PCOS and Fertility: What to Know When You're Trying to Conceive

Polycystic ovary syndrome (PCOS) is one of the most common reasons ovulation becomes irregular, and it’s often the first thing people worry about when conception takes time. The good news is that PCOS is also one of the most treatable — here’s what you actually need to know.

What is PCOS and why does it affect fertility?

PCOS is a hormonal condition that affects roughly 1 in 10 people with ovaries. It causes the ovaries to produce higher-than-usual levels of androgens (sometimes called “male hormones”), which disrupts the normal cycle of egg development and release.

In a typical cycle, one follicle matures and releases an egg. With PCOS, several small follicles start to develop but often don’t complete that process — so ovulation either happens less often or not at all. No ovulation means no egg available to fertilise, which is why irregular or absent periods are the main fertility challenge with PCOS.

Common signs include:

• Irregular periods — cycles that vary widely in length, or periods that are missing for months at a time.
• Extra hair growth on the face, chin, or body.
• Acne or oily skin, especially on the face, chest, or back.
• Small cysts on the ovaries, seen on an ultrasound (these are actually the undeveloped follicles).

Not everyone with PCOS has all of these. Some people find out they have it only when they start trying to conceive.

How does PCOS affect your chances of getting pregnant?

The short answer: it can take longer, but pregnancy is very much possible. PCOS is the most common cause of ovulatory infertility, and it is also one of the most responsive to treatment.

Many people with PCOS do conceive naturally, especially when ovulation is irregular rather than completely absent. Others benefit from lifestyle changes or medication that helps ovulation happen more reliably. The key is knowing where you stand — which means tracking your cycle and talking to your doctor sooner rather than later.

Our ovulation calculator can help you spot a pattern in your cycle, even when it’s irregular. If your cycles vary a lot, tracking over several months gives your doctor useful information.

Does PCOS mean I can’t get pregnant?

What lifestyle changes actually help?

This is the part you have the most control over, and the evidence here is encouraging:

Eating in a way that keeps blood sugar steady matters more with PCOS than with many other conditions, because insulin resistance is common in PCOS and can worsen the hormonal imbalance. You don’t need a special diet — just a pattern that avoids big blood-sugar spikes:

• Plenty of vegetables, whole grains (oats, brown rice, quinoa), legumes, and fruit.
• Lean protein and healthy fats at most meals.
• Less ultra-processed food, refined flour, and sugary drinks.

Regular moderate exercise — even a 30-minute walk most days — helps lower insulin and improve ovulation frequency.

Weight and PCOS: if you’re above a comfortable weight for your body, even a 5–10% reduction can be enough to restart more regular ovulation in some people. This isn’t about hitting a target number — it’s a genuine physiological lever that can make a noticeable difference. That said, people at any weight have PCOS, and weight loss is not a cure or a requirement.

For more on the lifestyle habits that support fertility in general, see Lifestyle Habits That Support Fertility.

Are there medications to help with PCOS and ovulation?

Yes — and they work well for most people. Your doctor may suggest:

• Letrozole or clomiphene: these are the most commonly used first-line medications to trigger ovulation. Letrozole is now often preferred for PCOS because it tends to produce more predictable results. They’re taken at certain points in your cycle and monitored with ultrasound or blood tests.
• Metformin: originally a diabetes medication, metformin lowers insulin levels, which can help restart ovulation on its own or make ovulation-stimulating drugs work better.
• Injectable gonadotropins or IVF: for cases where simpler options haven’t worked, a fertility specialist can offer more targeted treatment.

Most people with PCOS who want to get pregnant and seek medical help will find a treatment that works for them. This is a manageable condition.

How can I track ovulation with PCOS?

Standard ovulation predictor kits (OPKs) can be misleading with PCOS, because the condition raises LH levels even when ovulation isn’t happening — which can cause false positive results. A few strategies that work better:

• Basal body temperature (BBT) charting: tracking your temperature every morning and looking for a sustained rise confirms that ovulation actually happened. For a full guide, see How to Track Ovulation.
• Ultrasound monitoring: if you’re working with a doctor, they may use ultrasound to directly observe follicle growth and confirm ovulation — more reliable than any urine test.
• Progesterone blood test: done 7 days after a suspected ovulation, this confirms whether it actually occurred.

When should I see a doctor?

You don’t need to wait the full 12 months that’s usually suggested before seeking help, because PCOS is a known factor that warrants earlier attention:

• If your periods are very irregular (more than 35 days apart) or absent, see your doctor now — regardless of how long you’ve been trying.
• If you’ve been trying for 6 months without success and suspect PCOS, book an appointment.
• If you already have a PCOS diagnosis, it’s worth discussing fertility before you start trying, so you have a plan.

Your family doctor or gynaecologist can confirm the diagnosis, check your hormones, and either start treatment or refer you to a fertility specialist.

Related reading

• How to Track Ovulation (BBT, OPKs & Cervical Mucus)
• Lifestyle Habits That Support Fertility

This article is for general information only and is not medical advice. Always follow your healthcare provider’s guidance.