How does PCOS affect fertility and pregnancy? 

If you have PCOS, a healthy lifestyle, for example, a balanced diet and physical activity, can improve your chances of becoming pregnant.

Your doctor might suggest you make lifestyle changes before starting any other form of treatment.

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

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).

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

You may notice different symptoms of ovulation. For example:

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

Learn more about periods and ovulation

Some herbalists prescribe a combination of peony and liquorice to improve fertility in women with PCOS. It’s thought that this formula helps convert testosterone to oestrogen. But more research is needed in this area.

There have been some studies into the use of black cohosh (a herbal medicine) to treat fertility problems in women with PCOS. But more research is needed to better understand its effectiveness.

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

Injections or tablets, for example, letrozole or clomiphene citrate, 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 body mass index (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.

If you don’t ovulate, and other reasons for infertility have been ruled out, your doctor may recommend metformin.

Metformin can be combined with other medicines, for example, clomiphene citrate, to improve outcomes.

Metformin is not recommended for women who are 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 can result in multiple pregnancies or ovarian hyperstimulation syndrome.

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

Surgery is usually only recommended after other lifestyle changes and medical treatments have been unsuccessful.

Laparoscopic ovarian surgery

Laparoscopic ovarian surgery 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 belly (abdomen), under general anaesthetic. Small holes are made in the surface of the ovary to remove tissue that produces excessive amounts of androgens (hormones involved with the development of male characteristics, for example, facial hair). After surgery, ovulation is often restored for up to 12 months.

This surgery may cause scar tissue around the ovaries and damage to the bladder, bowel or blood vessels. Talk to your doctor about the benefits and risks of this surgery.

Bariatric surgery

Bariatric surgery may be an option if lifestyle changes and other weight-loss treatments haven’t 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.

Ask your doctor if bariatric surgery may be an option for you.

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

It’s important to understand the costs and emotional impact of this treatment before making a decision.

IVF is more successful in women who have made lifestyle changes and are a healthy weight before they begin treatment.