PCOS and Trying to Conceive
Yes, you can get pregnant with PCOS. Here's how to optimize your chances.
Key Takeaways
- PCOS is common: Affects 1 in 10 women of reproductive age
- Pregnancy is possible: Most women with PCOS can conceive with proper management
- The challenge: Irregular or absent ovulation is the main fertility barrier
- Solutions exist: Lifestyle changes, medication, and fertility treatments can help
What Is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder affecting approximately 10% of women of reproductive age. It's the most common cause of ovulatory infertility—but the good news is that it's also one of the most treatable.
PCOS is characterized by a combination of:
- Irregular or absent periods (indicating irregular or no ovulation)
- Elevated androgens (male hormones) causing acne, excess hair growth, or hair thinning
- Polycystic ovaries on ultrasound (multiple small follicles that don't mature properly)
You don't need all three to be diagnosed—typically, having two of these criteria indicates PCOS.
🔬 What's Actually Happening
In PCOS, the ovaries produce excess androgens, which interfere with follicle development. Instead of one follicle maturing and releasing an egg each month, multiple follicles start developing but get "stuck"—hence the polycystic appearance. This leads to irregular or absent ovulation.
How PCOS Affects Fertility
The primary fertility challenge with PCOS is anovulation—not ovulating regularly (or at all). Without ovulation, there's no egg to fertilize.
The Hormonal Cascade
PCOS involves several hormonal imbalances:
- High LH-to-FSH ratio: LH is often chronically elevated, which can cause OPKs to show false positives
- Elevated androgens: Testosterone and DHEA-S interfere with follicle maturation
- Insulin resistance: Present in 50-70% of PCOS cases; high insulin stimulates androgen production
- Low progesterone: Without ovulation, progesterone stays low, leading to irregular periods
But Here's the Good News
PCOS doesn't mean you can't ovulate—it means you don't ovulate predictably. Many women with PCOS do ovulate, just less frequently. And with proper management, ovulation can often be induced or regulated.
📊 The Statistics Are Encouraging
Studies show that with treatment, 70-80% of women with PCOS who want to conceive will successfully become pregnant. The key is working with your healthcare provider to find the right approach for you.
Lifestyle Strategies
Lifestyle modifications are often the first-line treatment for PCOS—and they can be remarkably effective, especially if insulin resistance is a factor.
1. Weight Management
For women with PCOS who are overweight, losing just 5-10% of body weight can:
- Restore ovulation in many cases
- Improve insulin sensitivity
- Lower androgen levels
- Increase pregnancy rates—even without other treatments
This doesn't mean you need to reach a "perfect" weight. Even modest weight loss can significantly improve fertility outcomes.
2. Low-Glycemic Diet
Because insulin resistance drives much of PCOS, eating in a way that keeps blood sugar stable can help:
- Choose complex carbs over refined (whole grains, legumes, vegetables)
- Pair carbs with protein and healthy fats to slow glucose absorption
- Limit sugar and processed foods
- Focus on fiber-rich foods
Some women do well with lower-carb approaches, but this isn't necessary for everyone. Work with a dietitian if possible.
3. Regular Exercise
Exercise improves insulin sensitivity independently of weight loss. Aim for:
- 150+ minutes of moderate activity per week
- A combination of cardio and strength training
- Consistency over intensity—regular moderate exercise beats occasional intense workouts
4. Stress Management
Chronic stress elevates cortisol, which can worsen hormonal imbalances. Consider:
- Mindfulness or meditation
- Yoga (which has specific evidence for PCOS)
- Adequate sleep (7-9 hours)
- Therapy or support groups for TTC stress
Tracking Ovulation with PCOS
Standard ovulation tracking can be tricky with PCOS. Here's what you need to know:
OPKs: Proceed with Caution
Many women with PCOS have chronically elevated LH, which can cause OPKs to show positive (or near-positive) results throughout the cycle. This makes them less reliable for predicting ovulation.
