How To Get Pregnant With PCOS: 11 Expert-Approved Tips

Polycystic ovary syndrome, or PCOS, is one of the most common causes of female infertility.

PCOS impairs ovulation [1, 2], reduces egg quality [3, 4], and makes the womb less receptive during implantation [5, 6]. Women with PCOS also tend to experience higher rates of miscarriage as a result of this syndrome [7].

Yet despite these disadvantages, it is still possible to get pregnant. It just requires a little more work.

I’ve done it, and so have thousands of other women, after completing my free 30-Day PCOS Diet Challenge.

If you want to know how to get pregnant with PCOS, then here are 11 expert-approved tips. The interventions covered range from a healthy diet to advanced reproductive technology.

1. Measure Your Metabolic Health

No one should ever feel ashamed of their weight, especially since PCOS can cause rapid weight gain. But the harsh reality is that both obesity and insulin resistance reduce fertility in PCOS women [8-10]. Because of this, your metabolic health can tell you a lot about your reproductive potential.

Obesity has many negative effects on reproductive processes. This includes reduced egg quality [11], disrupted embryo development, and impaired receptivity of the uterus [12]. For overweight women with PCOS, reducing body fat is one of the best ways to improve fertility and pregnancy outcomes [13]. Even modest weight loss of 5-10% can help [14-17] (see how to lose weight with PCOS here).

Insulin resistance is one of the primary causes of both weight gain and infertility in women with PCOS [18, 19]. This is a condition where your body becomes less sensitive to the hormone insulin. Lower insulin sensitivity causes elevated blood sugar levels. This causes body fat accumulation. But it also raises androgens, a.k.a. “male hormones.” This has a huge impact on your reproductive health. Physicians will often use fasting plasma glucose and A1C as indicators of insulin sensitivity. Monitoring these biomarkers over time can show improvements in your fertility.

Overweight women are often insulin resistant. But this diagnosis is often missed in normal-weight women with PCOS. Excess stomach fat is a common sign of insulin resistance in otherwise lean women. Having a waist-to-hip ratio higher than 0.85 is also used to assess this problem.

Hanna is a textbook case study of a lean woman with PCOS. She once suffered from insulin resistance and infertility. After realizing she had insulin resistance, Hanna made significant changes to her diet and lifestyle. By doing so, she was able to fall pregnant within a few months.

This was also my own experience after transforming my diet. Following over four years of failed fertility treatments, I was able to regulate my cycle and fall pregnant naturally.

2. Eat a PCOS-Friendly Diet

Scientists say that an unhealthy diet forms part of a “deadly quartet” of PCOS risk factors [20]. Together with insulin resistance, elevated androgen levels, and low-grade inflammation, high carbohydrate consumption causes PCOS infertility.

This is why a PCOS diet is one of the best fertility treatments. It’s not just about achieving a healthy weight. Dietary changes are often all that’s required to get pregnant too. The right diet improves insulin sensitivity and reduces inflammation. It fights all of the factors that reduce fertility in PCOS women. This can also improve other PCOS symptoms like unwanted hair, acne, anxiety, and depression. The best thing about eating for fertility though is that you can do it alongside any other treatment.

This was certainly Jamie’s experience. After participating in my free 30-Day PCOS Diet Challenge, Jamie lost weight, regulated her cycle, and soon fell pregnant.

If you want to test things out before making a 30-day commitment, this free 3-Day Meal Plan is a great place to start.

3. Consider Supplements

Certain minerals and vitamins can help with fertility. As explained in my article Vitamin D for PCOS, vitamin D supplementation is often warranted in women with PCOS. Vitamin D status impacts both fertility and pregnancy through a range of mechanisms [51-56]. Women with PCOS are also more likely to be deficient in this important nutrient. Methylated folate and iron are also among the most important supplements when trying to conceive.

Others worth considering include:

• Vitamins A, C, E, and K
• Various B vitamins, especially B6 and B12
• Calcium, iodine, magnesium, zinc, selenium, copper, and chromium

Prenatal vitamins aside, when it comes to fertility, myo-inositol is one of the most promising candidates for women with PCOS. This natural, vitamin-like sugar has a notable effect on fertility.

