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PCOS and Pregnancy: What to Know If You're TTC with PCOS

Hannah Berman
Hannah Berman

PCOS and pregnancy: what’s the connection? PCOS can affect your fertility, but it doesn’t have to stop you from getting pregnant. If you're trying to conceive with PCOS, here's what you need to know.

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PCOS and pregnancy: what’s the connection? PCOS can affect your fertility, but it doesn’t have to stop you from getting pregnant. If you're trying to conceive with PCOS, here's what you need to know.

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PCOS and pregnancy: what’s the connection? PCOS can affect your fertility, but it doesn’t have to stop you from getting pregnant. If you're trying to conceive with PCOS, here's what you need to know.

Does PCOS affect your fertility? Short answer: yes. But that doesn’t mean you can’t get pregnant if you have PCOS.

Polycystic ovary syndrome (PCOS) is a condition that refers to your ovaries being filled with many cysts, or small sacs filled with fluid. This endocrine condition, which can be genetically inherited, affects at least 7% of adult women. Not everyone with PCOS develops cysts, but everyone with PCOS does struggle with menstruation. PCOS causes hormonal imbalances that throw off regular ovulation.

Because PCOS messes with ovulation, it also has an impact on fertility. If you have PCOS, you ovulate less frequently, which means that if you’re trying to conceive (TTC) it becomes harder to get lucky and happen upon a pregnancy. So, how much harder is it for someone with PCOS to get pregnant? What are some ways to boost your chances of PCOS and pregnancy?

How common is pregnancy with PCOS?

Unfortunately, many people with polycystic ovary syndrome experience infertility. Infertility isn’t a forever diagnosis; it just means that after six months of unprotected sex, you haven’t conceived yet. Infertility happens often for people with PCOS, but luckily, it is still entirely possible to conceive with this condition. Depending on what type of infertility treatment you pursue, conception rates for PCOS treatments can range anywhere from 20-60%.

A PCOS diagnosis means that you have a hormone imbalance. Usually, you have too many androgens, hormones that are more typically present in bodies assigned male at birth. The overflow of hormones can cause all sorts of side effects, like acne, excess hair growth, and trouble with regulating weight, which is related to the way your body processes insulin. It also affects ovulation—with too many androgens in your system, your body is prompted to menstruate less often.

Preparing for PCOS and pregnancy

While people with PCOS struggle more often with infertility, there’s still hope for healthy pregnancy. The first step in preparing for pregnancy with PCOS is getting a PCOS diagnosis. Many people struggle with the symptoms of PCOS for many years without getting a diagnosis, which can delay any efforts toward fertility optimization. To get diagnosed, healthcare professionals need proof of two of three things: a history of irregular cycles, cyst-like growths within your ovaries, and a hormone imbalance in your blood.

>>MORE: How Is Polycystic Ovary Syndrome (PCOS) Diagnosed?

After you’ve been diagnosed, you can start crafting your preconception plan. It’s important to work with professionals who specialize in PCOS and fertility. All of their suggestions should be geared towards correcting anovulation, or making sure an egg actually leaves the ovaries when you’re in the ovulation period.

Medical interventions and treatments

The infertility treatment options for people with PCOS are medications that are designed to induce ovulation.

Clomiphene

Clomiphene is a non-steroidal drug. With clomiphene, doctors usually start you out on a low dose for the five days after your period. If you do not ovulate after taking the smallest dose of clomiphene, you might be moved up to a larger dose.

It is usually recommended to try this for three menstrual cycles before looking at other fertility treatment options. According to a 2013 paper, clomiphene results in pregnancy 30% of the time. Drawbacks include side effects like ovarian enlargement or ovarian hyperstimulation syndrome (OHSS), and the fact that 20% of those pregnancies end with “spontaneous abortions or stillbirths.”

Antidiabetic drugs

Another option to increase fertility in people with PCOS is the use of antidiabetic drugs. Antidiabetic drugs can be used in conjunction with clomiphene or on their own, but they are more effective when used with clomiphene. Examples of these drugs include:

  • Metformin: this drug is most often used on people with PCOS trying to conceive; it is designed to manage high blood sugar levels.
  • Letrozole: a medication originally designed to help with cancer, is also sometimes used to induce ovulation. (Don’t be scared by its original use — it’s been heavily tested!)
  • Gonadotropins: usually the final medical intervention, doctors prescribe this only after trying out less intense fertility drugs like clomiphene. These fertility drugs are more effective in inducing ovulation. In one 2012 study, gonadotropins had a 58% pregnancy success rate, while clomiphene resulted in a 44% pregnancy success rate. However, gonadotropins are also more expensive to administer, so they’re not usually suggested right off the bat. (Learn how to save money when trying to conceive.)

