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PCOS and Getting Pregnant: Top tips for fertility
Polycystic ovary syndrome is a common condition that affects one in five women. PCOS can make it harder to get pregnant, but if you’ve been told you have it, then you’ll be pleased to know that you can still conceive with treatment. Zoya Ali, Research Associate at Hertility Health, shares the facts on PCOS.
By Zoya Ali BSc MSc | Last updated Dec 13, 2021
Although polycystic ovary syndrome (PCOS) affects around 1 in 10 women and people with ovaries in the UK, many people don’t get diagnosed until they are struggling to get pregnant. Wondering what the signs associated with PCOS might be and how it can impact your ability to conceive? Read on for our in-depth guide to getting pregnant with PCOS.
What is PCOS?
PCOS is a common condition that causes an imbalance of hormones, especially testosterone. It’s also one of the most common causes of fertility issues in women.
Did you know? Although androgens are often called ‘male hormones,’ don’t let the name fool you. These are important hormones found in people of all biological sexes.
How can PCOS affect fertility?
A common symptom of PCOS is irregular or absent periods, which are due to problems with ovulation. Ovulation is the process during which a mature egg is released from the ovary, which happens around the middle of your cycle.
PCOS can cause ovulation to become less frequent and unpredictable, which may make it more tricky to conceive. If ovulation doesn’t occur, there’s no egg awaiting fertilisation.
Most people with PCOS also have polycystic ovaries. But don’t be fooled by their name! These aren’t actually cysts, but just many follicles growing together. Follicles are the little sacs that house immature eggs in the ovaries.
An imbalance between the levels of two other important hormones, follicle-stimulating hormone (FSH) necessary for the development of the immature follicles and luteinising hormone (LH) necessary to trigger ovulation, means that the eggs do not mature properly. This not only causes the polycystic appearance, but can also cause irregular ovulation.
Irregular ovulation will often result in irregular periods, where cycles are more than 35 days apart but less than six months apart, or amenorrhea, where someone may experience no periods for six to 12 months.
But even though ovulation might be unpredictable in people with PCOS, it can still happen, which is why it’s important to always use a suitable method of contraception to protect yourself and plan your pregnancy at your own pace.
Sometimes hormonal contraception in the form of contraceptive pills are prescribed to help manage PCOS symptoms. Hormonal contraception works by suppressing ovulation, and it might take some time after coming off it for you to start ovulating again. However, some people may get pregnant right after coming off contraception.
Did you know? You can get your period even though you may not have ovulated during that cycle. It’s called an anovulatory cycle. Anovulatory infertility is a common symptom of PCOS.
Will PCOS stop me from conceiving naturally?
Being diagnosed with PCOS doesn’t necessarily mean that you’ll face issues with your fertility. Many people with PCOS will get pregnant without any fertility treatment. However, others might need to explore fertility treatment options.
Although someone with PCOS may be more likely to need the support of fertility treatments than someone without, research shows that they both appear to have a similar number of pregnancies and children.
Tips for getting pregnant if you have PCOS
While getting pregnant with PCOS is certainly possible, it can be more difficult for some. Here are some top tips to help you on your fertility journey:
1. Understand your menstrual cycle: In particular, how frequent and regular it is. This is the first important step to take when it comes to fertility and understanding your condition. If you think you might be experiencing irregular cycles, it’s important to figure out what the underlying cause is. PCOS is a common reason for irregular cycles, but there are other common causes such as a thyroid hormone imbalance, stress, diet and lifestyle choices, and medication .
2. Cycle tracking: Irregular ovulation and changing cycle lengths can make it tough to determine your fertile window (which is usually around the middle of the month in people with regular periods), and timing sex for the middle of your cycle may not always coincide with ovulation, causing you to miss your optimum conception time. The best way to determine if and when you are ovulating is by tracking these signs.
Hertili-tip! After tracking your cycles for around three months, if you notice any irregularities we recommend taking a hormone and fertility test to help give you an insight into the inner workings of your cycle. The NHS recommends seeking advice if your cycles occur more often than 21 days or less often than every 35 days, especially if you are trying to conceive.
3. Maintain a healthy weight: Ensuring your weight is within a healthy range can increase your chance of spontaneous ovulation and regular periods.
