Can I still get pregnant with PCOS? Do I need medication? Will pregnancy be harder for me? How does PCOS affect pregnancy? If you’ve been diagnosed with polycystic ovary syndrome (PCOS), or even just suspect you might have it, you probably know how many questions can come with it. 

The truth is, PCOS can feel unpredictable, especially when your cycles don’t run on a regular schedule. But here’s the encouraging part: with the right plan which focuses on lifestyle shifts, smart cycle tracking, and evidence-based medical therapies, many women with PCOS conceive and go on to have healthy pregnancies.

Here, we’ll break down what PCOS actually is, how it affects fertility, the natural and medical tools that can restore ovulation, and what to expect once you’re pregnant. Whether you’re just starting to think about trying, or you’ve been on the path for a while, my goal is to give you clear, compassionate, and research-backed information to help you feel empowered as you move toward the family you’re dreaming of.

What is PCOS? 

Polycystic ovary syndrome (PCOS) is one of the most common, and often most misunderstood, conditions affecting people of reproductive age. It’s diagnosed when two out of three key features are present:

• Irregular or absent ovulation which can make cycles unpredictable
• Signs of higher androgen levels like acne, excess hair growth, or elevated labs
• Polycystic ovarian appearance on ultrasound multiple small follicles

These signs are considered only after other causes are ruled out, so a thorough evaluation is important.

Beyond reproduction, PCOS also has a “metabolic side,” meaning it can increase risks for insulin resistance, cholesterol imbalances, and cardiometabolic conditions over time. Think of it as a condition that touches both hormones and whole-body health.

Insulin resistance and excess androgens can interrupt the delicate hormonal “conversation” between your brain and your ovaries. This conversation is what helps a follicle mature and ovulate each month. When it’s disrupted, ovulation may happen less often, or not at all, which means fewer opportunities to conceive naturally.

When to check in with a fertility specialist:

• Conventional guidelines:
• Under 35: after 12 months of trying
• Age 35 or older: after 6 months of trying
• Much sooner if your cycles are very irregular or absent

From a functional medicine lens, you may benefit from seeking support earlier if:

• You’ve had a history of recurrent miscarriage (2 or more losses)
• You notice persistent symptoms of insulin resistance like energy crashes, intense sugar cravings, difficulty losing weight despite lifestyle changes
• You’re experiencing signs of thyroid dysfunction like chronic fatigue, hair loss, constipation, and/or cold intolerance, which can directly impact ovulation and egg quality
• You’ve had longstanding irregular cycles and want to get ahead of potential complications
• You have significant digestive issues (bloating, IBS-type symptoms, food intolerances) that may point to underlying inflammation affecting fertility
• You’re struggling with chronic stress, poor sleep, or high cortisol patterns that may be disrupting your cycle

You want a comprehensive preconception workup (labs like HbA1c/OGTT, fasting insulin, thyroid antibodies, vitamin D, homocysteine, and nutrient status like ferritin, B12, omega-3 index) rather than waiting until you’re already months into trying

In coordinated efforts with doctors, I often see that women with PCOS feel more empowered when they get this deeper assessment before hitting the conventional infertility milestones. It can uncover and address root causes early which supports both fertility and long-term metabolic health. A PCOS evaluation isn’t just about confirming the diagnosis, it’s also about protecting your long-term health. Your clinician should check blood pressure, fasting lipids, and blood sugar since PCOS itself raises cardiometabolic risk.

RELATED: The Impact of Inflammation on Fertility and Pregnancy Outcomes

PCOS & fertility

Can you get pregnant naturally with PCOS?

For anyone trying to conceive with PCOS, the main mission is simple: bring back regular ovulation. Ovulation is the event that makes pregnancy possible and any people with PCOS start ovulating again through nutrition and lifestyle changes, without needing fertility procedures.

In my clinical experience, the magic happens when you pair sustainable daily nutrition and lifestyle habits with smart cycle tracking. This combination not only improves your health but often shortens the time it takes to conceive.

Natural ways to support ovulation with PCOS include:

• Sleep & stress management: Your hormones thrive on rhythm. Going to bed and waking up at consistent times, and finding ways to keep stress in check, can improve insulin sensitivity and help your body signal ovulation.
  
  
• Nutrition: Forget the idea of a one-size-fits-all “PCOS diet.” The best eating plan is one you can maintain long term. Aim for balanced energy intake, high-fiber carbs from minimally processed foods, and enough protein and healthy fats to keep you full and stabilize blood sugar.
  