Assisted reproductive technologies

After attempting first with medication, assisted reproductive technologies (ARTs) like intrauterine insemination (IUI) and in-vitro fertilization (IVF) can also be used to help people with PCOS conceive.

Success rates for assisted reproductive technologies vary by type of technology; factors like maternal age and genetics can also affect conception rates. Eighty-eight percent of people who used IUI become pregnant within their first three cycles, while 95.5% become pregnant after the first four. Nearly 40% of IVF egg retrievals result in live births for women under 35, with percentages declining to under 5% for women older than 42.

Can I get pregnant with PCOS naturally?

Doctors might also ask you to consider making lifestyle modifications in order to optimize your fertility. These suggestions may include changes like following a more nutrient-rich diet, or folding more regular exercise into your day-to-day life.

>>MORE: 5 Tips for a PCOS Diet, According to a Registered Dietitian Nutritionist

According to the American College of Obstetricians and Gynecologists, weight loss in people who are overweight can lower androgen, luteinizing hormone (LH), and insulin levels. These changes help regulate your menstrual cycle. With a more regular cycle, ovulation is more predictable, and conceiving can become easier.

Of course, losing weight is not a one-size-fits-all plan for conceiving. Stress reduction is also highly important when it comes to conceiving with PCOS. Some techniques for stress reduction can include talk therapy, meditation, or exercise. There are also online support groups for people with PCOS; consider checking out the resources offered by My PCOS Team, a social network designed specifically to connect people dealing with PCOS diagnoses.

PCOS and pregnancy FAQs

What else do you need to know about PCOS and pregnancy when trying to conceive? Here's what else you might need to know when trying to conceive with PCOS.

Is pregnancy with PCOS high risk?

Pregnancy with PCOS is higher risk than in people who don’t have PCOS. Pregnancy complications for people with PCOS include miscarriage or early loss of pregnancy, gestational diabetes, preeclampsia, and preterm birth. However, some doctors have found that drugs like metformin can improve pregnancy and live-birth rates for people with PCOS.

How common is pregnancy with PCOS?

PCOS is associated with higher rates of infertility and high-risk pregnancy. While research is limited on exact rates of infertility and early pregnancy loss, one study suggests people with PCOS have 15 times greater rates of infertility and three times greater risk of EPL.

Can you have a healthy pregnancy with PCOS?

Although people with PCOS have higher risk of pregnancy complications, you can definitely have a healthy pregnancy with PCOS. Be in close communication with your doctor to ensure the best prenatal plan for you.

How fast did you get pregnant with PCOS?

People with PCOS can still expect to get pregnant within a year if there are no other infertility risk factors from either partner. This is especially true if someone with PCOS has regular cycles and normal ovulation. If there are other infertility risk factors or problems with ovulation, getting pregnant with PCOS may take longer, or you may need to seek the help of a fertility specialist.

Takeaway

At the end of the day, a PCOS diagnosis is not the end of the world for you and your fertility journey. Actually, it’s an important step toward getting the help your body needs in order to have a successful pregnancy. Stay hopeful, stay focused, and you’ll find a way to have a child — PCOS may be a roadblock, but it’s not blocking the whole road.

About the author

Hannah Berman
Hannah Berman is a Brooklyn-based educator and writer with a passion for all things sex ed. She is a graduate of Wesleyan University with majors in English Theory and Literary Forms, Italian Studies, and a minor in Education Studies. You can read more of her writing at hannah-berman.com.