Talking with your GP can help you to determine your ideal goal weight and the steps you can take to achieve it. Doctors often use Body Mass Index (BMI) as a reference to determine your ideal weight (you can check your BMI here). A normal BMI range falls between 19 and 25.
For someone with a BMI of 30 or over, NICE guidelines state that losing 5 to 10% of your weight is likely to increase your chance of conception. According to the NHS, it’s losing as little as 5%.
On the other hand, if you have a BMI of less than 19, it’s advised that you increase your weight to improve your chances of conception.
It’s also important to maintain a healthy weight before you conceive because PCOS can result in increased weight gain during pregnancy..
Being overweight before, and gaining excess weight during, pregnancy are both associated with an increased risk of pregnancy-related complications such as gestational diabetes and preeclampsia.
4. Eat a healthy balanced diet and regularly exercise: Although it’s commonly the first line of advice suggested by medical professionals, weight loss with PCOS is not always easy. This is where having a holistic approach is important, which can be achieved by eating a healthy balanced diet and incorporating exercise into your daily routine.
You should tailor your diet to your food preferences and keep it flexible. Avoid an unnecessarily restrictive or nutritionally unbalanced diet and focus on what nutrients you can add rather than overhauling your choices completely.
A Mediterranean style diet rich in whole grains, high-fibre fruit and vegetables, healthy fats from nuts, seeds and extra virgin olive oil, and good protein sources such as oily fish and lean proteins can help to improve PCOS symptoms.
You could also consider switching out carbohydrates with a high glycemic index (GI), such as white bread, cakes, pastries, white pasta and white rice (which can easily spike your blood sugar levels), for low GI foods such as some fruit and vegetables, pulses and whole-grain foods such as porridge oats.
5. Work on balancing your blood sugars: Limit your intake of sugary processed snacks and drinks, and try swapping them for healthier alternatives such as fruits and nuts. Combining protein with carbohydrates can slow the absorption and lessen any blood sugar spike. Think fruit with natural yoghurt or an apple with almond butter.
6. Manage stress levels: Excessive stress can negatively impact your fertility and overall health and can also cause irregular menstrual cycles.
PCOS is associated with an increased risk of developing mental health conditions such as depression and anxiety. A new diagnosis or experiencing fertility issues can unknowingly impact your emotional wellbeing, so it’s important to put yourself and your needs first,
If possible, try to cut down on your stress levels or try self-help measures to cope with stress, such as meditation, exercising and journaling. Adopting a healthy sleep schedule and planning to get at least eight hours of sleep can also help with stress and mood.
However, if these feelings do not go away or start interfering with your daily life, it’s important to remember that you don’t need to suffer in silence. If you find your self-help measures are not helping you cope, consider seeking advice from a mental health professional as your pathway to support.
Hertility has a specialised fertility counsellor care pathway that can help you navigate the emotional aspects of your diagnosis and fertility journey.
If you’re actively trying to conceive, taking care of your preconception health is very important to make sure you and your baby are healthy during and after pregnancy. Want to know more about the steps you should take to optimise your health before trying to conceive? Read more here.
Hertili-tip! If you’ve been actively trying to conceive for 12 months if you are under the age of 35, or for six months if you are over 35, it’s advised to consult a fertility specialist to understand what the underlying cause of the delay in getting pregnant might be.
They will advise on an early scan to check everything is where it should be and then treat it as a regular pregnancy.
Can medications for PCOS help me to get pregnant?
In some cases, making simple but effective lifestyle changes are enough to help people with PCOS conceive naturally. However, for others, lifestyle modifications might need a little helping hand from modern-day medicines and technology. Some commonly used medicines and supplements include:
Clomid: This is one of the most popular brands of clomifene citrate used in the UK - this helps to stimulate the ovaries to release eggs. The treatment is termed 'ovulation induction’ for those experiencing irregular ovulation due to PCOS.
Read more about the use of Clomid for PCOS
Metformin: Metformin is often prescribed to regulate blood glucose and insulin levels in order to manage insulin resistance.
Insulin resistance is when the body doesn’t respond to normal insulin levels - insulin is a hormone which regulates the amount of sugar in your blood. The body starts producing excess levels of insulin to compensate for this, which can impact the functioning of the ovaries and cause irregular ovulation. So regulating blood sugar levels and reducing insulin resistance can help to improve fertility for people with PCOS.