For women with PCOS, myo-inositol can improve ovarian function [21] and egg quality [22, 23]. During IVF trials, myo-inositol has increased the yield of mature eggs [24]. It’s improved pregnancy rates [25, 26] and reduced the risk of ovarian hyperstimulation syndrome [23]. Other studies have found that myo-inositol is better than birth control at regulating ovarian function [27]. It may also be better than metformin for boosting pregnancy rates [28].

Learn more about inositol for PCOS and fertility here.

4. Exercise Regularly

Exercise is a core component of any healthy lifestyle. It’s long been used to help people lose weight. But there’s also strong scientific evidence showing that it’s good for fertility. In overweight women with PCOS, exercise can lead to the resumption of ovulation [29]. This effect is independent of changes to your diet. Losing weight from exercise helps. But improvements in insulin sensitivity are the pivotal factor [30].

Both resistance (strength) training and aerobic activity are effective PCOS treatments [31-33]. This suggests that almost any kind of exercise is likely to be good for improving fertility.

5. Manage Your Stress

While it’s a cliché, stress can indeed play a significant role in preventing pregnancy in women with PCOS.

Studies have shown that women with PCOS produce unusually high levels of cortisol when stressed [34]. his reduces our capacity to cope. It also promotes insulin resistance and causes fat to accumulate on our stomachs and thighs [35, 36].

In a first-of-its-kind trial, US researchers found a two-fold increased risk of infertility in women that had the highest stress levels compared to those who were the least stressed [37]. This was a high-quality analysis that controlled for many confounding factors. This included age, race, income, alcohol, caffeine, and cigarette use.

Mindfulness meditation is one of the best direct stress-management tools. Similar practices like guided relaxation exercises and cognitive behavioral therapy are also helpful. Physical activity is another powerful way to reduce anxiousness [38].

Other, less direct stress management practices can help too. Referred to as “self-care” (for want of a better term), anything that helps you relax or let go of your stress can have a small but real effect.

6. Track Your Cycle

Getting pregnant is all about timing which is why tracking your menstrual cycle is so important. By monitoring changes in your basal body temperature and cervical mucus, you can know when you’re at your most fertile. Ovulation predictor kits can also be a valuable addition to your preconception toolkit.

Cycle tracking can be difficult for women with PCOS because they have irregular periods or they don’t ovulate. But a PCOS diet and other positive lifestyle changes can overcome these issues. Once your period is more regular, ovulation is more predictable.

7. Seek Fertility Treatment When Needed

For young women with PCOS, diet and lifestyle changes are often all that’s needed to restart ovulation. But these natural treatments can take between a couple of months to more than a year to work. If time is of the essence, then seeing a fertility specialist may be a good idea.

Besides male factor infertility, for women with PCOS, age is the key variable when deciding to advance to fertility treatments. Many fertility medications can help you get pregnant faster than you otherwise might.

As the figure below shows, egg quality peaks in your late twenties and then declines rapidly after your mid-thirties. This has a direct effect on your chances of getting pregnant.

Figure 1. Percentage of embryos produced by women that have the correct number of chromosomes i.e. “good quality” eggs [39].

What this means for our “natural” fertility is that for the average woman, things start to get difficult once you hit 40.

Knowing that fertility treatments can also take time, it’s important to consider how long you’ll try on your own, before seeking help.

As you enter your mid to late 40s, using donor eggs will greatly improve your chances of success. For younger women though, this shouldn’t be needed unless surgical treatments of PCOS have reduced ovarian reserves [50].

Figure 2. Changes in relative “natural” fertility rates with age from historical population data [40].

8. Skip Metformin & Birth Control

When seeking fertility treatment, it’s as important to know what not to do as it is to know which treatments are best. Metformin is a great example of this.

Metformin is still used for infertility in women with polycystic ovary syndrom. Yet, it’s one of the least effective fertility drugs. Older studies show that metformin improves menstrual frequency, ovulation, and clinical pregnancy rates. But more recent reviews of the evidence are less supportive of this approach.

A 2019 systematic review challenged the idea that metformin increases live-birth rates. The strength of the effect was found to be small, and the quality of the evidence was low. Gastrointestinal side effects from this medication are significant though [41].

There are simply better alternatives to metformin for fertility.

Even the Endocrine Society Clinical Practice Guidelines state that “…metformin is beneficial for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility” [42].

Learn more about metformin for PCOS here.