Sources

perimenopause-periods
Should I still see my gynecologist if my periods are just "weird" but not painful?
Yes. Annual visits remain important during perimenopause. Your provider can help determine if your "weird" periods are typical perimenopause changes or something requiring attention. They can also discuss management options to improve your quality of life.
perimenopause-periods
How long do irregular periods last before menopause?
Irregular perimenopause periods typically last 4 to 8 years before your final period, though this varies greatly. Some women experience irregularity for just a few months, while others have irregular periods for over a decade before reaching menopause.
perimenopause-periods
Is it normal to have two periods in one month during perimenopause?
Yes, this can happen, especially in early perimenopause when cycles shorten. You might have a 21 day cycle, meaning you could have a period at the beginning and end of the same calendar month. Track these patterns to distinguish between short cycles and abnormal bleeding.
perimenopause-periods
Why are my periods suddenly so heavy in my 40s?
Heavy perimenopause periods often result from estrogen dominance. When progesterone drops but estrogen remains high, your uterine lining builds up more than usual, causing heavier bleeding when it sheds. This is common in perimenopause but should be evaluated if it affects your daily life.
perimenopause-periods
Can I still get pregnant if my periods are irregular during perimenopause?
Yes. As long as you're having periods, even irregular ones, you may still be ovulating. Pregnancy is possible until you've gone 12 full months without any period. If you don't want to become pregnant, continue using contraception throughout perimenopause.
perimenopause-and-weight-gain
Can you prevent perimenopause weight gain completely?
While you may not prevent all weight changes during perimenopause, you can minimize gain through proactive strategies. Starting strength training before perimenopause, maintaining consistent sleep habits, and managing stress can help your body adapt to hormonal changes more smoothly. Remember, some body changes during this transition are normal and healthy.
perimenopause-and-weight-gain
At what age does perimenopause weight gain typically start?
Perimenopause weight gain can begin in your late 30s or early 40s, often coinciding with the first hormonal changes. Many women notice gradual changes starting 5 to 10 years before their final period. The timing varies greatly based on genetics, lifestyle, and overall health.
perimenopause-and-weight-gain
Does everyone gain the same amount during perimenopause?
No. Perimenopause weight gain varies significantly. Some women gain 5 pounds, others 20 or more, and some maintain their weight. Factors include genetics, starting weight, activity level, stress, sleep quality, and how dramatically hormones fluctuate. Your experience is unique to your body.
Is perimenopause weight gain different from regular aging weight gain?
Yes. While metabolism naturally slows with age, perimenopause weight gain has distinct characteristics. The hormonal shifts cause fat redistribution to the midsection, even if overall weight doesn't change dramatically. This abdominal weight gain pattern is specifically linked to declining estrogen and progesterone, not just aging.
perimenopause-and-weight-gain
Will the weight come off after menopause?
Perimenopause weight gain often stabilizes after menopause when hormones level out, but the weight doesn't automatically disappear. The metabolic and body composition changes that occur during perimenopause tend to persist. However, with consistent healthy habits, weight management becomes more predictable post menopause than during the fluctuating perimenopause years.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I take progesterone if I'm breastfeeding?
Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.
https://www.oova.life/blog/progesterone-supplementation-guide
Is it safe to take progesterone throughout pregnancy?
Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.
https://www.oova.life/blog/progesterone-supplementation-guide
Can progesterone supplementation cause weight gain?
Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I switch from pills to suppositories or vice versa?
Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.
https://www.oova.life/blog/progesterone-supplementation-guide
Will progesterone supplementation delay my period?
Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.
https://www.oova.life/blog/progesterone-supplementation-guide
Should I take progesterone pills orally or vaginally?
For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.
https://www.oova.life/blog/progesterone-supplementation-guide
When should I start taking progesterone after ovulation?
Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.
https://www.oova.life/blog/progesterone-supplementation-guide
What's better: progesterone cream or pills?
Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
How can I tell if I have low or high progesterone?
The only definitive way to know is through hormone testing via blood tests or at-home urine tests that measure progesterone metabolites. However, symptom patterns can provide clues: anxiety and irregular periods suggest low progesterone, while bloating and extreme fatigue suggest high progesterone.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
When during my cycle should I test progesterone levels?
Test progesterone levels during the luteal phase, typically 7 days after ovulation or around day 21 of a 28-day cycle. This is when progesterone should be at its peak, making it easier to identify if levels are too low or too high.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
