right? Weight and hormones are super connected and starting with lifestyle choices to support health is a great first step. You might have heard that you need to lose weight to get pregnant with PCOS, and while this may be true for you, calories in calories it out is definitely not the whole picture.

Firstly, you don't need to be thin to conceive with PCOS. However, for those who are overweight, even modest weight loss (5-10%) can significantly improve hormone levels and help restore ovulation.2 This is because fat tissue has hormonal impacts.10 The key to tackling weight loss healthfully is understanding that PCOS makes weight loss harder due to insulin resistance – this isn't a character flaw or lack of willpower. Facts. Be kind and honest with yourself. 

Focus on health improvements rather than the number on the scale:

• Diet modifications for insulin resistance (think balanced meals with protein, healthy fats, and complex carbs).2

• Exercise recommendations that support hormone balance (both cardio and strength training), but with adequate space for rest as well.2

• Sleep prioritization: Quality sleep supports hormone balance; it’s hard to overstate the importance of sleep in hormone balance and PCOS fertility.11

Here's something many doctors don't emphasize enough: women with PCOS have 4x higher risk of sleep apnea.2 Poor sleep worsens insulin resistance and increases stress hormones like cortisol, creating a vicious cycle that makes PCOS symptoms worse.10

If you suspect you may have sleep apnea; talk to your doctor. Your body needs to breathe and sleep if you want to have a baby. 

Medications to Support Ovulation

When lifestyle changes aren’t enough, modern medicine can lend a helping hand. Many women with PCOS find that working with medications can greatly help their fertility journey. So, whether you’re a fan of drugs or more of a Natural Nancy, read on to be informed about the basics of PCOS fertility pharmacotherapy.

Letrozole: Letrozole has become a first-line drug therapy for PCOS fertility treatment, and for good reason. This aromatase inhibitor works by temporarily blocking estrogen production, which tricks your brain into releasing more follicle-stimulating hormone (FSH).2,4 More FSH = better ovulation.

Clomiphene: Clomiphene citrate is another drug therapy option for women with PCOS and anovulatory infertility. It works by blocking estrogen receptors in your brain, causing increased production of hormones that stimulate ovulation.4,5

Metformin: Metformin isn't primarily a fertility drug – it's a diabetes medication that helps with insulin resistance. For women with PCOS, metformin is considered first-line treatment for metabolic complications and is often used alongside ovulation medications. Metformin works by improving how your body uses insulin, which can help normalize hormone levels and support more regular ovulation. 2,10 

Advanced Treatment Options

Injectable Fertility Medications 

• When oral medications don't work, your doctor might recommend injectable gonadotropins (FSH and LH hormones).4

• These are more powerful than pills and require careful monitoring with blood tests and ultrasounds to prevent complications like ovarian hyperstimulation syndrome (OHSS).4

In Vitro Fertilization (IVF) 

• IVF may be necessary when other treatments haven't been successful, or if you have additional fertility factors beyond PCOS.4

• The good news? Women with PCOS often respond well to IVF due to their high number of eggs, though they require careful monitoring to prevent OHSS.4

• Success rates for IVF in women with PCOS are generally good, especially with proper protocol management to minimize complications.4

Natural Conception After Ovulation Restoration

Here's encouraging news: once ovulation returns to normal (whether through lifestyle changes, medications, or both), many women with PCOS can conceive naturally.10 The timeline varies – some women conceive within the first few ovulatory cycles, while others may take longer.

 

Factors that improve your odds include:

• Consistent treatment compliance10 

• Addressing insulin resistance if present4

• Managing stress levels8 

• Having regular monitoring with your healthcare team4

• Partner's sperm health (don't forget – it takes two!)12

Just remember, persistence often pays off. It might take trying different treatment approaches -  lifestyle, medications, fertility procedures, etc., but, with appropriate medical support, most women with PCOS who want to conceive eventually do.6 We believe in you!

Next Steps: Your PCOS Fertility Action Plan

When to See a Doctor

Don't wait the full year that's typically recommended for fertility concerns. If you have PCOS and/or irregular periods, it makes sense to seek help after 6 months of trying, or even sooner! 

