Remedies

Can You Get Pregnant with PCOS? My Personal Story After 4 Pregnancies

A personal account of my pregnancy journey with PCOS.

When I was first diagnosed with PCOS (polycystic ovary syndrome) 17 years ago, the gynecologist warned me not to put off having a baby for too long. 

I sat in the consulting room, a tangle of confusion and fear: I was 24 years old at the time and in no shape to start a family. Fast forward, and at the time of writing this, I’m eight months pregnant with my fourth child. 

Living with PCOS can feel like you’re being robbed of your reproductive agency. And it took me some trial and error to understand how to manage my PCOS. This is what I learned. 

Why does PCOS affect fertility?

PCOS interferes with ovulation, and that’s the key reason why it affects fertility. What this means is that an egg isn’t released during every cycle. 

In a typical cycle, the pituitary gland releases follicle-stimulating hormone (FSH), which triggers follicle growth in the ovary. As a follicle matures, it produces oestrogen, which eventually triggers a surge of luteinising hormone (LH), causing the egg to be released.

In PCOS, this process is disrupted. Insulin resistance is present in 44–75% of women with PCOS. When cells don't respond properly to insulin, the pancreas produces more of it, and that excess insulin stimulates the ovaries to produce more androgens. Higher androgens then interfere with follicle development and suppress ovulation.

Irregular cycles are the visible result of this hormonal disruption. Cycles may be very long (60, 90, even 120 days), very short, or absent entirely. The practical consequence for conception is that the fertile window, approximately six days around ovulation, becomes difficult to identify. 

According to the Office on Women's Health, PCOS is one of the most common causes of infertility in women, accounting for approximately 80% of cases of anovulatory infertility. More than once, I didn’t even realise I was pregnant because my cycles were so irregular. 

Can you get pregnant with PCOS?

Yes, although PCOS makes getting pregnant harder for many women, it does not make it impossible. PCOS does not mean you will never ovulate but it does mean ovulation may be irregular, unpredictable, or less frequent than average. So the challenge is around timing and frequency. Fortunately, there are natural and medical treatments available to improve fertility. 

For a significant number of women, it does not require medical intervention at all. A 2023 randomised controlled trial following women with PCOS who were trying to conceive found that 58.3% conceived spontaneously. 

When I got my diagnosis, my life was messy. Outside of my career, I had no real direction and wasn’t even sure if I wanted children, ever. Suddenly I had this sense of urgency, the feeling of needing to decide and make the necessary plans. But it would take years before I felt the genuine urge to have a baby and I gave birth to my first child at 30.

The second followed three years later. My third child was born in 2023 and at the time of writing, in 2026, I’m eight months pregnant with my fourth. For most of my life, even leading up to my first two pregnancies, my cycle was wildly irregular. Then a year before conceiving my third child, I worked with a doctor to manage my PCOS naturally. This included changing my diet and incorporating exercise. I started getting my periods regularly and my skin cleared up right away. During my later pregnancies, I was also walking a lot. I had no car, was in a walkable city, and would average 7,000 to 10,000 steps a day.

If you have PCOS and you’re trying to get pregnant, consult with a doctor as soon as possible. A doctor will be able to help you identify if ovulation occurred when you think it did. You can also run tests for insulin resistance. 

You might need to see more than one practitioner before finding a good match. Despite how common it is, PCOS remains widely misunderstood. I received my share of poor medical advice when trying to manage my PCOS. One doctor told me irregular periods were the norm when I sought advice on how to regulate my cycle. Another said I likely had polycystic ovaries, not PCOS despite my history of hyperandrogenism and irregular cycles.  This is why it’s so important to become an expert in your own health. I now upload my blood test results to ChatGPT and let it do an analysis before a doctor’s appointment so I know which areas to focus on. 

Read more about me and my PCOS journey here.

How to track ovulation with PCOS when you have irregular cycles

The most reliable approach to ovulation tracking with PCOS involves layering multiple methods, including measuring your body temperature, cervical mucus and progesterone levels.

After ovulation, progesterone causes a slight but measurable rise in resting body temperature . BBT tracking cannot predict ovulation in advance, but it can confirm that ovulation has occurred. Taken together with other signals, it builds a picture of your cycle over time.

A mid-luteal serum progesterone test (taken around seven days after suspected ovulation) can confirm whether ovulation actually occurred. This is something your GP or gynaecologist can arrange.

As ovulation approaches, cervical mucus typically becomes clear, slippery, and similar in texture to raw egg whites. Monitoring this daily provides a free, fertility signal that can help confirm when your fertile window is opening.

As you can see, the standard advice  "take an ovulation test on day 14" doesn't apply when you have PCOS. Standard ovulation predictor kits (OPKs) measure LH levels in urine. The problem, as noted by Mira Fertility, is that many women with PCOS already have an elevated baseline LH level. This means the test line may frequently appear positive, even when you are not about to ovulate.

