PCOS and Pregnancy: What You Need to Know

If you have Polycystic Ovary Syndrome (aka PCOS), chances are you’ve thought once or twice about how your condition may impact your chances of getting pregnant. If you’ve found yourself asking ‘Can I get pregnant with PCOS?’ and are guilty of falling down the rabbit hole after a late-night Google search, we’re here to help. 

The truth is, while PCOS can make the journey to getting pregnant slightly complex, PCOS doesn’t make falling pregnant impossible. Many women and parents-to-be find success in falling pregnant – even with a PCOS diagnosis. 

The most important thing to keep in mind is that understanding all of your options, listening to your body, and taking small, manageable steps to support your fertility are all key to getting you to where you want to be. 

Ready to take back a little more control and understand your next steps to parenthood?

Let’s get started. 

What is PCOS? 

Despite being extremely underdiagnosed and misunderstood, PCOS still impacts up to 1 in 5 women and people with ovaries of reproductive age. 

But even given how common it is, up to 70% of Polycystic Ovary Syndrome cases remain undiagnosed…and we’ve got the Gender Pain Gap to thank for that (you can read more about that here). 

To make a long story short, PCOS can be confusing…and it all starts with the name itself. Despite earning the name Polycystic Ovary Syndrome, this condition affects more than just the ovaries – it can actually impact the whole body. 

PCOS occurs when your body produces higher-than-usual levels of male sex hormones (aka hyperandrogenism), resulting in ovulatory dysfunction, irregular cycles, and often, fluid-filled sacs on the ovaries. 

This hormonal imbalance can wreak all sorts of havoc on our bodies, resulting in: 

• Irregular or missed periods 
• Prolonged bleeding 
• Difficulty ovulating (aka anovulation, but more on this later) 
• Hormonal acne – typically on the chin and jaw 
• Excessive hair growth on the face and body 
• Hair loss and thinning on the scalp

While the exact cause of this condition isn’t clear, we now know that it’s completely manageable, with many women going on to lead healthy and happy lives, and yes – that can include having babies too. 

For more information on PCOS and how we can help you manage your symptoms here at Hazel, explore our resources.

PCOS and Pregnancy Symptoms 

PCOS can bring about its own unique set of challenges and obstacles to pregnancy, but understanding what you can expect can help place you back in control. 

For some people with PCOS, symptoms such as hormonal acne and excessive hair growth may be put on pause  due to hormonal changes and fluctuations brought on by pregnancy. However for others, their PCOS symptoms may still be present, or may even be heightened. 

Whether your symptoms have ramped up or have disappeared completely, remember that every experience with PCOS and pregnancy is different, and your journey may not look the same in future pregnancies, or the same as another woman living with the condition. 

People with PCOS are more likely to experience certain pregnancy-related complications. These can include: 

Gestational Diabetes 

If you have PCOS, you might already know that there’s a link between the condition and insulin resistance. Unsurprisingly then, one recent study found that women with PCOS are almost 3 times more likely to develop gestational diabetes. Regular appointments and monitoring with your care team, eating a balanced diet, and participating in physical activity can take the pressure off of monitoring gestational diabetes, and ensure that you and your baby are healthy and cared for – every step of the way. 

Pre-Term Delivery 

A 2021 study found that women with a PCOS diagnosis had a higher rate of preterm birth (birth that occurs before 37 weeks of gestation) than women without a PCOS diagnosis. The study also discovered that women with PCOS had more than a two-fold increased risk of extremely pre-term birth (birth that occurs before 28 weeks of gestation). 

Preeclampsia and Hypertension 

A 2024 report has shown that women with PCOS have a 50% increased risk of developing pregnancy-induced hypertension (aka PIH) and a 30% increased risk of developing preeclampsia than women without PCOS. Your healthcare team will monitor your blood pressure closely throughout pregnancy to screen for these conditions so you and your baby receive the care and support you need. 

Spontaneous Miscarriage 

Defined as the loss of a pregnancy before 24 weeks gestation, or the loss of a foetus weighing less than 500 grams, a spontaneous miscarriage is reported to affect 15% of all pregnancies. While the rate of miscarriage in women with PCOS is higher in comparison to women without the condition (20% compared to 15%), it’s important to recognise that PCOS is not an independent risk factor for pregnancy loss. Factors associated with PCOS, such as high BMI, obesity, and high blood pressure strongly increase the chances of miscarriage. 

No matter what symptoms or challenges you may be facing throughout your pregnancy, we’re here for you. We recommend staying on top of your regular prenatal care with a team you can trust, discussing any concerns as they appear with your doctors and support team, and continuing to eat a balanced diet and move your body in ways that make you feel good can all help you to navigate pregnancy while living with PCOS. 

With the right help and support, many women with PCOS can go on to have safe pregnancies, and deliver healthy babies. 

Will PCOS affect my fertility? 

If you’ve found yourself wondering whether or not your PCOS diagnosis might impact your fertility and ability to have children, know that it’s a valid concern. While PCOS can make getting pregnant a little more challenging, it doesn’t mean that it’s impossible. 

So…why exactly does PCOS impact fertility? The TLDR:PCOS often disrupts ovulation.