Another outdated practice is the use of hormonal birth control as a short-term PCOS preconception treatment. The idea here is that the pill suppresses the overproduction of androgens. In theory, this should then also kick-start ovulation once discontinued.

The problem with this approach is that it may do more harm than good. Preconception birth control has no benefit to your chances of ovulation. It can worsen metabolic health and may be detrimental to your fertility [43, 44]. See my PCOS birth control article for nine reasons to avoid this treatment.

9. Start with Clomid and/or Letrozole

When you need more help beyond diet and lifestyle changes, ovulation induction drugs are the obvious next step. Clomid and letrozole are the first-line therapies recommended by the World Health Organization [45]. Clomid has traditionally been the go-to first treatment. But many experts now believe that doctors should skip this step and head straight for letrozole instead. This is because letrozole results in better outcomes for women with PCOS [46-48].

Interestingly, this recommendation may soon be further updated. A randomized control trial found that clomid and letrozole used together were better than letrozole on its own [49].

In Karima’s case, Clomid + dietary change was the combination that worked for her. It was only after doubling down on the foods to avoid with PCOS that she fell pregnant on her seventh cycle.

10. Advance to Gonadotropins

If you don’t get pregnant with Clomid or letrozole, most fertility specialists will recommend injectable gonadotropins. These are used either with timed intercourse, intrauterine insemination (IUI), or in-vitro fertilization (IVF).

There are two active ingredients used in most gonadotropin products. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of the two. This includes Gonal-F, Follistim, Ovidrel, Bravelle, and Menopur. Gonadotropins can be used either on their own or in combination with oral fertility treatments like letrozole (Femara).

The biggest hazard with gonadotropins is their potential to overstimulate the ovary. This can cause ovarian hyperstimulation syndrome (OHSS). IVF egg collection is when the most gonadotropins are used, increasing the chances of OHSS. Studies show that myo-inositol can mitigate this risk [23]. But it remains important to establish the lowest effective gonadotropin dose required.

11. Add in IUI or IVF if Needed

Intrauterine insemination (IUI) is a type of artificial insemination that’s used to treat infertility. Sperm is first washed and concentrated. It’s then placed into the uterus with the hope that it’ll swim up into the fallopian tube to fertilize a waiting egg. This can be done with a “normal” cycle or after ovulation induction.

IUI is a limited procedure that still relies on the sperm and egg to do a lot of the “work.” By comparison, during in-vitro fertilization (IVF), every step of the process is controlled and monitored.

IVF starts with ovulation induction. But unlike natural conception or IUI, IVF uses a lot more gonadotropins. The goal is to mature and collect 12 – 20 eggs for fertilization in the lab.

Fertilization can occur by introducing the sperm into the same petri dish as the egg. Alternatively, one lucky sperm can be injected into the egg. This process is known as intracytoplasmic sperm injection (ICSI). ICSI is an optional technology. It increases fertilization rates and helps overcome male infertility.

Once the eggs are fertilized, they’re then grown for a few days under controlled lab conditions. After they’ve matured, these fertilized embryos can be placed back into the uterus as a “fresh embryo transfer.” They can also be cryogenically preserved for later use.

Somewhat ironically, women with PCOS may have an advantage over other women when it comes to IVF. This may be because PCOS women have higher ovarian reserve than age-matched controls. A higher ovarian reserve produces more embryos during IVF. This allows for more cycles which leads to better cumulative birth rates [57, 58].

In non-PCOS women, success rates go down significantly with age. But a 2011 study found that birth rates held stable between 22 and 41 years old in IVF patients with PCOS [59]. A similar study found that peak fertility was maintained until 38 years of age using IVF [60]. Others have found that PCOS women over 40 years have comparable success rates to those aged 35 to 40.

Just when you thought that it was all bad news!

The Bottom Line

Women with PCOS face a lot of extra obstacles when it comes to starting and growing their families. But that doesn’t mean it’s impossible with PCOS. You just need to work harder at it.

Diet and lifestyle changes can address the underlying root causes of PCOS. If required, assisted reproductive technologies also have outstanding success rates.

Whichever path you choose to go down, if you’re trying to conceive with PCOS, make sure to include diet and lifestyle changes as a core part of your fertility plan. You can get started today with this free 3-Day Meal Plan. Or sign-up for my free 30-Day PCOS Diet Challenge.

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