PCOS and pregnancy: can you get pregnant with PCOS?

A note on the name. The NHS now calls the condition polyendocrine metabolic ovarian syndrome (PMOS), and says it used to be called polycystic ovary syndrome (PCOS) (NHS, 2026). ACOG, the US Office on Women's Health, the CDC and the 2023 international guideline still use PCOS, and it is the name most people search for, so this guide uses it. Both names describe the same condition.

PCOS is common. The 2023 international guideline puts it at 10 to 13 in 100 women worldwide (Teede et al., 2023). The US Office on Women's Health gives a lower figure, 5 to 10 in 100 women aged 15 to 44 (Office on Women's Health, 2025), and the CDC says it affects as many as 5 million women in the US (CDC, 2024). The figures differ because they use different definitions and populations.

Can you get pregnant with PCOS?

Yes. The US Office on Women's Health answers the question directly: having PCOS does not mean you cannot get pregnant, and PCOS is one of the most common but treatable causes of infertility in women (Office on Women's Health, 2025). Can women with PCOS get pregnant? They can and do, though many need help to ovulate first.

The reason is the link between PCOS and ovulation. In PCOS the hormonal imbalance interferes with the growth and release of eggs from the ovaries, and if you do not ovulate, you cannot get pregnant (Office on Women's Health, 2025). The NHS says PMOS can sometimes cause problems getting pregnant, usually because the ovaries do not release an egg each month (NHS, 2026). So can you still get pregnant with PCOS? In any cycle in which an egg is released, yes, and treatment aims to make that happen.

How PCOS affects fertility

How does PCOS affect fertility? ACOG explains it through three linked problems (ACOG, 2022):

• High androgens. When the ovaries make more of these hormones than usual, they may be prevented from releasing an egg each month.
• Insulin resistance. The body's cells do not respond normally to insulin. Medicines that help the body respond to insulin can lower androgen levels and improve ovulation.
• Irregular periods. These can lead to infertility, and in some women to many small fluid-filled sacs in the ovaries.

Not everyone with PCOS has irregular periods. Under the 2023 international guideline, PCOS is diagnosed when two of three features are present: signs of high androgens, problems with ovulation, and polycystic ovaries on ultrasound or a raised anti-Müllerian hormone level (Teede et al., 2023). The guideline also notes that ovulation problems can occur even when cycles are regular (Teede et al., 2023).

Is it hard to get pregnant with PCOS? For many people it is harder, because the link between PCOS and fertility runs through ovulation. The sources cited here do not give a single PCOS pregnancy rate or PCOS pregnancy success rate: results depend on age, weight, treatment and other fertility factors in both partners, and the figures that circulate online rarely say which group they describe. The chances of getting pregnant with PCOS are best judged with a fertility specialist who knows your history.

How to get pregnant with PCOS

Guidelines and patient sources list the PCOS fertility treatment options in a broadly similar order: lifestyle and weight first where they apply, then medicines to help you ovulate, then surgery or IVF. ACOG advises seeing a fertility specialist early if you know you have PCOS, rather than waiting the usual year (ACOG, 2023). The guide on when to see a fertility doctor sets out the timetable, and the general steps are in how to get pregnant.

Weight and lifestyle

For women who are overweight, ACOG says weight loss alone may regulate the menstrual cycle, and even a small loss may help make periods more regular (ACOG, 2022). The US Office on Women's Health gives an example: losing 10 in 100 of body weight, such as 15 pounds from 150, can help make the cycle more regular and improve the chance of getting pregnant (Office on Women's Health, 2025). The 2023 guideline asks clinicians to be aware of weight stigma and to offer care that focuses on healthy habits for people of all sizes, not only on weight loss (Teede et al., 2023).