While a single positive OPK result in a PCOS cycle does not reliably confirm that ovulation is imminent. Research suggests that tracking LH patterns across several consecutive days is more useful than reading any single result in isolation. You're looking for a clear peak, a result that is distinctly higher than your usual baseline, rather than any positive reading.

Not only can LH levels remain elevated, they can also rise and fall erratically, according to research. And this also makes it harder to track. When I was trying to conceive my daughter, my second child, I bought a bunch of ovulation test kits and they all tested negative. One after the other. Honestly it was demoralising but I had no idea the kits were unlikely to pinpoint ovulation and I ended up falling pregnant during that cycle. 

Listen to your own body month to month for signs of ovulation. I’ve since found that increased cervical mucus and a higher libido usually indicates that I’m ovulating. I used to experience slight ovarian pain but that has lessened. 

How to get pregnant with PCOS

Lifestyle intervention, like diet and exercise, is the first-line recommendation for women with PCOS who are trying to conceive and the research supporting it is substantial.

Diet and insulin resistance

Because insulin resistance is so central to PCOS, dietary changes that improve insulin sensitivity have a direct impact on ovulation. A 2021 systematic review and meta-analysis found that low-glycaemic index (GI) diets improve ovulatory function and menstrual regularity in women with PCOS. A more recent 2025 review published in the Journal of Health, Population and Nutrition confirmed that low-GI diets have "been noted to be successful in bringing about ovulatory regulation, improving menstrual regularity, and increasing the fertility of women with PCOS."

This means prioritising:

  • Whole grains over refined carbohydrates
  • Lean protein and healthy fats at each meal
  • Plenty of non-starchy vegetables and fibre
  • Reducing ultra-processed foods and added sugars

The Mediterranean diet is also well-evidenced for PCOS, and a 2025 systematic review in Nutrients found that Mediterranean-style and anti-inflammatory diets improve both insulin sensitivity and hormonal balance in women with PCOS.

Exercise

Regular physical activity improves insulin sensitivity independently of weight loss. Research shows that both aerobic exercise and resistance training improve metabolic and reproductive outcomes in women with PCOS. Even moderate exercise, like walking, swimming, cycling, is beneficial.

Inositol supplementation

Myo-inositol (MI) is a naturally occurring compound involved in insulin signalling. A meta-analysis published in Nutrients found that inositol is effective and safe for women with PCOS, improving menstrual cycle normalisation, ovarian function, and pregnancy rates. A combination of myo-inositol and D-chiro-inositol in the physiological ratio of 40:1 is the most studied and supported formulation. It's widely available over the counter, but always discuss any supplements with your GP or midwife.

I initially consulted with an aesthetic doctor for guidance on how to control my breakouts. At 37, I was still suffering with painful acne that often left scarring. I had tried birth control, expensive creams, and painful topical treatments and nothing had worked. Working together, she helped me identify that my diet, high in processed foods and sugar, was the root cause of my breakouts and irregular periods. 

In addition to switching to a low carb diet, I started an exercise programme. Nothing too ambitious. I aimed to hit 10,000 steps a day, and did three to four walks throughout the day. Later on I started doing a weekly yoga class and eventually incorporated a short at-home yoga practice into my daily routine.

My treatment programme also included a regimen of supplements, including inositol and turmeric. A month after following this protocol, my cycles became regular and my skin stopped breaking out. A year later I fell pregnant with my third child at 38. My cycle was so regular at the time I could pinpoint the exact date of conception.

Medical treatment options for PCOS and fertility

When lifestyle changes alone are not sufficient to restore ovulation, there are several well-evidenced medical options available.

Letrozole (first-line treatment)

Letrozole, an aromatase inhibitor, is now considered the first-line pharmacological treatment for ovulation induction in PCOS. It works by temporarily blocking oestrogen production, which prompts the pituitary gland to release more FSH, stimulating follicle development. It is typically taken in tablet form for five days early in the cycle, and success rates for ovulation are high.

Clomiphene citrate (Clomid)

Clomiphene has been used for decades to induce ovulation in women with PCOS. It works by blocking oestrogen receptors in the hypothalamus, triggering a release of FSH and LH. It is effective, but letrozole has been shown in multiple studies to produce higher live birth rates in women with PCOS, which is why letrozole has largely superseded it as the first choice.

Metformin

Metformin is an insulin-sensitising medication originally developed for type 2 diabetes. In PCOS, it addresses the underlying insulin resistance that drives many of the syndrome's symptoms. It can help to restore ovulation and is sometimes used alongside other ovulation-induction medications. It is also frequently used during PCOS pregnancies to reduce the risk of gestational diabetes (see below).

Gonadotropins

Injectable gonadotropins (FSH and/or LH) directly stimulate the ovaries to produce and release eggs. They are more powerful than oral medications and require close monitoring via ultrasound to minimise the risk of multiple pregnancies.

