If you have polycystic ovary syndrome (PCOS), achieving pregnancy can be a challenging journey. Yet, with the right approach to diet and exercise — alongside medical options and guidance from your care team — it’s possible for many women to realize their dream of having a baby.
Polycystic ovary syndrome (PCOS) affects the entire body through hormone imbalances and interferes with ovluation.
Diet, exercise, and weight loss may be enough to start ovulation in PCOS.
Medications may help you ovulate if dietary changes do not help your PCOS.
Some women may need fertility procedures like intrauterine insemination (IUI) or in vitro fertilization (IVF) to get pregnant with PCOS.
Pregnancies with PCOS have a higher chance of many complications and need close monitoring. Some medications can decrease the risks of complications.
Your genetics and other factors will determine what you need to get pregnant and the best ways to keep you and your baby healthy through pregnancy for a safe delivery.
Why is it hard to get pregnant if you have PCOS?
Polycystic ovary syndrome (PCOS) interferes with the hormone balance in your body. In a normal menstrual cycle, hormone levels change to trigger eggs to mature in your ovaries and be released (called ovulation) allowing pregnancy to happen. If you have PCOS, your ovaries become covered with many small tissue pockets full of fluid (or cysts) instead. The cysts have immature eggs in them, but often do not grow. You may ovulate irregularly or not at all.
The exact reason for the hormone imbalance in PCOS is not known. It might be started by insulin resistance, meaning your body needs to make more of the hormone insulin to control your blood sugar. Insulin causes the ovaries to produce more testosterone and other hormones than they should. It works like a domino effect, with one imbalance leading to more.
The pituitary gland is another hormone maker in the body and is also affected by excess hormones. Your pituitary gland makes luteinizing hormone (LH), which helps control the menstrual cycle and tells your body to ovulate. In PCOS, you have a higher, constant level of LH rather than a changing level. Because of this, PCOS also makes it difficult to track ovulation with home ovulation tests that measure LH changes.
Ways to get pregnant with PCOS
Getting pregnant with PCOS can be complicated, but there are options. You may be able to help your body ovulate through diet changes, or it may take medications. Some people may need procedures like IVF or surgery.
Diet and exercise
Insulin resistance is a big part of PCOS. You may have insulin resistance because of genetics, too much sugar in your diet, excess belly fat, lack of physical activity, or a combination of these causes.
Eating a healthy diet low in processed carbohydrates, sugar, and unhealthy and processed fats can help. Instead, try eating:
- Whole grains like brown rice and quinoa
- Healthy fats like olive oil, avocado, and salmon
- Plenty of fresh vegetables
- Lean proteins like chicken breast, fish, and eggs
Exercise can also help. Studies have shown a single session of vigorous exercise can help your cells use blood glucose 40% more efficiently afterward. If you exercise regularly, your body will not need as much insulin to use glucose, and your PCOS can improve.
Losing weight can significantly help the symptoms of PCOS. Losing 5–10% of your weight can be enough to start ovulation and regular periods.
Your doctor or a fertility specialist can help guide you in what medications to try if changing your diet, exercising, and losing weight are not enough.
Metformin. A diabetes medication that can help with blood sugar and insulin resistance. The FDA has not approved metformin for treating PCOS, but it has been widely studied and shown to help.
- Clomiphene. A medication that causes eggs to mature and be released. The American College of Obstetricians and Gynecologists recommends this medication.
- Letrozole. Another medication that can help cause ovulation. It lowers estrogen production, which allows the body to make a follicle-stimulating hormone (FSH). FSH helps your eggs mature.
- Hormones. Injectable hormones are also used in PCOS to regulate the menstrual cycle and directly trigger ovulation.
Most women can get pregnant with diet changes, exercise, and medications. Some may need more help.
- Intrauterine insemination (IUI). Specially washed sperm is placed inside the uterus with a small tube at the same time that ovulation is triggered with medication.
- In vitro Fertilization (IVF). A medical team retrieves your eggs, then fertilizes them. They transfer one to two fertilized eggs (called embryos) to the uterus.
A procedure called laparoscopic ovarian drilling (LOD) is another possible option. LOD involves putting multiple punctures in the ovary. The way this helps is unclear, but it may work by lowering the levels of some excess hormones the ovary makes. It may not be more effective than medication therapy.
Is pregnancy high-risk if you have PCOS?
Yes. Having a healthy pregnancy involves every system of your body. Because PCOS changes your whole body through hormone balance problems and insulin resistance, it can affect pregnancy in many ways. PCOS can lead to a higher chance of several pregnancy complications.
- You are three times more likely to have a miscarriage if you have PCOS. There is evidence that taking metformin might lower this risk, but the evidence is not solid.
- You are more likely to get gestational diabetes.
- You are more likely to have a baby born preterm.
- You are more likely to have a baby with macrosomia (large birth size), which can lead to other problems.
- You are more likely to need a C-section.
- You are more likely to get pregnancy-induced hypertension and preeclampsia.
When pregnant with PCOS, work closely with your healthcare team to monitor your pregnancy and baby’s health. Your doctor might recommend medications, including metformin and aspirin, to decrease the risk of some complications. Things that help with PCOS symptoms, like eating a healthy diet and exercising, can also help support a healthy pregnancy.
Can PCOS be cured naturally?
How your body responds to PCOS depends on genetics and many other factors. Changes in diet and exercise, and losing weight, can make a big difference in PCOS for some women. Others may not have the same success and may need a doctor’s help. It is important to remember that the underlying cause of your PCOS may not go away, even if your symptoms are under control. Continuing with regular exercise and a healthy diet can keep you feeling well.
Getting pregnant if you have PCOS can be difficult, but it is not impossible. It is also essential to work closely with your care team to monitor for potential problems and make your pregnancy as safe as possible for you and your baby.
- American College of Obstetricians and Gynecologists. Polycystic Ovary Syndrome (PCOS).
- UpToDate. Patient education: Polycystic ovary syndrome (PCOS) (Beyond the Basics).
- National Health System. Polycystic ovary syndrome - Causes.
- Cochrane Database of Systematic Reviews. Ovarian surgery for symptom relief in women with polycystic ovary syndrome.
- Annals of Translational Medicine. Metformin use in women with polycystic ovary syndrome.
Show all references
- Eunice Kennedy Shriver National Institute of Child Health and Human Development. Does PCOS affect pregnancy?
- New England Journal of Medicine. Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects.
- A Case-Based Guide to Clinical Endocrinology. Getting Pregnant with PCOS.
- The Journal of Clinical Endocrinology & Metabolism. Weight Loss and Lowering Androgens Predict Improvements in Health-Related Quality of Life in Women With PCOS.