  
• Movement: You don’t need the “perfect” workout, just consistent activity. Research shows any regular physical activity improves PCOS outcomes. I often recommend starting with brisk walking daily and adding two or three resistance or strength training sessions each week.
  
  
• Cycle tracking: Knowing if and when you ovulate can be empowering when trying to conceive. Ovulation predictor kits (OPKs) can spot your LH surge about a day before ovulation, while basal body temperature (BBT) may confirm it afterward. For many with PCOS, BBT tracking can feel frustrating as irregular cycles, hormone shifts, and everyday factors like stress or poor sleep can make patterns hard to interpret. If that’s the case, it’s not you, it’s the condition. For clearer answers, bloodwork (like mid-luteal progesterone) or an ultrasound can confirm ovulation more reliably. Many women find that combining at-home tools with occasional medical support offers both confidence and peace of mind.

Weight reduction and PCOS

If your doctor has told you that you fall into the “overweight” category according to BMI charts, it can feel discouraging, especially when you’re already doing so much just to manage PCOS. The good news is that research shows you don’t need dramatic or extreme weight loss to see benefits. Even a modest shift (~5-10%) can improve insulin sensitivity, lower androgen levels, and make ovulation more likely. I often remind my clients: it’s not about perfection, it’s about progress. Small, sustainable steps really do add up.

Simple, realistic ways to support your body:

• Prioritize protein: Spreading protein throughout your meals helps keep you full and supports stable energy.
  
  
• Build balanced plates: Fill at least half your plate with colorful, high-fiber non-starchy veggies. One-fourth of your plate should be high-quality protein, and the remaining fourth should be made up of whole-food carbohydrates from legumes, whole grains, low-glycemic fruits, or starchy vegetables, to help steady post-meal blood sugar.
  
  
• Move in ways you enjoy: As previously mentioned, two to three resistance or strength sessions each week (think bands, light weights, or bodyweight moves) help preserve muscle, while daily walking or simply moving more gently boosts metabolism.

What matters most is finding a routine you can actually see yourself living with, and enjoying, for the long term. That’s what makes the difference for fertility, for pregnancy, and for your health down the road.

First-line fertility treatments for PCOS

When lifestyle changes alone don’t restore regular ovulation, medications can help give your ovaries the nudge they need. The good news? We have safe, effective options, and many women with PCOS conceive with just a little extra support.

• Letrozole: Current international guidelines and large clinical trials agree letrozole is the first-line medication for ovulation induction in PCOS. Compared with the older drug clomiphene, letrozole leads to higher ovulation and live-birth rates. It’s typically taken as a short 5-day course early in your cycle, and ovulation is tracked with ovulation predictor kits (OPKs) or ultrasounds. Most people need to try several cycles, and your provider will monitor your response along the way.
• Clomiphene: Clomiphene is still a reasonable option if you and your provider decide it’s the right fit. 
• Metformin: Metformin is often prescribed to improve insulin resistance, and for some women with PCOS it can also help restore ovulation. 
• Inositol: Supplements like myo-inositol and D-chiro-inositol have gained popularity, and some studies suggest they may improve insulin sensitivity and cycle regularity. But when it comes to the most important outcomes of live birth and pregnancy rates, the evidence is still mixed. If you’re considering inositol, it’s worth having a conversation with your provider about dose, product quality, and expectations.

Does PCOS affect pregnancy?

The short answer is yes, but it doesn’t mean you can’t have a healthy pregnancy. Most people with PCOS go on to have very successful pregnancies. What’s different is that certain risks, like gestational diabetes (GDM), high blood pressure or preeclampsia, miscarriage, preterm birth, and cesarean delivery can show up a little more often in this population.

However, when PCOS is identified early in prenatal care and your care team can support you with a personalized plan to minimize these risks. I remind my clients that knowledge is power, knowing your risks means you can take steps to protect both your health and your baby’s.

What early prenatal care should include

At your very first prenatal visit (or even before you conceive), it’s helpful to start laying the groundwork. Ask your provider about:

• Baseline checks like blood pressure and weight
  
  
• Early blood glucose monitoring if you’re at risk, since PCOS can increase chances of gestational diabetes
  
  
• A proactive wellness plan that includes nutrition, movement, stress support, and sleep strategies
  
  

These basics create a strong foundation that helps you feel more confident and supported throughout pregnancy.

