What Are the Chances of Getting Pregnant with PCOS?

Reviewed on 4/6/2022
A couple looking at a pregnancy test together
About 70% of women who have PCOS have difficulty conceiving, either because of ovulation issues or not having enough progesterone.

Polycystic ovarian syndrome (PCOS) is a condition caused by an imbalance of reproductive hormones that results in problems in the ovaries. Monthly ovulation does not occur and levels of male hormones (androgens) in women are elevated. 

  • Polycystic ovarian syndrome is a common cause of infertility and cysts in the ovaries. PCOS can make it more difficult to get pregnant because it can prevent ovulation from occurring and it can cause hormonal imbalances that affect cervical fluid, making it more difficult for sperm to survive. 
  • About 70% of women who have PCOS have difficulty conceiving, either because they are not ovulating regularly or at all, or they do not have enough progesterone to support a pregnancy in its early stages. 
  • The best way for people who have PCOS to increase the chances of conceiving naturally is to have unprotected sex more frequently. Many women time intercourse to their most fertile days, which is generally in the middle of the menstrual cycle. But for women with PCOS who do not ovulate on a regular schedule, this timing may not work. Women over 35 who have PCOS and are trying to get pregnant often require medical intervention. 

What Are Symptoms of PCOS?

Symptoms of polycystic ovarian syndrome (PCOS) usually start around puberty, but some women may not develop symptoms until late adolescence or early adulthood, and can include:

  • Irregular menstrual cycle
    • Missed periods 
    • Unpredictable periods
    • No menstrual periods
    • Less frequent periods (fewer than eight periods in a year)
    • Heavy or prolonged periods
  • Weight gain, obesity, or difficulty losing weight
    • Up to 80% of women with PCOS are obese
  • Thinning hair or hair loss on the scalp; male-pattern baldness
  • Excess hair growth (hirsutism)
    • Affects up to 70% of women with PCOS
    • Occurs on the face, chin, neck, sideburn area, chest, abdomen, upper arm, inner thighs, or other parts of the body where men usually grow hair
  • Oily skin
  • Severe acne or acne that does not respond to usual treatments
  • Darkening of skin (acanthosis nigricans)
    • Especially along neck creases, in the groin, and underneath breasts
  • Skin tags
  • Infertility 
  • Multiple small fluid-filled sacs in the ovaries
  • Increased risk of heart disease and heart attack
  • Sleep apnea
    • May occur in up to 50% of women with PCOS
    • May result in fatigue and daytime sleepiness
  • Depression 
  • Anxiety 
  • Sexual dysfunction 
  • Eating disorders, including bulimia and binge eating

What Causes PCOS?

The cause of polycystic ovarian syndrome (PCOS) is unknown but it is thought that several factors may play a role, such as:

  • Insulin abnormalities
  • Reproductive system abnormalities
    • High levels of male hormones (androgens) 
    • Abnormal levels of the pituitary hormone luteinizing hormone (LH
  • Irregular menstrual cycle

How Is PCOS Diagnosed?

Polycystic ovarian syndrome (PCOS) is diagnosed with a patient history, physical examination and tests such as:

Once other conditions are ruled out, a diagnosis of PCOS may be made when at least two of the following symptoms occur: 

  • Irregular periods
  • Signs of high levels of androgens such as:
    • Excess male-pattern hair growth (hirsutism)
    • Acne
    • Thinning of scalp hair
  • High blood levels of androgens
  • Multiple cysts on one or both ovaries

What Is the Treatment for PCOS?

There is no cure for polycystic ovarian syndrome (PCOS), and treatment is aimed at managing symptoms. Many women will need a combination of treatments, including:

  • Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD)
    • Helps make the menstrual cycle more regular
    • Lowers the risk of endometrial cancer
    • Can improve acne and reduce excess hair growth
  • Anti-androgen medications such as spironolactone 
    • Can help with excess hair growth, acne, and scalp hair loss
    • Not approved by the Food and Drug Administration (FDA) to treat PCOS
    • May cause problems during pregnancy
  • Metformin (Glucophage)
    • Can help lower insulin and androgen levels
    • Not approved by the Food and Drug Administration (FDA) to treat PCOS
  • Prescription skin treatments or oral antibiotics for acne
  • Eflornithine HCl cream to slow hair growth in unwanted places
  • Infertility medications

Treatment to help with infertility caused by PCOS may include: 

  • Metformin (Glucophage)
    • To help the body process insulin, which can help regulate periods 
  • Hormonal birth control
    • This may seem counter-intuitive, but it may help regulate periods for a few months, at which point it is stopped and you try to get pregnant again 
  • Have unprotected sex more frequently 
  • Exercise and eat a healthy, low-sugar diet
    • Can help with weight loss, which can increase the chances of conceiving in patients who are overweight
    • Can help regulate hormones
  • Charting your cycle
    • PCOS often causes irregular periods
    • Tracking basal body temperature, cervical fluid, and the position of the cervix can help determine when ovulation occurs to time sex for an increased chance of conception

Treatments women can do on their own to help PCOS symptoms include: 

  • Weight loss
    • One of the most effective approaches for managing insulin abnormalities, irregular menstrual periods, infertility, and other symptoms of PCOS
  • Regular exercise
  • Hair removal treatments
  • Hair replacement and wigs for scalp hair loss

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Reviewed on 4/6/2022
Image Source: iStock Images