Throughout a regular cycle, the ovaries will typically release one egg for fertilisation – this is known as ovulation. In women with PCOS, the process of ovulation may be irregular and only occur sporadically, or it may be absent altogether (known as anovulation). This is because the hormonal imbalance in PCOS impacts the ovaries' ability to release eggs and results in the development of multiple underdeveloped follicles that don’t mature into eggs. 

And just when you thought this condition couldn’t get any more confusing, these underdeveloped follicles are what give Polycystic Ovary Syndrome its name – no actual cysts here, just countless underdeveloped follicles. 

While the disruption in ovulation can make it more difficult for those with PCOS to fall pregnant, it’s important to note that experiencing anovulation doesn’t mean that you’re infertile. Many women with PCOS still ovulate occasionally – whether that be naturally, or with the assistance of ovulation tools, such as lifestyle changes or medication (including low-dose gonadotropins). 

Remember, PCOS doesn’t affect every woman in the same way; there’s no one way for this condition to look or impact people. Some individuals may still experience regular cycles and ovulation, while others may have irregular cycles and no ovulation at all. 

While PCOS can impact your fertility, if you have dreams of starting a family one day, know that you are not out of options. Read that line again. 

With the right guidance, treatment, and support from a medical team you can trust, you can increase your chances of successfully falling pregnant. If you’re having difficulties conceiving, we recommend speaking to an experienced GP or women’s health doctor, who can refer you to a fertility specialist. 

Natural ways to improve fertility 

Want to boost your fertility with PCOS but looking for a more natural approach? The good news is that small lifestyle changes can make a big difference in helping you reach your end goal. 

Some natural ways you can improve your fertility include: 

Eating a balanced diet

Disclaimer: We don’t believe in “good” or “bad” foods here at Hazel. What we do believe in is needing a whole lot of balance in our diets, and regularly consuming nutrient-dense whole foods. 

And there’s a reason we believe in it. Eating a well-rounded diet rich in nutrients and whole foods has been proven to reduce insulin resistance, decrease high blood pressure, and reduce inflammation. Research has also identified that a balanced diet is significantly related to improved fertility outcomes, including ovulation, menstrual regularity rate, reduced miscarriage rate, and pregnancy. 

Try incorporating more of the following foods into your diet: 

• Fatty fish 
• Berries 
• Leafy greens 
• Chia seeds 
• Grains and legumes 
• Lean proteins 
• Avocados 

As we said before, life is all about balance. While we recommend trying to incorporate as much of the foods we listed above as possible, try limiting your intake of the following foods too:
 

• Highly processed foods 
• Refined sugars 
• High GI foods (think white bread, potatoes, etc.)  
• Fried foods 

While it’s more than okay to consume these foods in moderation, over-consumption of them can result in rapid spikes in blood sugar, elevated insulin levels, rising blood glucose levels, and worsened inflammation. 

Understanding what foods can help your PCOS symptoms and what foods hinder them can be tricky. But we’re here to help. Book a consultation with Hazel’s Clinical Naturopath and Nutritionist to see how you can use food as a medicine. 

For more information on how eating the right foods can help you to manage your PCOS symptoms, check out our article.

Maintaining a healthy weight 

Up to 88% of women with PCOS are affected by obesity or being overweight, which has been known to contribute to insulin resistance, difficulties ovulating, and hormonal imbalances. 

One 2020 study conducted on a group of obese, anovulatory women found that after losing an average of 10kgs, ovulation was restored in 90% of participants, with 78% going on to successfully conceive. 

While weight loss doesn’t always need to be top of the priority list, in overweight and obese women with PCOS, maintaining a healthy weight through diet and regular exercise can help to restore ovulation and improve fertility, both of which boost your chances of successfully conceiving. 

Regular exercise 

Regular physical activity helps to improve insulin sensitivity, maintain a healthy weight, and help to balance your hormones. As always, moderation is key, and it’s important to avoid over-exercising, as excessive physical activity can increase stress (which can impact fertility and undo all of your hard work!). 

Aim for a mix of cardiovascular exercises that feel good for you and your body, such as swimming, walking, or cycling, and strength training to improve your overall fitness. 

Supplements 

Research has found that supplements such as inositol (vitamin B8), vitamin D, CoQ10, and curcumin help to decrease insulin sensitivity and inflammation, improve ovarian function, regulate the menstrual cycle, and restore ovarian function among women living with PCOS. 

As always, we recommend speaking to a trusted doctor or naturopath before adding any new supplements to your routine. Remember, no single approach works for every woman with PCOS, and what works for one person may not work for you. 

The key to successful PCOS management is to find what works best for your body and your unique needs and goals. 

Medical ways to improve fertility

While natural methods can be an effective starting point, because every PCOS patient is different, some women may need a little extra help to boost their chances of getting pregnant if natural alternatives haven’t worked for them. 

Thankfully, there are a range of medical treatments that are available to help regulate ovulation and improve fertility. Some options include: 

Metformin 

Metformin is a commonly prescribed medication used to manage insulin resistance, improve ovulation, and manage infertility and other symptoms of Polycystic Ovary Syndrome in some women. 

