This post was updated on February 17th, 2023
By Kym Campbell, BSc. | Updated February 17th, 2023
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 get pregnant with PCOS, then here are 11 science-based strategies that help. The interventions covered range from simple dietary changes to advanced reproductive technology.
1. Measure Your Metabolic Health
No one should ever feel ashamed of their weight. But the harsh reality is that both obesity and insulin resistance reduce fertility in women with PCOS [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 means that it can tell us a lot about our reproductive health. Physicians will often use fasting plasma glucose and A1C as indicators of insulin sensitivity. For women wanting to conceive, changes to these biomarkers can be monitored for progress over time.
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 contributes to infertility and poor metabolic health.
This is why a PCOS diet is one of the best fertility treatments. Dietary changes are often all that’s required to achieve a healthy, successful pregnancy. This is especially true if you’re overweight or insulin resistant. By improving insulin sensitivity and reducing inflammation, the right diet resolves both of these fertility-reducing factors. 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 has been shown to 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 may be more effective 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
You might know it already, but there’s strong scientific evidence showing that exercise is 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. Improvements in insulin sensitivity are the pivotal factor. The mechanism is different though from that which comes about through diet [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 a more regular period is achieved, ovulation becomes a lot more predictable.
7. Get Medical Help When Needed
For young women with PCOS, diet and lifestyle changes are often all that is 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 seeking fertility treatment may be warranted.
Besides male factor infertility, for women with PCOS, age is the key variable when deciding to advance to fertility treatments.
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 just 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 commonly used for infertility in women with PCOS, yet, it’s not an effective treatment. Older studies that show metformin improves menstrual frequency, ovulation, and clinical pregnancy rates. But more recent reviews of the evidence are less supportive of this approach.
A 2019 Cochrane database 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’s been shown to 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 has been shown to result 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 seven foods to avoid for PCOS that she fell pregnant on her seventh cycle.
10. Advance to Gonadotropins
If Clomid or letrozole fails to achieve pregnancy, most fertility specialists will recommend the use of injectable gonadotropin products. These are used either with timed intercourse, intrauterine insemination (IUI), or in-vitro fertilization (IVF).
Follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of the two, are the active ingredients in the most commonly used gonadotropin brands. This includes products such as 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 over-stimulate 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 and 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. This enables more embryos to be produced 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 next free 30-Day PCOS Diet Challenge.
Author
Since 2010, Kym Campbell has used evidence-based diet and lifestyle interventions to manage her PCOS. After getting her symptoms under control and falling pregnant naturally, Kym now advocates for dietary change as part of any PCOS treatment plan. Combining rigorous science and clinical advice with a pragmatic approach to habit change, Kym is on a mission to show other women how to take back control of their health and fertility. Read more about Kym and her team here.
Co-Authors
This blog post has been critically reviewed to ensure accurate interpretation and presentation of the scientific literature by Dr. Jessica A McCoy, Ph.D. Dr McCoy has a master’s degree in cellular and molecular biology, and a doctorate in reproductive biology and environmental health. She currently serves as a University professor at the College of Charleston, South Carolina.
This blog post has also been medically reviewed and approved by Dr. Sarah Lee, M.D. Dr. Lee is a board-certified Physician practicing with Intermountain Healthcare in Utah. She obtained a Bachelor of Science in Biology from the University of Texas at Austin before earning her Doctor of Medicine from UT Health San Antonio.
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