Metformin has also been found to have additional benefits, including weight management, lowering the risk of miscarriage, lowering high cholesterol levels and reducing the risk of heart disease.
Read more about the use of metformin for PCOS
Letrozole: This sometimes used as an alternative to clomid. It generally blocks oestrogen production and is FDA-approved as a treatment for breast cancer.
While it’s not yet FDA-approved for ovulation induction, clinicians use it for treatment in those with PCOS if they think the benefits of treatment outweigh any associated risks.
Gonadotrophins: Gonadotrophins are an injectable form of fertility drugs. It might be suggested for those who have tried treatment with the above medications as first-line therapy but were unsuccessful.
Inositol: This is a non-prescription dietary supplement that’s often recommended in online PCOS support communities. Although some small studies have shown it might increase the likelihood of ovulation, the evidence is limited and is based on the use of inositol combined with other therapeutic options.
Further research is required to fully understand its effect. However, because the side effects are minimal, clinicians sometimes recommend it for treatment in those with PCOS if they think the benefits of treatment outweigh any associated risks. You should always consult with a doctor before considering any supplements.
Vitamin D supplements: Vitamin D supplementation has been found to help improve insulin resistance and testosterone levels. Vitamin D deficiency has been linked to a poorer response to ovarian stimulation during fertility treatment, however further research is required to understand its role. You should always consult with a doctor before considering any supplements.
Can fertility treatments help if I have PCOS?
For some who come up against some challenges on their PCOS and fertility journey, fertility treatments might be a route they are suggested.
IUI: Intrauterine insemination is a fertility treatment in which sperm is transferred into the uterus using a device called a catheter. It’s usually recommended in combination with medications to stimulate ovulation.
IVF: In vitro fertilisation is a fertility treatment that involves taking medication to stimulate the ovaries to produce multiple eggs. These are then retrieved and fertilised in a lab with sperm to form embryos.
Laparoscopic ovarian drilling: This is a surgical procedure that uses heat or a laser to destroy the cells on the ovaries that produce androgen hormones, such as testosterone. It’s carried out under general anaesthetic. A small cut is made to the lower abdomen through which a thin microscope is passed so doctors can look inside your body.
One thing to note for our PCOS community is that people with PCOS who opt for fertility treatment are at a higher risk of developing a rare complication called ovarian hyperstimulation syndrome (OHSS), which is an exaggerated response to fertility drugs. It can lead to abdominal pain, nausea and vomiting, rapid weight gain and blood clots. It’s therefore important to keep an eye on all the symptoms you experience during your treatment cycle and contact your fertility clinic if something doesn’t feel right.
PCOS is also associated with increased risk of underlying health conditions such as obesity, diabetes and cardiovascular disease. So it’s very important to work closely with your doctor to help keep these things under control before you try to conceive.
My doctor prescribed me a higher dose of metformin when I got pregnant because of the risk of miscarriage. The increased risk is very low. The biggest challenge is getting pregnant – so I wouldn't panic.
Can PCOS affect my pregnancy?
In most cases, people with PCOS will have an uncomplicated vaginal delivery. However, the pregnancy complications which occur more frequently in people with PCOS (and not PCOS itself) are known to increase the likelihood of needing a caesarean section (C-section).
PCOS has also been associated with an increased risk of pregnancy-related complications such as miscarriage or early pregnancy loss, preeclampsia, pregnancy-induced high blood pressure, gestational diabetes and preterm birth (delivering before 37 weeks of pregnancy), all of which can impact you and your baby’s health.
This is why it’s essential to work closely with your midwife and obstetrician to help support you and your baby stay healthy through your pregnancy.
The result of my successful pregnancy is currently one day old and sleeping on my chest. I had a very easy pregnancy with no problems and a very easy birth too.
If you’re experiencing PCOS symptoms, want to understand what an existing PCOS diagnosis means for you, or are planning your fertility journey, Hertility is here to guide you. The Hertility Health PCOS journey includes a comprehensive hormone test, digital personalised results, access to highly-rated PCOS experts and clinics, nutritional advice and symptom management, educational content and a community of care. We are here to support you through your PCOS journey so that you can take control of your health.