Trying to Conceive with PCOS: What You Need to Know

September is PCOS Awareness Month, and if you’re trying to conceive with polycystic ovary syndrome (PCOS), you may have already discovered how much misinformation exists online. 

PCOS affects around 1 in 10 women in the UK, yet many don’t receive a diagnosis until they start facing fertility challenges.

If you’ve been told (or read online) that “PCOS means you can’t get pregnant,” let’s stop right there. PCOS can feel like a roadblock, but the truth is many people with PCOS go on to have healthy pregnancies, sometimes naturally, sometimes with a little help. But understanding how PCOS impacts fertility is the first step to taking back control. 

In this guide, we’ll break down what PCOS actually means for your fertility, natural ways to improve your chances of conception, the most effective medical treatments, and when to seek extra support. We’ll also cover the emotional side of trying to conceive with PCOS, because it’s about much more than just biology.

TL;DR (Trying to Conceive with PCOS – Quick Summary)

• PCOS affects around 1 in 10 women in the UK, and while it can make ovulation irregular, pregnancy is still possible.
• Many people with PCOS conceive naturally, though it may take longer due to unpredictable cycles.
• Lifestyle changes like balanced nutrition, exercise, supplements, and stress management can improve the regularity of your cycles, PCOS symptoms and fertility outcomes.
• Medical treatments from ovulation induction (Clomid/Letrozole/Gonadotrophin injections) to in-vitro fertilization (IVF) may be needed to address PCOS-related fertility issues.
• Getting support early, through fertility testing, nutrition and lifestyle management and tailored care, can make a big difference.
• You are not alone, PCOS is one of the leading causes of fertility issues, but with the right support, pregnancy is absolutely possible.

What is PCOS and How Does It Affect Fertility?

Polycystic Ovary Syndrome, better known as PCOS  is one of those conditions that most of us have heard of, but few of us really understand. It’s often framed as a fertility roadblock, but the reality is more nuanced.

Around 1 in 10 women in the UK are thought to live with PCOS, though many don’t even know they have it until they start thinking about pregnancy. That’s often when the questions start: Why are my periods so irregular? Why does ovulation feel impossible to track? Is getting pregnant even an option for me?

In PCOS, a delicate hormonal relay between the brain and the ovaries gets disrupted. Instead of one egg maturing and being released each month, multiple small follicles often develop but don’t quite make it to the finish line. In some cases, the ovaries can end up looking ‘polycystic’ on an ultrasound, but they are not cysts, they are lots of tiny immature follicles.

At the same time, higher levels of androgens (so-called “male hormones”) and insulin resistance can throw the whole system off balance. The result? Ovulation might become unpredictable or stop altogether. That said, difficult does not mean impossible, ovulation can still occur in PCOS, sometimes unpredictably, and with the right intervention, it can be regulated.

What Are My Chances of Getting Pregnant with PCOS?

If you’ve Googled “Can you get pregnant naturally with PCOS?“, ” How to get pregnant with PCOS quickly” ? You’ve probably come across some pretty gloomy takes, headlines about infertility, scary statistics, forums filled with worst-case scenarios. It’s no wonder that so many people with PCOS assume pregnancy is out of reach.
The truth? Yes, you absolutely can get pregnant naturally with PCOS. It just might not follow the textbook cycle you read about in biology class.

Why Getting Pregnant Naturally Can Be Harder with PCOS

Natural conception relies on timing, you need to ovulate, sperm needs to be there at the right moment, and fertilisation has to line up. With PCOS, ovulation is often the unpredictable piece of the puzzle.

Some people with PCOS ovulate only a few times a year. Others might ovulate irregularly, one cycle at 35 days, the next at 60. That makes it harder to know when you’re ovulating, and harder to plan sex around your fertile window. But harder doesn’t mean impossible.

Studies suggest that while it may take longer, many people with PCOS conceive without medical treatment. For some, it happens once they start making small lifestyle shifts (like balancing blood sugar, exercising regularly, or addressing stress). For others, they might need medical support.

So rather than thinking of PCOS as shutting the door on pregnancy, it’s more accurate to see it as a condition that may require a different key. 

