PCOS often makes ovulation irregular, which is the main reason it can affect fertility. Many people with PCOS conceive, some without treatment and others with simple first steps. Both partners should still be checked.
What PCOS is
Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions in women of reproductive age. Despite the name, it isn't really about cysts. It is a pattern of three features:
- irregular or absent ovulation, which usually shows as irregular or missed periods
- signs of higher androgen ("male-type" hormone) levels, such as excess facial or body hair, acne or thinning scalp hair, or high levels on a blood test
- ovaries with many small follicles on an ultrasound scan
Under the 2023 international PCOS guideline, a diagnosis usually needs two of those three, once other causes have been ruled out. In adults, a raised AMH blood test can be used instead of the scan. In the first eight years after periods start, scans are not used for diagnosis, because many follicles are normal at that age.
Good to know. Having polycystic-looking ovaries on a scan doesn't mean you have PCOS. Many people without the condition have them too. PCOS is also not caused by anything you did.
How it affects fertility
To conceive, an egg has to be released. With PCOS this may happen less often or unpredictably, so there are fewer chances each year and it is harder to know when they are. For most people with PCOS, ovulation is the main issue, and the uterus and tubes are usually not affected by the condition itself. Our guide to checking for ovulation explains how doctors confirm whether an egg is being released.
PCOS can happen at any body weight, including in people who are slim. In India, many people with PCOS are not overweight, and it is still worth checking.
Other health effects worth knowing
PCOS is more than a fertility question. It is linked with:
- insulin resistance, where the body needs more insulin to keep blood sugar normal, and a higher chance of type 2 diabetes
- a higher chance of diabetes in pregnancy (gestational diabetes) and high blood pressure in pregnancy
- higher rates of anxiety and depression, which deserve care in their own right
Preparing for pregnancy
The 2023 guideline suggests a few steps before trying, or before fertility treatment:
- A blood sugar check. It recommends a glucose tolerance test, a blood test before and after a sugary drink, for people with PCOS who are planning a pregnancy or treatment.
- Folic acid. Take 400 micrograms a day, or as your doctor advises.
- Blood pressure and general health. Including stopping smoking.
- Healthy eating and activity. These help everyone with PCOS, whatever their weight. For people with a higher weight, even a modest reduction may help periods and ovulation return. No single diet has been shown to work better than others, so the aim is something you can keep up, with support if you want it.
Options usually tried first
| Option | What it does | Usually involves |
|---|---|---|
| Lifestyle support | Can help ovulation return for some people | Diet, activity and sleep, with support |
| Letrozole tablets | Encourage an egg to be released; the guideline's first-choice medicine for ovulation in PCOS | Tablets for a few days early in the cycle, with scans to monitor |
| Other tablets (clomiphene, metformin) | Alternatives, alone or together, in some situations | Your doctor will explain which and why |
| Hormone injections | Stimulate the ovaries more directly | Daily injections and close monitoring |
| Keyhole surgery on the ovaries | Can help ovulation in some people when tablets haven't worked | A short operation under general anaesthetic |
| IVF | Collects eggs and fertilises them in a lab | Considered if other steps haven't worked, or if there are other factors |
People with PCOS are more likely to over-respond to injections and IVF medicines, so clinics use approaches that lower that risk. Our guide to ovulation induction explains how these medicines and scans work.
Caution. Ovulation medicines should only be taken with monitoring by a doctor. Without scans there's a higher chance of multiple pregnancy, and of the ovaries over-responding.
Supplements and remedies
You may see supplements such as inositol promoted for PCOS. The 2023 guideline treats inositol as experimental: the evidence for fertility outcomes is limited. Herbal and other remedies are not recommended as fertility treatment. If you take anything, tell your doctor, as some products can interact with medicines.
Both partners still matter
PCOS is rarely the only question. A semen analysis for the male partner, and a check of the tubes when appropriate, are usually part of the plan, especially before moving to injections or IVF.
When to see a doctor
- Your periods are very irregular, usually come more than about 35 days apart, or have stopped.
- You have been trying for 12 months (under 35) or 6 months (mid-30s and over), or sooner if your periods are irregular.
- You have PCOS and want to plan a pregnancy. You can see a doctor before you start trying.
- Low mood or anxiety is affecting daily life. Tele-MANAS offers free mental-health support 24x7: call 14416 or 1-800-891-4416.
If you are taking ovulation medicines and develop severe tummy pain or swelling, breathlessness, or are passing much less urine, contact your clinic straight away. If symptoms are severe, call 112 or go to the nearest hospital.
Sources
This is general information, not medical advice. It can't account for your history. Please talk to a doctor about your own situation. Medical disclaimer
Severe pain, heavy bleeding or fainting? Call 112 or go to the nearest hospital.