PCOS and fertility: everything you need to know

PCOS, short for polycystic ovary syndrome, is a common condition related to hormones, in which the ovaries don’t always release an egg every month. It can lead to difficulty getting pregnant.

On this page

What is polycystic ovary syndrome (PCOS)?

Symptoms of PCOS

Do I have PCOS?

How is PCOS diagnosed?

How does PCOS affect ovulation?

What are the causes of PCOS?

What is the treatment for PCOS?

Is there treatment available to help me conceive?

What are my chances of getting pregnant with PCOS?

Mental health and PCOS

PCOS and pregnancy

More support

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a common condition that affects how your ovaries work. This in turn can affect your periods and hormones and make it harder to get pregnant.  It is thought to be very common, affecting about 1 in every 10 women and birthing people in the UK. 

Symptoms of PCOS

Having polycystic ovaries does not mean that you have PCOS. To be diagnosed as having PCOS you would also need to have some of the symptoms of PCOS.

These vary from person to person. Some people have very few symptoms, which are mild, while others have a wider range of more severe symptoms. Common symptoms include:

• irregular periods, or no periods at all
• an increase in facial or body hair (hirsutism)
• loss of hair on your head
• being overweight, seeing a rapid increase in weight, or finding it harder to lose weight
• oily skin, and acne
• difficulty getting pregnant (reduced fertility)
• tiny excess flaps of skin (skin tags) in the armpits or neck area
• areas of darker, thickened skin in body folds and creases (Acanthosis nigricans).

Do I have PCOS?

Many people with PCOS only have mild symptoms. They may only find out they have PCOS when they start trying for a baby.

This is especially true if they have been using hormone contraception. This is because you can still have what seem like regular periods while taking it. These false periods can be mistaken for real ones.  

The pill also contains hormones that can help ease the symptoms of PCOS, making you less likely to notice them. In fact, it is often prescribed for PCOS symptoms for people who are not trying to get pregnant, as it can improve acne and lessen excess hair growth. 

How is PCOS diagnosed?

A diagnosis of PCOS is made when you have any two of these:  

• irregular periods, or no periods at all
• a transvaginal scan showing polycystic ovaries
• an increase in facial hair or body hair  
• blood test results showing you have excess levels of testosterone.

Your GP will discuss your symptoms with you. They may do hormone tests and blood tests to find out if it is PCOS or perhaps a different condition.

Even if you’re not trying to get pregnant, if you think you have PCOS, visit your GP and ask to be referred to a gynaecologist. If you want children, it’s best to do this as soon as you can.

How does PCOS affect ovulation?

Your ovaries contain a number of sacs, or follicles, which contain eggs. In a normal menstrual cycle with ovulation a follicle grows then bursts each month, releasing an egg into one of your fallopian tubes each month.  

If you have PCOS the follicles do not grow or release eggs every month. Instead, they build up in your ovaries, and can look like lots of cysts on a scan. This is why PCOS is called polycystic (which means ‘many cysts’) ovary syndrome.

“Since my diagnosis and journey to conceive began, I have found out so many other women I know have it and have also had problems conceiving. I think a lot of us had the symptoms when we were teenagers, but went on the pill, which masked the condition for years.” 

PCOS sufferer

What are the causes of PCOS?

PCOS is thought to be caused by too much testosterone or insulin. These hormones can stop you ovulating. The exact reason why these imbalances happen is not known, but it is thought to run in families. So, if a relative had PCOS, you’re more likely to have it.

What is the treatment for PCOS?

There is no treatment for PCOS in itself, but the symptoms can be treated. If you have a BMI of over 30, you will be advised to lose weight with healthy eating and exercise. This alone will improve symptoms and may get your body ovulating.  

Regular meals and a balanced diet that has lots of foods with a low glycaemic index (a low GI diet) is best.

Lifestyle changes can also make medication for managing your symptoms work better. They will also help you plan for a healthier pregnancy.

Is there treatment available to help me conceive?

A number of medicines may be offered to help you conceive with PCOS, including:

• Clomifene citrate tablets (the best known brand in the UK is Clomid). These encourage your follicles to release eggs (ovulate).
• Metformin, which can be used to make your periods more regular. It can also correct insulin resistance, which you may have alongside PCOS, and can reduce the risk of miscarriage.
• You could take a combination of clomifene citrate and metformin.

If you are taking clomifene citrate:

• You will have a transvaginal scan in your first cycle of treatment to look at how many eggs are developing and check you’re on the right dose.
• You will not be given it for more than six months. Longer use may increase your risk of ovarian cancer.

If clomifene citrate doesn't work, then you may be offered:

• Gonadotrophins. This is another drug that helps you ovulate. Gonadotrophins may encourage too many eggs to ripen which means you’re more likely to have twins or more. You will have regular scans to check how many eggs are developing.
• Surgery called laparoscopic ovarian drilling (LOD). This kills tissue on the ovaries that produces too much testosterone.
• In vitro fertilisation (IVF). This involves retrieving one of your eggs, fertilising it outside the body, and putting it back into the uterus.

Read more about treatment for infertility.

What are my chances of getting pregnant with PCOS?

It is a good idea to see your GP as soon as possible if you have PCOS and are trying to get pregnant.

Most people with PCOS can have a baby with fertility treatment. If you’re under 35, your chances are better but even if you are older, you don’t need to give up on conceiving.

Cases vary and different treatments have different success rates, so there are no exact statistics.  

Having conversations with your GP early about fertility treatment options gives you the best chance of getting pregnant. Find out more about fertility options here. 

There are also some changes you can make yourself to get ready to conceive.

Mental health and PCOS

Finding out that you are having fertility issues can be a real shock. Feelings of guilt and even failure are not uncommon.  

It is still possible to conceive naturally if you have PCOS, and the symptoms can be treated. Plus, there are many, many people who use fertility treatment and manage to get pregnant.  

For some people, the symptoms of PCOS, and working through different treatments, can be stressful. If you have a partner, try to support each other as much as you can through the process.  

If you need mental health support, you can talk to your GP, find an NHS talking therapies service or contact a mental health or specialist PCOS charity like MIND or Verity.

“When I got diagnosed, I had to accept that conceiving a baby was going to take time, and that I needed to be kind to and patient with my body, but I would never give up hope that I would become pregnant. I spent time getting my diet right, started a couch to 5k programme, and de-stressed my life.”  

PCOS and pregnancy

PCOS in pregnancy can increase the risk of some pregnancy complications, such as high blood pressure (pregnancy-induced hypertension), pre-eclampsia, type 2 diabetes, cardiovascular disease (CVD) and preterm birth.  

This all sounds scary, but there’s still a good chance overall that you will not have each of these complications. Plus, your midwife will monitor you regularly. You will be screened for gestational diabetes by 20 weeks and your doctor will review any medication you are taking.

More support

A charity called Verity runs a special website with resources and support for everyone living with PCOS.