Polycystic ovary syndrome (PCOS) affects approximately 6–20% of women of reproductive age worldwide, making it one of the most common endocrine disorders in this group1 . Women with PCOS face a higher risk of infertility and pregnancy complications, including miscarriage, gestational diabetes, and preeclampsia2 . However, with appropriate lifestyle changes and medical management, many women with PCOS can successfully conceive and have healthy pregnancies3 .
Can You Get Pregnant if You Have PCOS?
PCOS is characterized by hormonal imbalances such as hyperandrogenism (elevated male hormones) and oligo-anovulation (infrequent or absent ovulation), which can impair fertility2 . While PCOS increases the risk of early pregnancy loss by about threefold compared to women without the condition, most women with PCOS can conceive naturally or with medical assistance4 .
Pregnancy in women with PCOS carries additional risks beyond fertility challenges. These include gestational diabetes, preeclampsia, preterm birth, and delivering infants who are small for gestational age2 . Obesity and insulin resistance, common in PCOS, further increase these risks5 . The severity of pregnancy complications also varies by PCOS phenotype, with hyperandrogenic subtypes linked to higher risks of gestational diabetes and preeclampsia6 .
Despite these challenges, many women with PCOS achieve pregnancy through a combination of lifestyle modifications and medical treatments tailored to their individual needs3 . Early preconception care and prenatal monitoring are essential to optimize outcomes7 .
Lifestyle Changes To Improve Fertility
Lifestyle modifications are foundational in managing PCOS-related infertility and improving pregnancy outcomes. These changes primarily target weight management, insulin sensitivity, and overall metabolic health5 .
Maintain a Healthy Weight
Obesity is more prevalent in women with PCOS and significantly worsens hormonal imbalances and insulin resistance1 . Even modest weight loss of 5–10% can restore ovulation and improve fertility8 . Achieving a healthy body mass index (BMI) before conception reduces the risk of pregnancy complications such as gestational diabetes and hypertensive disorders5 .
Women with PCOS should aim for a BMI within the normal range (18.5–24.9 kg/m²) to optimize reproductive health8 . Excess gestational weight gain during pregnancy should also be avoided, as it may exacerbate risks for both mother and baby5 .
Exercise
Regular physical activity improves insulin sensitivity and helps regulate menstrual cycles in women with PCOS5 . Exercise contributes to weight management and cardiovascular health, reducing the risk of metabolic syndrome and type 2 diabetes1 . Consistent moderate exercise is recommended as part of a comprehensive lifestyle approach to enhance fertility and pregnancy outcomes5 .
Diet and Nutrition
A balanced diet rich in whole foods, fruits, vegetables, lean proteins, and whole grains supports weight management and metabolic health8 . Dietary interventions that improve insulin sensitivity can help regulate ovulation and reduce androgen levels5 . Women with PCOS are encouraged to limit processed foods and added sugars to manage blood glucose levels effectively8 .
Dietitians can provide personalized nutrition plans to address individual needs and improve fertility8 .
Medical Treatments To Promote Pregnancy
When lifestyle changes alone do not restore fertility, medical treatments are available to induce ovulation and support conception in women with PCOS9 .
Ovulation-Inducing Medication
Clomiphene citrate is the most common first-line medication for inducing ovulation in women with PCOS-related infertility9 . It works by stimulating the release of hormones that promote egg maturation and ovulation. Clomiphene is FDA-approved for this use and has been shown to increase ovulation rates, although it carries a slightly increased risk of multiple pregnancies, typically twins9 .
Letrozole, an aromatase inhibitor, is increasingly used as an alternative to clomiphene. It temporarily lowers estrogen production, leading to increased follicle-stimulating hormone (FSH) release and ovulation9 . Studies indicate that letrozole may be more effective than clomiphene in improving live birth rates in PCOS9 . However, its use for fertility is off-label, and animal studies suggest potential risks if used during pregnancy, so timing and monitoring are critical9 .
Gonadotropins
Gonadotropins are injectable hormones used to stimulate ovulation when oral medications are ineffective9 . They require close monitoring with ultrasounds and blood tests due to a higher risk of ovarian hyperstimulation and multiple pregnancies9 . Gonadotropins are typically reserved for women who do not respond to first-line treatments9 .
Metformin
Metformin is an insulin-sensitizing agent commonly used in PCOS to improve metabolic parameters9 . It can be used alone or combined with clomiphene to enhance ovulation9 . While metformin improves ovulation rates, evidence suggests it does not significantly increase pregnancy rates when used alone9 .
Metformin is considered safe during preconception and pregnancy and may reduce the risk of preterm birth in women with PCOS, although it does not prevent gestational diabetes5 . It also supports weight management and reduces cardiometabolic risks5 .
Surgery
Laparoscopic ovarian drilling (LOD) is a surgical option for women with PCOS who do not respond to medical treatments9 . This minimally invasive procedure uses heat or laser to destroy androgen-producing ovarian tissue, which may restore ovulation8 .
LOD may lower androgen levels and improve hormonal balance but does not address metabolic issues and carries risks such as ovarian scarring9 . It is generally considered when lifestyle and medications have failed9 .
“Letrozole is considered the first‐line pharmacological treatment for anovulatory infertility in PCOS. An individualized approach should be considered in the management of pregnancy in PCOS.”
— Bahri Khomami et al. 5
Assisted Reproduction
If other treatments fail, assisted reproductive technologies (ART) such as in vitro fertilization (IVF) may be recommended9 . IVF involves fertilizing eggs outside the body and transferring embryos to the uterus. It offers the highest chance of pregnancy for women with PCOS but carries risks of multiple pregnancies and requires careful monitoring9 .
ART should be considered after thorough discussion of risks, benefits, and individual circumstances9 .