Supplements during TTC and pregnancy

• Prenatal vitamins: Ideally, start 1–3 months before conception and continue through pregnancy and postpartum. PCOS guidelines recommend supplementing with a high-quality prenatal vitamin for those using ovulation-induction medications.
  
  
• Inositol: Several randomized trials and meta-analyses show that myo-inositol (MI) and D-chiro-inositol (DCI) can improve markers of insulin sensitivity in women with PCOS (e.g., lower fasting insulin and HOMA-IR), often alongside reductions in androgens and more regular cycles. 

What does that mean for pregnancy? Better insulin sensitivity pre-conception is one of the levers that can support a healthier pregnancy. During pregnancy itself, several trials in high-risk groups (which can include PCOS, obesity, or abnormal early glucose) suggest myo-inositol supplementation is associated with a lower risk of gestational diabetes (GDM) and modest improvements in glucose on Oral Glucose Tolerance Test (OGTT). That said, study quality is mixed and not all trials are PCOS-specific.

RELATED: Your fertility meal plan: A week of healthy, easy recipes

Postpartum & long-term health

Your PCOS journey doesn’t end after delivery, in fact, the postpartum season is the perfect time to build on the healthy habits you’ve already started. Here are key areas to focus on:

• Continue healthy habits: Carry forward the foundations you built before and during pregnancy with focusing on a balanced nutrition, regular movement, stress management, and good sleep hygiene.
  
  
• Monitor metabolic health: PCOS guidelines recommend ongoing blood sugar checks (such as A1c or insulin), along with regular blood pressure and cholesterol monitoring. These screenings help protect your heart, hormones, and overall vitality for years to come.
  
  
• Don’t skip your postpartum visit: This is a valuable chance to review your recovery, plan for future fertility (if desired), and create a personalized roadmap for long-term wellness.
  
  
• Empowerment through proactive care: In my experience, women who engage in this kind of follow-up feel more confident, more supported, and less anxious about what PCOS means for their future health.
  
  

A note from WeNatal on PCOS and fertility

Living with PCOS can sometimes feel unpredictable, especially when it comes to cycles and fertility. The encouraging news is that with the right combination of lifestyle shifts, smart cycle tracking, and evidence-based therapies, many people with PCOS go on to conceive and have healthy pregnancies.

Nutrition is also an important piece of the puzzle. That’s why we created WeNatal for Her, a comprehensive prenatal designed to help lay a strong foundation before and during pregnancy. Paired with WeNatal Omega DHA+, which provides daily omega-3 DHA to support brain, eye, and nervous system development, you’re covering key essentials for both you and your baby. For additional support, Egg Quality+ delivers a targeted blend of antioxidants that help protect and nourish cellular health which is an important factor in optimizing ovulation, fertilization, and early embryo development.

If you’re navigating PCOS and planning for pregnancy, consider talking with your clinician about whether these nutrients could be a supportive part of your overall strategy. Wherever you are in your journey, remember you’re not alone, and small, intentional steps can move you closer to the family you’re dreaming of.

RELATED: Gut health and fertility: How your gut impacts fertility

References

Farland LV, Stern JE, Liu CL, et al. Polycystic ovary syndrome and risk of adverse pregnancy outcomes: a registry linkage study from Massachusetts. Hum Reprod. 2022;37(11):2690-2699. doi:10.1093/humrep/deac210

Ghafari A, Maftoohi M, Eslami Samarin M, Barani S, Banimohammad M, Samie R. The last update on polycystic ovary syndrome (PCOS), diagnosis criteria, and novel treatment. Endocr Metab Sci. 2025;17:100228. doi:10.1016/j.endmts.2025.100228.

International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2023. Monash University; 2023.

Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371(2):119-129. doi:10.1056/NEJMoa1313517

Mashayekh-Amiri S, Mohammad-Alizadeh-Charandabi S, Abdolalipour S, Mirghafourvand M. Myo-inositol supplementation for prevention of gestational diabetes mellitus in overweight and obese pregnant women: a systematic review and meta-analysis. Diabetol Metab Syndr. 2022;14(1):93. Published 2022 Jul 6. doi:10.1186/s13098-022-00862-5

Shukla A, Rasquin LI, Anastasopoulou C. Polycystic Ovarian Syndrome. [Updated 2025 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: 

Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. doi:10.1210/clinem/dgad463

Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocr Connect. 2017;6(8):647-658. doi:10.1530/EC-17-0243