Short answer: Many women with polycystic ovary syndrome (PCOS) can get pregnant, though it may take help. PCOS often stops the ovaries from releasing an egg every month. Treatment usually starts with healthy habits and, when needed, a tablet that helps you ovulate. Current guidelines name letrozole as the first medicine to try for most women with PCOS.
Yes, many women do. The main problem in PCOS is usually ovulation, not the eggs themselves. When ovulation happens only now and then, there are fewer chances each year to conceive, and it is hard to know when your fertile days are.
PCOS also often comes with insulin resistance. High insulin levels can push the ovaries to make more androgens, which can further upset ovulation. That is why care often looks at blood sugar and weight as well as hormones.
General advice is to seek an infertility evaluation after 12 months of trying if you are under 35, or after 6 months if you are 35 or older. With PCOS, you do not need to wait. If your periods are irregular, far apart or missing, that is a sign you may not be ovulating, and it is reasonable to be seen before you start trying or soon after.
An evaluation usually includes:
For women with PCOS and excess weight, losing even 5 to 10% of body weight may help periods become more regular and ovulation return. Guidelines recommend healthy eating and regular activity for all women with PCOS, at any weight. There is no single "PCOS diet" proven to be better than others; the plan you can stick with matters most.
Other steps before pregnancy:
The 2023 international guideline, led by Monash University with major societies including the American Society for Reproductive Medicine, sets out a step-by-step approach.
First line: letrozole. Letrozole is a tablet taken for 5 days early in the cycle. It lowers estrogen for a short time, which prompts the brain to signal the ovary to mature an egg. In a large US trial of 750 women with PCOS, 27.5% of women on letrozole had a live birth, compared with 19.1% on clomiphene. Letrozole is FDA-approved for breast cancer, not for fertility. Using it to help ovulation is an off-label use, though it is widely used and recommended by the guideline.
Other options:
Each step is usually tried for a set number of cycles before moving to the next.
Does PCOS mean I am infertile? No. PCOS makes ovulation less regular, which can make it harder to conceive. Many women with PCOS get pregnant, some on their own and some with treatment.
Is letrozole safe for getting pregnant? The 2023 guideline found no evidence that letrozole raises the risk of birth defects compared with other ovulation medicines. It is still an off-label use, so your clinician will go over the benefits and risks with you.
Will losing weight help me get pregnant with PCOS? For many women with excess weight, losing 5 to 10% may help ovulation return. It is not required before treatment, and some women with PCOS are not overweight at all.
Do birth control pills cause PCOS or infertility? No. Birth control pills are often used to manage PCOS symptoms when you are not trying to conceive. Fertility usually returns after stopping them, though PCOS cycles may still be irregular.
Does PCOS affect pregnancy itself? Yes. It raises the risk of gestational diabetes, high blood pressure and preeclampsia. Your prenatal care team may test for diabetes earlier and watch your blood pressure closely.
If you have irregular periods or PCOS and want to plan a pregnancy, Dr. Vargas can review your history, order the right tests and talk through options, including referral to a fertility specialist when that is the right next step.
Book a visit or call (210) 903-1030 In-clinic in San Antonio • Telehealth for women located in Texas Yaso Wellness Health Clinic, 1907 Goliad Rd, San Antonio, TX 78223
Leticia Vargas, MD, OB/GYN. About Dr. Vargas
Education only, not medical advice or a diagnosis. In an emergency, call 911.