Hertili-tip: If you’ve been trying for 12 months (under 35) or 6 months (over 35) or you have irregular cycles, book a Hertility Advanced at-home hormone and fertility test to get ahead.

Step-by-Step: How to Boost Your Chances of Conceiving with PCOS

Trying to conceive with PCOS can feel overwhelming, but breaking it down into clear steps makes the journey more manageable. Think of this as a roadmap, not a rigid schedule, but a sequence of strategies that build on each other.

Pay attention to the preconception phase, the preconception phase is defined as the three months before you conceive. Why? Well, a few lifestyle changes before actively trying can make all the difference to your chances, according to the NHS. They recommend eating a healthy, balanced diet, drinking less alcohol, and exercising regularly to help prepare your body for getting pregnant. 

Step 1: Get Clear on What’s Happening in Your Body

The first step is clarity. Not every woman with irregular cycles has PCOS, and not everyone with PCOS experiences it in the same way. Getting a confirmed diagnosis through hormone blood tests and an ultrasound scan is important, because it helps rule out other conditions that can mimic PCOS. 

Once you have that clarity, the next part is understanding how your cycles work. Most cycle tracking apps assume a neat 28 – 30 day cycle, where ovulation happens like clockwork around day 14. With PCOS, ovulation may happen on day 20, day 40, or not at all in a given cycle. That means period-prediction apps often churn out inaccurate fertile windows, leaving you with a false sense of timing.

On top of that, many women with PCOS can have elevated LH (luteinising hormone). This matters because LH is the hormone most ovulation predictor kits (OPKs) are designed to measure. In PCOS, high baseline LH can trigger repeated “false positives” suggesting ovulation is imminent when, in reality, an egg isn’t being released.

Although trickier, tracking ovulation with PCOS is not impossible. It usually requires combining different approaches:

Cervical mucus monitoring: Learning to recognise the change to “egg-white” cervical mucus can help identify when your body is gearing up for ovulation.

Basal body temperature (BBT): Taking your temperature every morning can confirm when ovulation has occurred, as temperatures rise slightly after an egg is released. The downside? It only confirms ovulation after the fact and can be harder to interpret if cycles are very irregular.

Hormone testing: Blood tests can confirm whether ovulation has happened by checking progesterone levels in the second half of your cycle. At-home hormone tests, like Hertility, go one step further, showing whether ovulation is happening at all, how your reproductive hormones are behaving, and what that means for your fertility.

When to Have Sex When Trying to Get Pregnant with PCOS

Pregnancy happens when sperm meets egg during the short window around ovulation. The egg only survives for about 12–24 hours, but sperm can live inside the female reproductive tract for up to five days. This means the fertile window is roughly the five days before ovulation plus the day of ovulation itself.

For women with predictable cycles, the fertile window is easier to estimate. With PCOS, irregular ovulation makes it harder to pinpoint, which is why focusing on frequency rather than exact timing often works better.

Most fertility specialists recommend having sex every 2–3 days throughout the cycle, this way, sperm are almost always present when an egg is released, even if you can’t predict when that will happen. It also reduces the pressure of “perfect timing,” which can be emotionally draining.

If you’re tracking your cycle, you may still want to use fertile signs to guide timing:

• Cervical mucus: When you notice clear, stretchy, egg-white-like discharge, it’s a good time to have sex.
• BBT charting: A rise confirms ovulation has already happened, so use this mainly to review patterns, not to time sex in the moment.
• Ovulation predictor kits (OPKs): Be careful. With PCOS, false positives are common due to elevated LH levels, so a positive doesn’t always mean ovulation is imminent.

There’s no need to have sex every day, in fact, too much frequency can sometimes reduce sperm quality. Every other day (or every 2–3 days) is usually the sweet spot, ensuring a regular supply of healthy sperm without creating pressure. If you’re using tracking tools, use them as guides, but don’t rely on them exclusively. And above all, try to keep intimacy from becoming a chore, pressure and stress can take their own toll on fertility and relationships.

