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Fertility and pregnancy

Many women with polycystic ovary syndrome (PCOS) have children naturally, but some need medical help to get pregnant. Learn how to improve your chances of becoming pregnant and ways to reduce potential risks during pregnancy.

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PCOS can affect ovulation (when an egg is released from an ovary). The ovaries produce an egg each month. When the egg is mature, it’s released from the ovary and pushed down the fallopian tube so it can be fertilised.

With PCOS, high levels of androgens (male-type hormones) and insulin can affect the menstrual cycle and lead to irregular ovulation – or ovulation may stop altogether.

The increased levels of androgens in the ovaries can stop follicles from developing and eggs from being released from the ovaries. The under-developed eggs stay in the ovaries. It’s okay to have some under-developed eggs in your ovaries, but too many can make it hard to get pregnant.

Fertility can be affected by other factors, so it’s important to investigate causes with your doctor. They may refer you to a fertility specialist and other healthcare professionals, for example, a counsellor or psychologist, if needed.

Natural ways to improve fertility

Healthy lifestyle

A healthy lifestyle (i.e. balanced diet and physical activity) can improve your chances of becoming pregnant. For women with PCOS who have a higher weight, a 5% to 10% weight loss can help restore regular ovulation and greatly improve their chances of becoming pregnant.

Your doctor might suggest you make lifestyle changes before starting any other form of treatment. Evidence shows that fertility treatments are more effective when you have a healthy lifestyle.

If you have a healthy weight, it will also reduce the risk of complications during pregnancy.

Having children earlier

If you are diagnosed with PCOS and you want to have children (or more children), it’s recommended you try to conceive as early as possible. This way, you can try different fertility treatment options before age-related infertility begins to increase (at about the age of 35).

Keeping track of your ovulation

To improve your chance of becoming pregnant, you can keep track of your ovulation. If you find a pattern of ovulation, try to have sexual intercourse around that time each month.

You may notice different signs and symptoms of ovulation.

For example:

  • mucus changes – your vaginal mucus becomes slick and slippery
  • abdominal pain – you may feel pain across your abdomen or on one side
  • premenstrual symptoms – such as sore breasts, abdominal bloating and moodiness.

Medical help to improve fertility

Ovulation induction

If you have problems with fertility after making lifestyle changes, your doctor may recommend ovulation induction treatments.

Injections or tablets (e.g. letrozole, clomiphene citrate or Clomid) may be used to stimulate the ovaries to increase egg production. Talk to your doctor about the best medicines for you. Ultrasounds and blood tests are performed to determine the best time to trigger ovulation.

Once ovulation has been triggered, semen (sperm) is introduced either by sexual intercourse or inter-uterine insemination (IUI). IUI is when collected semen is placed directly into the uterus through the cervix.

Ovulation induction is not recommended for women with PCOS who have a BMI greater than 35. Learn how to measure your BMI.

Not all women with PCOS are responsive to these treatments and some might need a combination of medicines to improve outcomes.


Your doctor may recommend metformin if you don’t ovulate and other reasons for infertility have not been found.

Metformin reduces insulin resistance and the production of androgens (testosterone) in the ovaries. This can improve how the ovaries work and may re-establish regular periods.

Metformin can be combined with other medicines (e.g. clomiphene citrate) to improve outcomes.

Metformin has some side effects, such as nausea, abdominal bloating and loss of appetite. But Metformin can be taken at lower doses or at night to reduce the severity of the side effects.

Metformin is not recommended for women who become pregnant, but there may be medical reasons to continue using it. Ask your doctor if metformin is right for you.


Gonadotrophins are hormones that stimulate the growth and release of eggs. They are usually used when women with PCOS haven’t had success with other medicines such as clomiphene citrate or metformin.

Your doctor will carefully regulate the dosage, as these hormones may result in multiple pregnancies or ovarian hyperstimulation syndrome.

Fallopian tube assessment

Your doctor may recommend you have a fallopian tube assessment to see if blocked or damaged fallopian tubes are causing infertility. This may be done before starting fertility treatment or after trying different treatments.

Surgery to improve fertility

Women with PCOS may choose to have surgery to improve their fertility. Surgery is usually only recommended after other lifestyle and medical treatments have been unsuccessful.

Laparoscopic ovarian surgery

Laparoscopic ovarian surgery (ovarian drilling) is a surgical procedure that can improve the function of the ovaries and increase or restore ovulation.

This surgery is performed using a laparoscope (a small telescope-like instrument). The laparoscope is inserted via an incision in the abdomen (under general anaesthetic). Small holes are drilled in the surface of the ovary to remove tissue that produces excessive amounts of androgens. After surgery, ovulation is often restored for up to 12 months.

Side effects associated with ovarian drilling include a small risk of scar tissue around the ovaries and damage to the bladder, bowel or blood vessels.

Bariatric surgery

The option of bariatric surgery may be explored if lifestyle changes and other weight-loss treatments have not helped to improve your fertility. This surgery reduces the size of your stomach, so you feel full after eating small amounts of food.

Bariatric surgery is not a quick option for improving fertility, as your weight needs to be stable for longer than 12 months after the surgery before you try to get pregnant.

Talk to your doctor about the benefits, risks and costs involved with surgery.

Assisted reproductive technology

Women with PCOS might consider assisted reproductive technology such as in vitro fertilisation (IVF) if other treatments have been unsuccessful.

IVF can be costly and demanding. This technology is more successful in women who have made lifestyle changes and are a healthy weight before they begin treatment.


If you have PCOS, it’s important to discuss pregnancy planning with your doctor. Women with PCOS may need extra care before, during and after pregnancy. For example, you might need to have your blood pressure monitored or have a diabetes test before becoming pregnant.

PCOS can increase the risk of complications during pregnancy.

For example:

  • early miscarriage
  • diabetes during pregnancy (gestational diabetes) – due to insulin resistance
  • high blood pressure
  • high blood pressure (preeclampsia)
  • premature delivery
  • caesarean delivery.

Some women with PCOS may also develop type 2 diabetes after pregnancy.

You can reduce these risks with regular health checks and by taking extra care during your pregnancy.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at May 2023.

This con­tent has been reviewed by a group of med­ical sub­ject mat­ter experts, in accor­dance with Jean Hailes pol­i­cy.

Goodman NF, Cobin RH, Futterwelt W, Glueck JS, Legro RS, Carmina E et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: guide to the best practises in the evaluation and treatment of polycystic ovary syndrome – part 1. Endocr Pract. 2015 Nov;21(11) 1291–300.
Monash University. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. 2018. Melbourne, Australia.
Joham AE, Boyle JA, Ranasinha S, Zoungas S, Teede HJ. Contraception use and pregnancy outcomes in women with polycystic ovary syndrome: data from the Australian Longitudinal Study on Women's Health. Hum Reprod. 2014 Apr;29(4):802–8. doi: 10.1093/humrep/deu020. Epub 2014 Feb 18.
Last updated: 
07 December 2023
Last reviewed: 
29 May 2023

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