PCOS and Fertility: Current Approaches to Enhancing Conception Outcomes

How PCOS affects fertility — and what can help

Polycystic Ovary Syndrome (PCOS) is a common hormonal condition that can affect ovulation, making it harder to conceive. While it may contribute to fertility challenges, it doesn’t rule out pregnancy. With the right clinical support, many women with PCOS are able to conceive — either naturally or through assisted approaches.

Timely diagnosis, a personalised management plan, and lifestyle modifications can significantly improve reproductive outcomes. Understanding your hormonal rhythms and working closely with a healthcare provider plays a vital role in navigating this journey.

How PCOS Affects Fertility?

The core fertility challenge in PCOS stems from anovulation, or lack of ovulation. Normally, a mature egg is released during the menstrual cycle. But in PCOS, hormonal imbalances — particularly elevated androgens and insulin resistance — disrupt this cycle.

Common issues that affect fertility in PCOS:

Irregular or absent ovulation
Poor egg quality due to chronic inflammation or oxidative stress
Imbalanced LH:FSH ratio
Uterine lining thickening (endometrial hyperplasia)
Weight-related hormonal disruption
Higher miscarriage risk due to insulin resistance or progesterone issues (1)

Diagnostic Workup: First Step Toward Conception

Before choosing a fertility strategy, a complete diagnostic workup is crucial. Your doctor may assess:

Ovulation status: through LH surge testing, ultrasound, or progesterone levels
Ovarian reserve: AMH (Anti-Müllerian Hormone) blood test
Thyroid and prolactin: to rule out secondary causes of infertility
Insulin resistance: fasting insulin or HOMA-IR
Semen analysis: to assess male partner’s fertility status
Tubal patency: through HSG or saline infusion sonogram

A personalised treatment plan follows this evaluation.

First-Line Fertility Interventions for PCOS

1. Lifestyle Optimisation

For overweight women with PCOS, even 5–10% weight loss can restore ovulation and improve pregnancy outcomes (2). Focus on:

Regular meals with low glycaemic index foods
Daily movement: 30–45 mins walking, yoga, or resistance training
Consistent sleep and reduced screen time
Stress management (to lower cortisol that affects ovulation)

2. Ovulation Induction (OI)

Your doctor may suggest hormonal support therapies to help stimulate egg release, especially if you’re not ovulating regularly. These are typically prescribed in phases — starting with oral agents, and if needed, progressing to advanced injectable options. Regular monitoring is essential to ensure safety and optimise timing.

Complementary Approaches

1. Inositol Supplementation

Myo-inositol and D-chiro-inositol are natural compounds that improve insulin sensitivity, restore ovulation, and reduce androgen levels in women with PCOS.

2. Antioxidants

Vitamin D, Coenzyme Q10, and Omega-3 fatty acids may improve egg quality and endometrial receptivity.

Always consult a doctor before starting any supplementation.

Can You Correct PCOS to Improve Fertility?

While PCOS can’t be fully corrected, it can be managed effectively. A personalised strategy combining medical treatment, lifestyle change, and hormone tracking can optimise your chances of conception — especially if started early.

Correcting PCOS isn’t about eliminating the condition but regaining hormonal balance and ovulation.

References

Frequently Asked Questions (FAQs): PCOS and Fertility

1. Can PCOS cause infertility?

Yes, PCOS is a common cause of infertility due to irregular or absent ovulation (3). However, many women conceive naturally or with minimal treatment.

2. What is the first step if I want to get pregnant with PCOS?

Consult a gynaecologist or reproductive endocrinologist. A fertility workup will guide whether you need ovulation induction, IUI, or IVF.

3. Is IVF the only option for PCOS-related infertility?

No. In many cases, conception is achieved through initial lifestyle interventions and oral hormonal support prescribed by a fertility specialist. Advanced techniques like IVF are considered only when simpler, first-line approaches are not effective. The right treatment depends on individual hormonal patterns, ovulation status, and age — and should always be guided by a qualified doctor.

4. Does weight loss improve fertility in PCOS?

Yes, even 5–10% weight reduction can significantly improve hormonal balance and ovulation rates (2).

5. How long should I try naturally before seeking help?

If you're under 35 and have been trying to conceive for over 12 months, or over 35 and trying for more than 6 months, it's advisable to consult a fertility specialist. For women in their late 30s or 40s, earlier evaluation may be recommended, as age can significantly affect egg quality and treatment timelines.