Step 2: Lifestyle Changes to Improve Fertility with PCOS

When you’re trying to conceive with PCOS, it’s easy to feel like your body isn’t playing ball. But here’s the empowering part: while we can’t cure PCOS, there’s a lot you can do to tip the odds in your favour. Small, consistent lifestyle changes can have a big impact on hormone balance, ovulation, and overall fertility.

We know weight management is a sensitive and often frustrating topic. Not every woman with PCOS struggles with weight, and not every woman with PCOS will benefit from losing it. That’s because PCOS isn’t a single condition, but a spectrum of phenotypes. For some, PCOS worsens with weight gain as it amplifies insulin resistance and androgen production, disrupting ovulation. In these cases, studies show that losing even 5–10% of body weight can restore cycles and improve the likelihood of pregnancy.

But this isn’t universal. Many those with lean PCOS, weight loss won’t help and shouldn’t be the focus. Instead, the emphasis shifts to optimising nutrition, managing insulin sensitivity, reducing inflammation, and supporting overall hormone balance.

The takeaway? Weight is one lever in PCOS management, but not the only one. The most important thing is tailoring strategies to your individual presentation of PCOS,  not applying a one-size-fits-all approach.

Nutrition: Balancing Blood Sugar, Supporting Hormones

Because insulin resistance is so common in PCOS, stabilising blood sugar is key. Spikes in insulin don’t just affect energy levels, they directly influence hormone production. Food is one of the most powerful tools for managing PCOS, what you eat and how you eat it really matters.

• Balanced meals: Aim for plates that pair carbohydrates with protein and healthy fats. Think: salmon with roasted veg and quinoa, or wholegrain toast topped with eggs and avocado or or hummus with veggies to reduce insulin surges.
• Low-GI carbohydrates approach: choosing lower-glycaemic-index carbs help steady blood sugar spikes and dips. Think: whole grains such as quinoa, beans and pulses,fruit such as berries,nuts and non- starchy vegetables such as asparagus. 
• Anti-inflammatory foods: Omega-3-rich fish, nuts, seeds, and colourful fruit and veg can support egg quality and reduce systemic inflammation.
• Opt for good quality protein sources such as beans, pulses, nuts, seeds, fish, eggs and lean poultry.  
• Don’t forget folate, vitamin D, omega-3s, and iron all support egg health and hormone function.

This isn’t about “dieting” or cutting out food groups, it’s about consistency, balance, and fueling your body for pregnancy.

Exercise: Consistency Over Intensity

You don’t need to run marathons to improve PCOS symptoms. In fact, too much intense exercise can backfire by raising cortisol (the stress hormone). Instead, think moderation:

• Strength training and resistance exercise improve insulin sensitivity and metabolic health.
• Moderate cardio like walking, swimming, or cycling supports heart health and helps regulate cycles.

The key is finding movement you actually enjoy, so it’s sustainable.

Sleep & Stress: The Overlooked Fertility Factor

When you’re not sleeping well, your body produces more cortisol, which can disrupt the delicate balance of reproductive hormones. Aim for 7–9 hours of consistent, good quality sleep. Evening screen-free time, winding down with a book or calming routine, can improve sleep hygiene.

Stress, too, is a sneaky disruptor. The mind–body connection matters. PCOS itself can be stressful, add fertility worries, and it’s a double hit. Chronic stress raises cortisol, which can throw off ovulation. Mindfulness, yoga, breathwork, or even simply scheduling downtime can help. One study found that women with PCOS who engaged in stress-reduction practices reported improved menstrual regularity alongside reduced anxiety and depression symptoms.

Supplements: Targeted Support

While supplements aren’t a magic bullet, some have been shown to help with PCOS fertility:

• Inositol (especially myo-inositol and D-chiro-inositol) may improve ovulation and insulin sensitivity.
• Vitamin D is often low in people with PCOS and plays a role in hormone regulation.
• Omega-3 fatty acids support inflammation balance and egg health.
• A high-quality folic acid or prenatal vitamin is essential for anyone trying to conceive (TTC).

Always speak with a healthcare professional before starting supplements, as needs differ from person to person.