What are the main differences between low and high progesterone symptoms?
Low progesterone typically causes irregular or heavy periods, anxiety, hot flashes, and sleep issues. High progesterone causes bloating, fatigue, intense breast tenderness, and depression-like mood changes. Low progesterone symptoms persist throughout your cycle, while high progesterone symptoms are most intense during the luteal phase.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
Can you have symptoms of both low and high progesterone?
Some symptoms like breast tenderness and mood changes can occur with both low and high progesterone, making it confusing. However, the timing, intensity, and accompanying symptoms differ. Hormone testing is the best way to determine which imbalance you're experiencing.
https://www.oova.life/blog/10-dpo
Can stress affect 10 DPO symptoms?
Yes, stress can worsen or mimic 10 DPO symptoms. Stress increases cortisol, which can cause cramping, fatigue, and mood changes similar to both PMS and early pregnancy. During the two-week wait, try stress-reduction techniques like gentle exercise, meditation, or spending time with loved ones.
https://www.oova.life/blog/10-dpo
Is it better to test at 10 DPO or wait?
It's better to wait until 12–14 DPO for more accurate results. Testing at 10 DPO often leads to false negatives because hCG levels may still be too low. If you absolutely can't wait, use a sensitive early detection test with first morning urine, and be prepared to retest in 2–3 days if negative.
https://www.oova.life/blog/10-dpo
What does implantation bleeding look like at 10 DPO?
Implantation bleeding at 10 DPO is typically light pink or brown, much lighter than a period, and lasts 1–2 days. It's often just spotting when you wipe or a few drops on a panty liner. However, only 15–20% of pregnant women experience implantation bleeding—most don't have any bleeding at all.
https://www.oova.life/blog/10-dpo
Why am I cramping at 10 DPO?
Cramping at 10 DPO can be caused by elevated progesterone (whether you're pregnant or not), implantation (if you're pregnant), or premenstrual cramping. Unfortunately, cramping alone can't tell you if you're pregnant since progesterone causes similar symptoms in both scenarios.
https://www.oova.life/blog/10-dpo
What are the chances of a BFP at 10 DPO?
If you're pregnant, you have about a 50–60% chance of getting a positive test at 10 DPO. This means there's a 40–50% chance of a false negative even if you conceived. Chances improve significantly by 12–14 DPO.
https://www.oova.life/blog/10-dpo
What DPO is most accurate for pregnancy testing?
14 DPO (the day of your missed period) is the most accurate time to test, with 99% accuracy. 12 DPO offers 80–90% accuracy. 10 DPO has only 50–60% accuracy. For best results, wait as long as you can—ideally until 12–14 DPO.
https://www.oova.life/blog/10-dpo
Is 10 DPO too early to test?
10 DPO is considered early for pregnancy testing. While some women get positives at 10 DPO, accuracy is only 50–60% if you're pregnant. For best results, wait until 12 DPO (80–90% accuracy) or 14 DPO/missed period (99% accuracy).
https://www.oova.life/blog/10-dpo
Can you have implantation at 10 DPO?
Yes, implantation can still occur at 10 DPO, though 84% of women have already implanted by this point. Late implantation at 10–12 DPO is normal. If implantation happens at 10 DPO, you won't get a positive pregnancy test for another 2–3 days.
https://www.oova.life/blog/10-dpo
What does a negative test at 10 DPO mean?
A negative test at 10 DPO does not mean you're not pregnant. It's very common to get negatives at 10 DPO even if you conceived. Your hCG levels may still be too low, or implantation may have occurred later. Wait until 12–14 DPO to retest for more accurate results.
https://www.oova.life/blog/10-dpo
Can you get a positive pregnancy test at 10 DPO?
Yes, but only about 50–60% of pregnant women will get a positive at 10 DPO. The other 40–50% have hCG levels that are still too low to detect. If you test negative at 10 DPO, wait 2–3 days and test again.
https://www.oova.life/blog/high-progesterone-symptoms
Can high progesterone cause weight gain?
Yes, elevated progesterone can cause temporary weight gain through water retention and bloating. This is a normal part of the luteal phase and early pregnancy.
https://www.oova.life/blog/how-to-increase-estrogen
Does stress affect estrogen levels?
Yes, chronic stress elevates cortisol, which can suppress estrogen production and disrupt hormonal balance. Stress reduction through meditation, yoga, adequate sleep, and self-care practices helps maintain optimal estrogen levels.
https://www.oova.life/blog/how-to-increase-estrogen
When should I consider medical treatment for low estrogen?
Consider medical intervention if natural methods don't improve symptoms after 3 months, if symptoms severely impact quality of life, if you're experiencing early menopause (before 40), or if you have fertility concerns. Hormone replacement therapy may be appropriate in these cases.
https://www.oova.life/blog/how-to-increase-estrogen
What are the signs that my estrogen is increasing?
Signs of rising estrogen include more regular menstrual cycles, reduced hot flashes, improved vaginal lubrication, better mood stability, increased energy, and improved skin elasticity. You may also notice reduced symptoms that originally indicated low estrogen.
https://www.oova.life/blog/how-to-increase-estrogen
Can exercise increase estrogen levels?
