Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age. It can affect menstrual cycles, ovulation, fertility, skin and hair, and long-term metabolic health.
Importantly, having PCOS does not mean that you cannot fall pregnant. With the right assessment and treatment, many women with PCOS conceive naturally or with medical assistance.
What is PCOS?
PCOS is a condition involving hormonal and metabolic changes that can affect the normal process of ovulation.
Women with PCOS may have:
- Irregular or infrequent periods
- Difficulty ovulating
- Increased levels of androgens (“male” hormones)
- Acne or oily skin
- Increased facial or body hair
- Thinning of the hair on the scalp
- Difficulty falling pregnant
Some women with PCOS may have ovaries with many small follicles on ultrasound, but the appearance of the ovaries alone does not mean that you have PCOS.
In fact, the terms PCOS and polycystic ovarian morphology (PCOM) should not be confused. PCOM describes an ultrasound appearance, whereas PCOS is a clinical diagnosis based on a combination of symptoms, signs and/or laboratory findings.
How does PCOS affect fertility?
The main reason PCOS can make it difficult to fall pregnant is irregular ovulation.
Normally, an egg develops and is released from the ovary approximately once during each menstrual cycle. In PCOS, hormonal disturbances can prevent regular ovulation.
This means that:
Irregular periods → irregular ovulation → fewer opportunities to conceive.
However, this does not mean that pregnancy is impossible. Some women with PCOS continue to ovulate occasionally and may become pregnant naturally.
Can I fall pregnant naturally with PCOS?
Yes.
Many women with PCOS become pregnant without fertility treatment.
If your periods are irregular, however, it can be difficult to know when you are ovulating. If you have been trying to conceive, an assessment can help determine whether you are ovulating and whether there are other factors affecting fertility.
What can I do to improve my chances of pregnancy?
1. Optimise your general health
A healthy lifestyle is an important part of managing PCOS.
Depending on your individual circumstances, this may include:
- Regular physical activity
- A balanced diet
- Achieving or maintaining a healthy weight
- Avoiding smoking
- Limiting excessive alcohol intake
- Taking folic acid before pregnancy
For women who are overweight, even modest weight loss may improve ovulation and metabolic health in some cases.
Importantly, PCOS occurs in women of all body sizes. Being overweight is not required to have PCOS.
2. Find out whether you are ovulating
If your periods are very irregular, your doctor may assess whether you are ovulating.
This may involve looking at your menstrual history, blood tests and, when appropriate, ultrasound monitoring.
3. Ovulation induction
If PCOS is causing irregular or absent ovulation, medication can be used to help stimulate ovulation.
Letrozole is generally recommended as the first-line medication for ovulation induction in women with PCOS who are not ovulating and have no other major infertility factors.
Treatment should be prescribed and monitored by a doctor who can determine the appropriate medication and dose for you.
4. Consider other causes of infertility
It is important not to assume that PCOS is the only reason a couple is struggling to conceive.
A fertility assessment may also consider:
- The fallopian tubes
- The uterus
- Ovarian reserve where appropriate
- Your partner’s sperm
- Other hormonal conditions
Treating PCOS alone will not overcome another significant fertility problem.
When should I see a doctor?
Consider speaking to a gynaecologist or fertility specialist if:
- Your periods are very irregular or absent
- You know or suspect that you have PCOS
- You have been trying to conceive without success
- You are unsure whether you are ovulating
- You have other symptoms such as excessive facial hair or severe acne
- You have concerns about your weight, blood sugar or cholesterol
Women with very irregular periods may benefit from an assessment earlier rather than simply waiting for a year, because irregular ovulation can already indicate a potential fertility problem.
PCOS and pregnancy
Once pregnant, women with PCOS may have an increased risk of certain pregnancy complications, including gestational diabetes and hypertensive disorders of pregnancy.
This does not mean that a pregnancy with PCOS will be complicated.
It means that appropriate antenatal care and screening are important.
If you have PCOS and become pregnant, tell your healthcare provider so that your pregnancy can be appropriately assessed and monitored.
Does having PCOS mean I need IVF?
No.
IVF is not automatically required simply because you have PCOS.
Many women with PCOS conceive after lifestyle optimisation and/or medication to help them ovulate.
Fertility treatment such as IUI or IVF may be considered when:
- Ovulation induction has not been successful
- There are additional fertility factors
- The fallopian tubes are blocked
- There is significant male-factor infertility
- Other treatments have not resulted in pregnancy
The appropriate treatment depends on the individual couple.
A final message for women with PCOS
A diagnosis of PCOS can be frightening, particularly if you are hoping to have children.
But PCOS does not mean infertility.
For many women, the main problem is irregular ovulation—and there are effective treatments available to help restore or induce ovulation.
If you have irregular periods, difficulty falling pregnant or symptoms suggestive of PCOS, a personalised assessment can help determine the best way forward.
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