Lifestyle changes may not feel glamorous, but they are the foundation. For many women, they are enough to restore ovulation; for others, they pave the way for medical treatments to work more effectively. The focus should be on balance and sustainability, not quick fixes or restrictive regimes. Trying to conceive with PCOS isn’t about perfection, it’s about creating the conditions your body needs to give you the best possible chance.

Step 3: Medical Options if Lifestyle Changes Aren’t Enough

Sometimes lifestyle changes alone aren’t enough to get ovulation going. That doesn’t mean the door to pregnancy is closed, it just means modern medicine can step in and give your body the nudge it needs. The good news is that PCOS is one of the most treatable causes of infertility, and success rates are high once the right plan is in place.

First-Line: Ovulation Induction

The first-line treatment for PCOS fertility is usually ovulation induction, these medications aim to coax the ovaries into releasing an egg.

• Letrozole (Femara): It works by temporarily lowering  oestrogen, which tells the brain to produce more FSH, stimulating egg growth. Studies show it often works better than older drugs like Clomifene.
• Clomifene citrate (Clomid) has been used for decades and still works well for many. It is taken orally in the early days of the cycle (usually 2nd to 6th day of the cycle) and results in ovulation in around 80% of women and a six-month successful pregnancy rate of 20 to 40%.
• Gonadotropin injections : if tablets don’t work, injectable hormones (FSH, sometimes with LH) can directly stimulate the ovaries. Because these are stronger, they require close ultrasound monitoring to avoid the risk of multiple pregnancies or overstimulation.

Metformin and Insulin-Sensitising Medications

Because PCOS often comes hand-in-hand with insulin resistance, some women are prescribed Metformin, a medication often used to treat type 2 diabetes, but it can also lower blood sugar levels in women with PCOS. As well as stimulating ovulation, encouraging regular periods and lowering the risk of miscarriage, metformin can also have other long-term health benefits, such as lowering high cholesterol levels and reducing the risk of heart disease.

Metformin isn’t a fertility drug per se, but it can be part of a wider treatment plan, particularly if weight, blood sugar, or type 2 diabetes risk is also a concern. Metformin is not licensed for treating PCOS in the UK, but because many women with PCOS have insulin resistance, it can be used “off-label” in certain circumstances to encourage fertility and control the symptoms of PCOS. It can cause an upset tummy especially diarrhoea but symptoms usually settle if tolerated for a couple of weeks and it is safe in pregnancy

GLP-1 Receptor Agonists: A New Frontier in PCOS Care

One of the newest additions to the PCOS toolkit is a class of drugs called GLP-1 receptor agonists (you might know them by brand names like Ozempic, Wegovy or Saxenda). Originally developed to treat type 2 diabetes, these medications improve insulin sensitivity, support weight loss, and help regulate appetite.

For women with PCOS, that matters because insulin resistance and weight gain are key drivers of hormonal imbalance. By addressing these, GLP-1s may help restore more regular cycles and improve the chances of ovulation.

• Early studies show GLP-1s can reduce weight, improve metabolic health, and sometimes even normalise menstrual cycles in some women with PCOS.
• They’re not officially licensed as fertility drugs, but they may be offered as part of a wider treatment plan, particularly if weight management has been difficult through lifestyle changes alone.
• For women planning pregnancy, these drugs usually need to be stopped before trying to conceive, as their safety in early pregnancy isn’t established. Instead, they’re often used to optimise metabolic health before trying to conceive (TTC) or IVF.

In other words: GLP-1s aren’t a direct fertility treatment like Letrozole or IVF, but they can play a supportive role in helping achieve a healthier lifestyle before conception”. 

it is important for them to know that a lot of people will relapse and gain weight once stopped the medication. it can also promote muscle and bone loss so regular strength training and healthy diet whilst using GLP-1 agonist is vital. 

there is emerging evidence that there are no foetal anomalies if taken in the first few weeks of a pregnancy but more research is needed, hence, to stop before conception and achieve a sustainable lifestyle without medication

IVF and ICSI: When Extra Support Is Needed

If ovulation induction doesn’t do the trick, or if there are other fertility factors at play (like sperm quality issues), in vitro fertilisation (IVF) may be recommended, though there’s one extra consideration, women with PCOS are at a higher risk of ovarian hyperstimulation syndrome (OHSS), a rare complication where the ovaries over-respond to fertility medication. Clinics are very aware of this and use tailored protocols to minimise risk.