IVF and assisted conception

IVF is not the inevitable next step for women with PCOS who are struggling to conceive. Most will respond to one of the treatments above. However, IVF is an option when other approaches have not been successful. It is worth noting that women with PCOS are at higher risk of ovarian hyperstimulation syndrome (OHSS) during IVF, so protocols need to be carefully managed by a reproductive medicine team.

PCOS pregnancy risks and complications 

Understanding specific PCOS pregnancy risks and complications helps you go into pregnancy informed rather than anxious.

Gestational diabetes

Women with PCOS are approximately twice as likely to develop gestational diabetes mellitus (GDM) as women without PCOS. A large study published in HCPLive found an adjusted odds ratio of 2.19 for gestational diabetes in women with PCOS, even after controlling for underlying conditions. This is thought to be a direct consequence of the pre-existing insulin resistance associated with PCOS.

The practical implication is that you should be screened for gestational diabetes early and thoroughly. Many clinicians recommend testing in the first trimester for women with PCOS, particularly those with additional risk factors.

I’ve noticed that my body doesn’t tolerate glucose well in my pregnancies. In my third pregnancy, I was sent for additional gestational diabetes screening. This test is known as the Oral Glucose Tolerance Test. Different countries have different diagnostic thresholds and the country where I gave birth did not diagnose gestational diabetes, even though I “failed” one of the readings. I was then again on the border in my fourth pregnancy and I was sent for additional screening. This time my levels were within a healthy range. 

I decided to keep my blood sugar levels in check through diet and exercise but getting useful exercise advice when you're pregnant and trying to lower your GDM risk is harder than it sounds. Most of what you'll find online gives you the same line. Do 150 minutes of moderate activity per week. But that’s the catch-all recommendation handed out to everyone, men and women alike, regardless of their specific situation.

Eventually I found this 2018 study published in the Journal of Diabetes Investigation that looked specifically at daily walking in pregnant women with GDM. What they found was that women who walked 6,000 steps a day had significantly lower blood glucose levels than those who didn't reach that threshold. 

Pre-eclampsia and gestational hypertension

The same meta-analysis mentioned above found that women with PCOS have a 29% higher odds of pre-eclampsia. The chronic inflammation, insulin resistance, and hyperandrogenism associated with PCOS all contribute to increased cardiovascular risk during pregnancy. Regular blood pressure monitoring throughout pregnancy is essential.

FAQs

What is PCOS?  PCOS is the most common endocrine disorder in women of reproductive age, affecting between 5% and 13% of women globally. The condition is defined using the Rotterdam criteria, which requires at least two of the following three features to be present:

  • Ovulatory dysfunction: irregular, infrequent, or absent periods
  • Hyperandrogenism: elevated levels of androgens ("male hormones") such as testosterone, which can cause acne, unwanted hair growth, and hair thinning
  • Polycystic ovarian morphology: multiple small follicles visible on ultrasound

Can you get pregnant naturally with PCOS? Yes. A significant proportion of women with PCOS conceive without medical intervention. A 2023 study found that 58.3% of women with PCOS conceived spontaneously. The likelihood of natural conception depends on individual factors including age, weight, insulin resistance severity, and whether ovulation is still occurring.

Does PCOS get worse over time? Not necessarily. For many women, PCOS symptoms shift across different life stages. Weight management, sustained dietary changes, and treatment for insulin resistance can all meaningfully improve hormonal balance and ovulatory function over time. My symptoms were 41 were milder than at in my 20s when my PCOS was untreated.

How do I know if I'm ovulating with PCOS? Standard ovulation tests can be unreliable in PCOS due to elevated baseline LH levels. A combination of basal body temperature charting, cervical mucus monitoring, and mid-luteal progesterone blood testing provides the most reliable confirmation of ovulation. A fertility specialist or GP can also monitor follicle development via ultrasound.

Is PCOS genetic? There is a strong genetic component to PCOS. According to the Office on Women's Health, your risk is higher if your mother, sister, or aunt has PCOS. However, genetic predisposition interacts with lifestyle and environmental factors, meaning symptoms can vary significantly within families.

Are PCOS pregnancies high-risk? PCOS pregnancies carry higher statistical risks of gestational diabetes, pre-eclampsia, and miscarriage compared to the general population. However, "higher risk" does not mean "high risk". The absolute risk remains manageable with appropriate monitoring and care. Most women with PCOS go on to have healthy pregnancies and healthy babies.

Will I need IVF to get pregnant with PCOS? Most women with PCOS will not need IVF. Many conceive with lifestyle changes alone or with oral ovulation-induction medications such as letrozole. IVF is typically considered after other approaches have not been successful.

Key sources

This article is for informational purposes only and does not constitute medical advice. If you are trying to conceive or have been diagnosed with PCOS, please speak with your GP, gynaecologist, or reproductive endocrinologist.

Featured image courtesy of Pexels

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