Medicines to help you ovulate

The 2023 international guideline makes letrozole the first-line medicine to bring on ovulation in women with PCOS who do not ovulate and have no other fertility factor, and recommends it over clomiphene because it improves ovulation, pregnancy and live birth rates (Teede et al., 2023). Clomiphene can be used in preference to metformin (Teede et al., 2023). The US Office on Women's Health notes that metformin, a diabetes medicine, may help restart ovulation after a few months of use (Office on Women's Health, 2025). The guideline notes that using these medicines for ovulation is off-label in many countries, so doctors need to discuss the evidence and side effects, and that clomiphene raises the chance of a multiple pregnancy, so its cycles may need ultrasound monitoring (Teede et al., 2023).

Patient sources name the same medicines. The NHS lists clomifene, the UK spelling, as a medicine used to improve fertility (NHS, 2026), and the US Office on Women's Health says a doctor may prescribe medicine such as clomiphene after ruling out other causes of infertility in both partners (Office on Women's Health, 2025). Which medicine and what dose are decisions for your doctor; this guide does not give them.

Surgery and IVF

If other treatments have not worked, the NHS says a doctor may suggest laparoscopic ovarian drilling, which uses heat or a laser to remove tissue on the ovaries and may help them release eggs (NHS, 2026). The US Office on Women's Health notes that the surgery usually restores ovulation for only 6 to 8 months (Office on Women's Health, 2025), and ACOG says the long-term effects of surgery on the ovaries are not clear (ACOG, 2022). IVF is an option if medicine does not work; compared with medicine alone, the US Office on Women's Health says it has higher pregnancy rates and better control over the risk of twins and triplets (Office on Women's Health, 2025).

How to get pregnant with PCOS quickly depends on getting the right treatment early, which is why ACOG's advice to see a specialist early matters more than any single tip (ACOG, 2023).

Before you try: the checks guidelines recommend

The 2023 international guideline asks for three things when someone with PCOS is planning a pregnancy (Teede et al., 2023):

• a blood pressure check, because of the higher risk of high blood pressure in pregnancy
• an oral glucose tolerance test when planning a pregnancy or seeking fertility treatment, or else at the first antenatal visit, and again at 24 to 28 weeks of pregnancy
• prenatal vitamins, started alongside any treatment to bring on ovulation, as part of routine preconception care

The US Office on Women's Health adds reaching a healthy weight and healthy blood sugar levels before pregnancy, and taking folic acid, asking your doctor how much you need (Office on Women's Health, 2025). The guide to preconception health covers folic acid and the other steps before pregnancy.

Pregnancy with PCOS: the risks

The 2023 international guideline says pregnancies in women with PCOS are higher risk, and lists a higher chance of greater weight gain in pregnancy, miscarriage, gestational diabetes, high blood pressure in pregnancy and pre-eclampsia, a baby that grows less than expected or has a low birth weight, preterm birth and cesarean birth (Teede et al., 2023). It asks for PCOS to be recorded in antenatal care so that the right monitoring and support are offered (Teede et al., 2023). The US Office on Women's Health adds that babies of women with PCOS have a higher chance of being large and of spending time in neonatal intensive care (Office on Women's Health, 2025).

A 2024 meta-analysis that informed the guideline, covering 104 studies and 106,690 pregnancies, put numbers on four of these risks (Bahri Khomami et al., 2024):

An odds ratio of about 2 means the odds of that outcome were roughly twice as high as in women without PCOS. It does not mean that most pregnancies are affected; most are not. The raised odds held when women of the same age and body mass index were compared, and when the analysis kept only high-quality studies (Bahri Khomami et al., 2024). The pregnancy weight gain calculator shows the ranges recommended for weight gain in pregnancy.

Ovulation tracking with PCOS

Irregular cycles make calendar estimates of ovulation unreliable, because the next cycle's length is not known in advance. ACOG's patient guidance says that with highly irregular periods, predicting ovulation at home is not worth the time or money, and that such periods may be a sign you are not ovulating and may need medicine to help you ovulate (ACOG, 2023). Urine LH tests can also be harder to read in PCOS; the guide to ovulation predictor kits explains why. The guides to ovulation and irregular periods and irregular periods cover cycle tracking in more detail.

This guide is information, not a diagnosis or a recommendation of treatment, and it is no substitute for your own clinician. See the medical disclaimer.