Yes, moderate exercise stimulates estrogen release and helps maintain hormonal balance. Aim for 150 minutes of moderate cardio weekly plus strength training twice per week. However, excessive exercise can actually lower estrogen, so balance is key.
https://www.oova.life/blog/how-to-increase-estrogen
How long does it take to increase estrogen naturally?
With consistent dietary and lifestyle changes, you may notice improvements in symptoms within 4-8 weeks. However, significant hormonal changes typically take 2-3 months. Tracking your cycle and symptoms can help you monitor progress.
https://www.oova.life/blog/how-to-increase-estrogen
What foods increase estrogen levels naturally?
Foods high in phytoestrogens can help increase estrogen naturally. The best options include flax seeds (high in lignans), soy products (tofu, tempeh, edamame), lentils, chickpeas, whole grains (oats, quinoa, brown rice), and garlic. These plant compounds mimic estrogen's effects in the body.
https://www.oova.life/blog/perimenopause
What helps relieve hot flashes quickly?
Cool environments, layered clothing, herbal teas, and medical treatments like gabapentin or HRT may help—depending on severity. Lifestyle changes like reducing caffeine and alcohol can also provide relief.
https://www.oova.life/blog/perimenopause
Are there tests to confirm perimenopause?
Yes. Tests measuring estradiol, LH, and FSH levels can indicate hormonal shifts—but diagnosis is often symptom-based since hormone levels fluctuate widely during perimenopause.
https://www.oova.life/blog/perimenopause
How do I know it's perimenopause and not something else?
A doctor may recommend hormone testing (like LH, E3G, and PdG) and track symptom timing. Diagnosis is often based on symptoms combined with age and menstrual pattern changes.
https://www.oova.life/blog/perimenopause
What's the earliest age perimenopause can start?
Some women begin experiencing symptoms as early as their mid-30s, though perimenopause typically starts between ages 38-45.
https://www.oova.life/blog/perimenopause
Does perimenopause affect mental clarity?
Yes. Brain fog and difficulty concentrating are common during hormone fluctuations in perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What happens after the last sign of perimenopause?
After your final period, you enter postmenopause. You'll need 12 consecutive months without a period to confirm menopause. Many symptoms gradually improve, though some like vaginal dryness may persist without treatment.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
When do perimenopause symptoms finally stop?
Some symptoms like brain fog improve after menopause, while others like hot flashes may continue for up to 10 years post-menopause. Vaginal symptoms often persist or worsen without treatment. Each person's timeline is different.
https://www.oova.life/blog/high-progesterone-symptoms
Is high progesterone a sign of pregnancy?
Yes, high progesterone is one of the earliest indicators of pregnancy. Progesterone levels rise significantly after conception to support the developing embryo and reach their peak during the third trimester.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Can you still get pregnant in late perimenopause?
Yes, you can still get pregnant during perimenopause as long as you're having periods, even if they're infrequent. Continue using birth control until you've gone 12 consecutive months without a period and have officially reached menopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Do symptoms get worse before perimenopause ends?
Yes, most perimenopause symptoms intensify in the final 1-2 years before menopause. Hot flashes peak around your final period, vaginal symptoms worsen, and mood changes increase. However, brain fog typically improves in late perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
How long does late perimenopause last?
Late perimenopause typically lasts 1-3 years before your final period. However, the exact duration varies significantly from person to person. You've reached menopause after 12 consecutive months without a period.
https://www.oova.life/blog/high-progesterone-symptoms
What are the symptoms of high progesterone?
High progesterone symptoms include fatigue, bloating, breast tenderness, weight gain, anxiety, depression, headaches, and food cravings. During pregnancy, you may also experience increased nipple sensitivity and muscle aches.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What are the first signs that perimenopause is ending?
The earliest signs include longer gaps between periods (60+ days), intensifying hot flashes that peak around your final period, and worsening vaginal dryness. These symptoms typically increase in late perimenopause before you reach official menopause.
https://www.oova.life/blog/high-progesterone-symptoms
When should I be concerned about high progesterone?
Consult a healthcare provider if you experience high progesterone symptoms outside your luteal phase when not pregnant, or if symptoms include severe pelvic pain, abnormal vaginal bleeding, or rapid weight gain while on hormone therapy.
https://www.oova.life/blog/high-progesterone-symptoms
How do you test progesterone levels?
Progesterone can be measured through blood tests at your doctor's office or at-home urine tests that measure PdG (a progesterone metabolite). Testing is typically done during the luteal phase, about 7 days after ovulation.

About the Oova Blog:
Our content is developed with a commitment to high editorial standards and reliability. We prioritize referencing reputable sources and sharing where our insights come from. The Oova Blog is intended for informational purposes only and is never a substitute for professional medical advice. Always consult a healthcare provider before making any health decisions.