While it’s important to note that metformin is not a fertility drug, nor a drug that is guaranteed to resolve infertility, it has been shown to have a positive effect on hormonal balance and ovulation. 

One particular study found that the use of metformin during pregnancy in women with PCOS helped reduce pregnancy complications such as:

• Pregnancy-induced hypertension 
• Pre-term delivery 
• Gestational diabetes
• Preeclampsia 

Side effects of metformin

If you’re considering metformin for the management of your PCOS symptoms, it’s important that you’re familiar with the possible side effects that can be associated with this medication. 

Some of the most common side effects of metformin include: 

• Nausea 
• Diarrhoea 
• Vomiting 
• Flatulence 
• Bloating 
• Generalised weakness 

As with every possible treatment option, we recommend discussing metformin with a trusted doctor who has an understanding of women’s health conditions like Polycystic Ovary Syndrome to help determine if this could be the right option for you. 

Hormone Therapy 

Hormone therapy is another option for women with PCOS who struggle with regular ovulation. 

Clomiphene citrate (CC) is used to help induce ovulation in some women with PCOS. CC works by blocking oestrogen receptors at the level of the hypothalamus and pituitary glands, resulting in an increased output of gonadotropins (these are the hormones responsible for ovarian function) – which stimulates ovulation. 

One study found that CC helps to increase the probability of ovulation from just 45% to 90%.

Letrozole is another medication that can be used to assist ovulation. It is associated with producing a higher live birth and ovulation rate among infertile women with Polycystic Ovary Syndrome when compared to clomiphene citrate. 

Each medication comes with its own unique set of benefits and risks. Speaking with your doctor and care team about your symptoms, goals for treatment, and concerns will help determine what treatment option is best for you and your needs. 

Assisted Reproductive Technologies 

Assisted reproductive technologies, such as In Vitro Fertilisation (IVF), are commonly used as a next step for women with Polycystic Ovary Syndrome when hormone therapy and oral medications have failed. 

IVF involves the implantation of a fertilised egg into the uterus. Because IVF does not require ovulation to occur, it increases the chances of pregnancy for women with PCOS who are struggling to ovulate and conceive. 

As with every treatment option (whether it be natural, medical, or a mixture of both), medical treatments can be incredibly effective and help get you one step closer to conceiving, but they’re not a one-size-fits-all solution. 

It’s important to facilitate a conversation with your doctor and care team about all of your options (yes, we mean all of them) to help you find the path that feels best for your body, your lifestyle, and your goals. 

Surgery for Fertility 

We know, we know – surgery might sound slightly daunting, but for some women living with Polycystic Ovary Syndrome, it can be the missing piece of the puzzle helping to get you closer to your goals when other treatments have fallen short.. 

Surgical options have been shown to help some women to encourage ovulation and improve their chances of conceiving. Here’s what you need to know: 

Bariatric surgery 

Bariatric surgery has been shown to promote significant weight loss, which in cases of women with PCOS who are obese or overweight, can be associated with improving insulin resistance, menstrual irregularity, decreasing hyperandrogenism, and promoting ovulation. 

Your doctors may consider bariatric surgery as a possible option for you if lifestyle changes haven’t resulted in ovulation or pregnancy, and if your BMI is ≥35 kg/m2. 

Ovarian Drilling 

Ovarian drilling is a less commonly used surgical technique that can be used to help promote regular ovulation and rebalance hormones for women living with PCOS. The surgery involves using a laser to make small perforations in the outer layer of the ovaries. 

These tiny holes work to reduce the number of hormone-producing cells, which can have a direct impact on your cycle. Research has found that ovarian drilling has long-term benefits, with more than 60% of patients experiencing an improvement in their symptoms for up to 20 years following the procedure. 

Remember, surgery isn’t for everyone, and we’re here to remind you that it doesn’t have to be. Surgical options are typically considered when medications and natural alternatives haven’t worked – they aren’t a magic fix (trust us, we’re still trying to find one). 

If you’re considering surgery as an option, it’s important you weigh up the potential risks and side effects with your doctor and understand all your available options. 

The Wrap Up 

If you only take one thing from us today, let it be this: 

Yes, you can conceive and successfully fall pregnant with PCOS. Yes, you can carry a healthy baby. No, Polycystic Ovary Syndrome and infertility aren’t always synonymous. 

We understand that navigating pregnancy and the journey to get there with PCOS may feel overwhelming at times. Heck, being a woman is hard enough without the added stress of hormonal imbalances, anovulation, missed cycles…the list goes on. But that’s where we come in. 

Your condition does not define you – and here at Hazel, it never will. 

We’re here to lay out all your options on the table for you, whether you’re interested in exploring hormonal therapy, medication, surgical options, a mix of all three (or even something else entirely!), and help you reach your goals through truly comprehensive care. 

Every journey is different, and working closely with a women’s health expert who specialises in conditions like Polycystic Ovary Syndrome is the first step to helping you find the right path to enhance your fertility, manage your PCOS symptoms, and deliver a healthy and happy baby. 

Get started today by booking a consultation with one of our PCOS experts.