PCOS and Fertility: How to Get Pregnant

Most women with PCOS who want a baby will have one. I lead with that because so many arrive in my clinic convinced the diagnosis means infertility. It doesn't. PCOS is one of the most common reasons conceiving takes longer — and one of the most treatable things I see.

The PCOS fertility myths worth dropping

Let me clear away the fears first, because they shape everything that follows.

• "PCOS means I'm infertile." No. It usually means ovulation needs a little help — not that pregnancy is off the table.
• "I'll need IVF." Rarely. Most women conceive with far simpler steps. IVF is the top of the ladder, not the first rung.
• "I've run out of eggs." Often the opposite. PCOS affects how eggs are released, not how many you have, and the egg count is frequently high.
• "It's my fault, because of my weight." It isn't a moral failing. PCOS makes weight genuinely harder to manage, and we work with that, not against you.

Keep those in mind. They reframe the rest.

Why PCOS makes conceiving harder

It comes down to ovulation. In a regular cycle, an ovary releases an egg about once a month. With PCOS, that rhythm breaks down — eggs are released unpredictably, or not at all. And you cannot conceive in a month when you do not ovulate. That single fact explains why long or absent periods come up again and again in the women I see.

Behind it sits a hormonal loop. Many women with PCOS have some insulin resistance, so the body makes more insulin to keep blood sugar steady. That extra insulin nudges the ovaries to produce more testosterone. The raised testosterone then interferes with the monthly maturing and release of an egg. Round it goes. It is why the metabolic side of PCOS and the fertility side are so tightly linked — and why treating one often helps the other.

Getting the diagnosis right first

It is worth being sure the label is correct, because PCOS is over-diagnosed in some women and missed in others. Doctors use the Rotterdam criteria: you need two of three features — irregular or absent ovulation, signs of raised male hormones (on a blood test or physically, such as acne or unwanted hair), and a particular look to the ovaries on a scan. Other conditions, like thyroid trouble, have to be ruled out. For the fuller picture I have written separately about the wider symptoms of PCOS, and ongoing specialist PCOS care is something I offer directly.

How to improve your chances: the treatment ladder

Treatment climbs a ladder. We start gentle, and only go further if we need to. In practice it looks like this:

• Confirm whether you are actually ovulating.
• Treat the metabolic side — including modest weight loss if that applies to you.
• If needed, tablets to encourage ovulation.
• Specialist help only if those do not work.
• And, importantly, do not sit and wait a year if your cycles are very irregular.

Metabolic health first

For women carrying extra weight, losing five to ten per cent of body weight can be enough to restart regular ovulation on its own. That is a small change with a big effect. I am careful how I put this, because the last thing anyone needs is to feel blamed — but the evidence is solid, and for some women it is all that is required to conceive naturally. Regular exercise and steadier eating help the hormones as much as the scales. For some, a functional-medicine approach to insulin resistance adds something useful alongside standard care.

One caution on the newer weight drugs: GLP-1 medications can help with weight and insulin resistance, but they are not safe in pregnancy or while trying to conceive, and must be stopped well beforehand — at least a couple of months before you start trying. Plan that timing with your doctor.

Ovulation induction: letrozole first

When lifestyle alone is not enough, the next rung is a tablet to prompt ovulation. The advice here has shifted, and not every clinic has caught up. The current international PCOS guidance now puts letrozole first, ahead of the older drug clomifene. In head-to-head studies it led to more live births and fewer twins. Treatment is monitored, usually with a scan, to check the ovaries respond sensibly. Metformin is sometimes added.

When more is needed

If tablets do not work, the options are hormone injections under close monitoring, a small procedure on the ovaries, or IVF. Most women never get this far. But it helps to know the ladder keeps going.

The emotional side of trying with PCOS

There is a part of this that rarely makes it onto medical pages. Trying to conceive with PCOS can be quietly exhausting — the uncertainty, the waiting, the sense that your body is not cooperating. Low mood and anxiety are common, and they are not a weakness. I mention it because it matters as much as the hormones, and because naming it usually helps. You are allowed to find this hard.

When to seek help, and not to wait too long

The usual rule is to seek advice after twelve months of trying, or six months if you are over thirty-five. With PCOS I would not wait the full year if your periods are very irregular or absent — that is a clear sign you may not be ovulating, and there is little to gain from hoping. Coming in earlier lets us check your ovulation, your egg reserve and your partner's side before time slips away. If you are right at the start, my guide to the first steps when trying to conceive is a good place to begin.

Seeing a French-speaking specialist in London

For French-speaking women in London, all of this can feel doubly isolating — a complicated hormonal story to untangle, in a second language, inside a health system that works differently from home. I trained in France and practise here. So we can talk it through in French, I can explain how the UK pathway actually works, and nothing gets lost in translation when the details matter most.

PCOS is a long-term condition. But where fertility is concerned, it is one of the more hopeful diagnoses I give. With the right steps, in the right order, most women get the outcome they came in for.