Solutions:
- Use OPKs that measure actual hormone levels (like Mira or Inito) rather than threshold-based strips
- Look for a significant change/surge rather than just a positive result
- Combine with other tracking methods for confirmation
BBT Charting: More Reliable
Basal body temperature tracking works well for PCOS because it confirms ovulation after the fact. You'll see a clear temperature shift when ovulation actually occurs, regardless of what your LH is doing.
The downside: it tells you ovulation happened, not that it's about to happen. But over several cycles, you'll learn your patterns.
Cervical Mucus: Helpful Context
Egg-white cervical mucus (EWCM) indicates rising estrogen and approaching ovulation. With PCOS, you may see multiple patches of EWCM as your body gears up for ovulation multiple times before finally succeeding.
Ultrasound Monitoring
The most accurate method is ultrasound monitoring with your doctor, which can track follicle development and confirm ovulation. This is especially useful when using fertility medications.
Mira Fertility Analyzer
Measures actual LH concentrations (not just threshold), making it more useful for PCOS. Also tracks estrogen and progesterone to confirm ovulation occurred. Expensive but valuable for complex cycles.
Medical Treatments
If lifestyle changes aren't enough to restore regular ovulation, your doctor may recommend medication. Here are the common options:
| Treatment | How It Works | Success Rate |
|---|---|---|
| Letrozole (Femara) | Lowers estrogen, prompting FSH release to stimulate ovulation | ~60-80% ovulation rate; often first-line for PCOS |
| Clomid (Clomiphene) | Blocks estrogen receptors, triggering FSH release | ~50-80% ovulation rate; traditional first-line |
| Metformin | Improves insulin sensitivity, which can restore ovulation | May help ~30-50% ovulate; often used with other meds |
| Gonadotropins (Injectable FSH) | Directly stimulates follicle growth | Higher success but requires careful monitoring |
| IVF | Eggs retrieved and fertilized in lab | High success rates; used when other methods fail |
Letrozole vs Clomid for PCOS
Recent research shows Letrozole may be more effective than Clomid for PCOS. A major study found higher ovulation rates, higher pregnancy rates, and higher live birth rates with Letrozole. Many reproductive endocrinologists now use it as first-line treatment.
⚠️ Important: Multiple Pregnancy Risk
Ovulation-inducing medications can cause multiple eggs to be released, increasing the risk of twins or higher-order multiples. This is why monitoring (blood tests and ultrasounds) is recommended during treatment cycles.
Ovarian Drilling
For women who don't respond to medication, laparoscopic ovarian drilling is a surgical option. Small holes are made in the ovaries to reduce androgen production. It can restore ovulation for 6-12 months and is sometimes used before IVF.
Supplements That May Help
Some supplements have evidence for improving PCOS symptoms and fertility. Always discuss with your doctor before starting.
Inositol (Myo-Inositol + D-Chiro-Inositol)
Inositol improves insulin sensitivity and may help restore ovulation. The combination of myo-inositol and D-chiro-inositol (40:1 ratio) has the most research support. Often called "nature's Metformin."
Vitamin D
Many women with PCOS are vitamin D deficient, and supplementation may improve insulin resistance and ovulation. Get your levels tested and supplement if deficient.
Omega-3 Fatty Acids
May help with inflammation and insulin resistance. Choose a high-quality fish oil or algae-based option.
Other Potentially Helpful Supplements
- Berberine: May work similarly to Metformin for insulin sensitivity
- NAC (N-Acetyl Cysteine): Antioxidant that may improve ovulation
- Spearmint tea: May help reduce androgens
- CoQ10: Supports egg quality
The Bottom Line
PCOS is the most common cause of ovulatory infertility, but it's also one of the most treatable. With the right combination of lifestyle changes, tracking methods, and medical support, most women with PCOS can conceive.
Work with your healthcare provider to develop a personalized plan. Be patient—PCOS often requires more time and intervention, but success rates are high. You've got this. 💚