Possible things to expect at your first fertility appointment:

• Complete medical history and physical exam6

• Blood tests to check hormone levels6

• Possibly imaging studies like pelvic ultrasound6

• Discussion of your treatment options6

Questions to Ask Your Healthcare Provider

• How severe is my PCOS, and what's the best first-line treatment for my situation?

• Should I be tested for insulin resistance?

• What lifestyle changes will have the biggest impact on my fertility?

• What are realistic timelines for treatment response?

• What signs should prompt me to move to more intensive treatments?

Building Your Support Team

Your PCOS fertility journey might involve several healthcare professionals:

• Reproductive endocrinologist or fertility specialist

• Your regular gynecologist

• Possibly an endocrinologist for metabolic issues

• Mental health support – fertility struggles are emotionally challenging  

Don't underestimate the importance of emotional support. Consider connecting with PCOS support groups, online communities, or counseling services. The fertility journey can be isolating, but you don't have to go through it alone. Check out the organizations below if you want to find out more:

• PCOS Awareness Association

• Resolve - the national infertility association

The Bottom Line

Having PCOS doesn't mean you can't get pregnant – it just means you might need some extra help along the way.6 With today's treatment options, many, many women with PCOS who want to conceive eventually do.7

To help improve your chances, work with knowledgeable healthcare providers, stay consistent with treatment, and maintain realistic expectations about timelines. Some women conceive quickly with first-line treatments, while others need more time and different approaches. 

Remember: every PCOS journey is unique. Your friend's experience, online stories, or even your own previous attempts don't predict what will happen next. With the right treatment plan and support team, the odds of your dream coming true are better than you might think.

Remember, the science is on your side, the treatments work, and many women with PCOS become mothers every year.3,9

There's every reason to be hopeful about your fertility journey ahead.

Ready to connect with others who understand? Join the Wholesome Story community on social media for support, encouragement, and practical tips for building meaningful connections.  Find us on Facebook, Instagram, Pinterest, and TikTok! 

In parting, remember that eating healthy, whole foods, and lots of plant foods, is one of the simplest, safest, and most effective things we can do to promote good health in our bodies. As with every preventative/restorative measure though, sometimes these changes alone are not enough to help our bodies function the way we want or need them to. If you are struggling with health problems, please contact your doctor or other healthcare provider such as a Naturopathic Doctor, Dietitian, or Mental Health Professional to see if they can offer appropriate guidance and care. We at Wholesome Story believe that healthy communities require community effort, so we advise you to keep your healthcare community aware and involved in your journey as you pursue better health.

Sources: 

1. World Health Organization. (2025). https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

2. Williams, T., et al. (2023). American Family Physician, 107(3), 264-272. https://www.aafp.org/pubs/afp/issues/2023/0300/polycystic-ovary-syndrome.html

3. Medical News Today. (n.d.). www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/312841

4. Cunha, A., & Póvoa, A. M. (2021). Porto Biomedical Journal, 6(1), e116. doi:https://doi.org/10.1097/j.pbj.0000000000000116

5. Lolla, S., et al. (2025). International Journal of Pharmaceutical Sciences, 03(01). doi:https://doi.org/10.5281/zenodo.14637872

6. Healthline. (2020). https://www.healthline.com/health/womens-health/pcos-and-fertility#pcos-and-fertility

7. Melo, A., et al. (2015). Clinics, 70(11), 765-769. doi:https://doi.org/10.6061/clinics/2015(11)09

8. Healthline. (n.d.). https://www.healthline.com/health/subfertility

9. CDC. (2024). https://www.cdc.gov/reproductive-health/infertility-faq/index.html

10. Sadeghi, H. M., et al. (2022). International Journal of Molecular Sciences, 23(2), 583. doi:https://doi.org/10.3390/ijms23020583

11. Teo, P., et al. (2022). Expert Review of Endocrinology & Metabolism, 17(4), 305-318. doi:https://doi.org/10.1080/17446651.2022.2082941

12. National Institutes of Health. (2018). http://www.nichd.nih.gov/. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/common

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