In some cases, intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg may be recommended, especially if there are male-factor fertility issues too.

Surgical Option: Ovarian Drilling

Although less common today, laparoscopic ovarian drilling may still be offered if medications fail. A surgeon makes tiny punctures in the ovary using heat or laser, which can reduce androgen production and help restore ovulation. It can be effective, but because it’s invasive and carries risks, it’s considered a second-line option after medical therapy.

Step 4: The Emotional Impact of Trying to Conceive with PCOS

PCOS doesn’t just affect your hormones, it can take a real toll on your mental health too. The uncertainty of not knowing when (or if) you’ll ovulate, the endless cycle tracking, the pressure of timed sex, and the constant comparisons to friends who seem to “fall pregnant” overnight, all of it can weigh heavily.

Stress, Anxiety, and the Weight of Uncertainty

Studies consistently show that women with PCOS experience higher rates of anxiety and depression compared to those without the condition. One study found rates of depression to be almost three times higher in women with PCOS. The reasons are complex: the hormonal imbalances themselves can affect mood, but so can the lived reality of irregular cycles, fertility struggles, and the rollercoaster of “will this be the month?”

When ovulation is unpredictable, planning sex can feel clinical rather than intimate. Each negative test or late period can trigger fresh waves of disappointment. Over time, the cycle of hope and heartbreak creates chronic stress, which only feeds back into hormone imbalance.

Stigma and Self-Blame

PCOS also carries a layer of stigma. Symptoms can chip away at self-esteem, add fertility struggles into the mix, and many women internalise feelings of guilt or inadequacy, even though PCOS is a medical condition, not a reflection of personal failure. Social media doesn’t always help: endless pregnancy announcements, TTC hacks, and diet fads can make women feel like they’re not trying hard enough, when in reality, biology is simply more complicated.

Relationships and Intimacy

Fertility pressures don’t happen in a vacuum, they affect relationships too. The emotional burden of scheduled sex, financial strain of treatments, or repeated disappointments can create tension between partners. Some couples report that intimacy shifts from something spontaneous and joyful into something mechanical. Recognising this dynamic early, and keeping communication open, can help couples weather the storm together rather than in silence.

Finding Support That Actually Helps

The good news is: you don’t have to go through it alone. Talking openly about PCOS, whether with your partner, a close friend, or a support group can be a lifeline. Many women also find counselling helps them process the emotional side of the journey. And increasingly, clinics and digital platforms (like Hertility) are recognising that fertility care needs to be holistic, supporting mental health as much as physical health.

When to Seek Help

One of the hardest parts of trying to conceive with PCOS is knowing when to stop waiting it out and start asking for help. Fertility guidance can feel rigid, the standard NHS advice is to seek support after 12 months of trying (or 6 months if you’re over 35). But PCOS doesn’t always fit neatly into that timeline.

For women with PCOS, the story isn’t so straightforward. If your cycles are very irregular, say, going months without a period, you may not be ovulating regularly. In those cases, waiting a full year before getting checked out can feel like wasted time. Many clinicians recommend speaking to your GP sooner if:

• Your cycles are consistently longer than 35 days
• You go three months or more without a period
• You’ve been tracking ovulation but can’t find any clear fertile window
• You’re over 35 and suspect PCOS may be playing a role

Early testing doesn’t mean jumping straight to IVF, it means understanding your baseline and knowing what options are available.

Don’t Forget Partner Testing

It’s not just about you. If you’re trying to conceive with a partner, their fertility matters just as much. One of the first and simplest steps is a semen analysis, which checks sperm count, motility (movement), and morphology (shape). This is crucial because male factor accounts for roughly 50% of infertility cases.

Even if PCOS seems like the obvious explanation, overlooking your partner’s reproductive health can delay answers and waste valuable time. Scheduling a semen analysis alongside your own hormone investigations means you get the full picture from the start.

How Hertility Can Help If You Have PCOS

If you’re trying to conceive with PCOS, clarity is everything. Knowing whether you’re ovulating, how your hormones are behaving, and what support you might need can save months (or even years) of guesswork.

At Hertility, we specialise in reproductive hormone testing and personalised fertility care. With a simple at-home blood test, we can give you:

• Clear insights into your ovulation and hormone health
• Personalised reports reviewed by our in-house clinicians
• Guidance on next steps, from lifestyle changes to treatment options

Because PCOS doesn’t just affect fertility, it affects confidence too. And the sooner you understand your body, the sooner you can take back control of your fertility journey.

[Explore Hertility’s Advanced At-Home hormone and Fertility testing]

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Book online appointments with one of our registered nutritionists or dieticians. Optimise your nutrition, diet, lifestyle and get a personalised hormone and fertility nutrition plan. Our Fertility Nutritionists and dieticians can offer you personalised support to help you optimise your pre-conception health, and optimise fertility and pregnancy. Nutrition is really important in the management of PCOS and we can help you to manage your symptoms, regulate your periods and reduce your long term associated risks of PCOS.

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PCOS and Pregnancy: What to Watch Out For

Research shows that women with PCOS are more likely to experience certain complications during pregnancy compared to women without PCOS. These include:

• Gestational diabetes: Because insulin resistance is common in PCOS, there’s a higher chance of developing diabetes during pregnancy. This can affect the baby’s growth and increase the likelihood of a caesarean birth, but with screening and management, outcomes are usually excellent.
• Hypertensive disorders: Conditions such as gestational hypertension and pre-eclampsia are more common in women with PCOS. Regular blood pressure checks are vital.
• Preterm birth: PCOS is linked to a slightly increased risk of babies being born before 37 weeks.
• Miscarriage: Studies suggest miscarriage rates may be higher in women with PCOS, particularly if they also have obesity or insulin resistance.

The exact reasons aren’t fully understood, but it’s thought that a combination of insulin resistance, hormonal imbalance, and inflammation contribute.

The reassuring part is that knowing about these risks means they can be actively managed. Women with PCOS are usually offered closer monitoring during pregnancy, with extra blood tests and scans if needed. Gestational diabetes is routinely screened for around 24–28 weeks, and earlier if you have known risk factors. Lifestyle measures like a balanced diet, regular physical activity, and maintaining a healthy weight before conception, can lower the risks significantly.

FAQs: Trying to Conceive with PCOS

Can I get pregnant naturally with PCOS?

Yes. Many women with PCOS do conceive naturally, though it may take longer because ovulation is often irregular. Some people ovulate just a few times a year, while others ovulate unpredictably — making it harder to catch the fertile window. With patience, healthy lifestyle changes, and sometimes a little medical support, natural conception is possible.

What is the best treatment for PCOS infertility?

The first-line treatment is usually ovulation induction with medication such as Letrozole or Clomifene. If those don’t work, gonadotropin injections or IVF may be recommended. Metformin and, in some cases, GLP-1 receptor agonists can also support fertility by improving insulin sensitivity. The “best” option depends on your unique hormone profile and health history.

How long does it take to get pregnant with PCOS?

There’s no single answer. Some people conceive within a few months, others may take a year or longer. Because ovulation is often less frequent with PCOS, it can take longer to achieve the same chance of conception as someone with regular cycles. Seeking medical advice early can shorten the wait.

Does losing weight help with PCOS fertility?

For women with PCOS who are overweight, even a 5–10% reduction in body weight can improve hormone balance, restore ovulation, and increase the chances of conception. That said, not everyone with PCOS is overweight, and weight is only one piece of the puzzle. Nutrition, movement, stress, and sleep all matter too.

Is IVF successful for women with PCOS?

Yes. In fact, IVF success rates are often higher in women with PCOS than in those with other causes of infertility, thanks to generally good egg numbers. The main risk is ovarian hyperstimulation (OHSS), but fertility clinics use tailored protocols to minimise this.

Disclaimer

This article is for educational purposes only and should not replace medical advice. Always consult a qualified healthcare professional for diagnosis, treatment, or personalised guidance.