Can I get pregnant with PCOS? Diagnosis and fertility treatment

Yes. Most women with polycystic ovary syndrome (PCOS) can get pregnant, naturally or with treatment. The 2023 international guideline recommends healthy lifestyle support for everyone, letrozole tablets as the first medicine to bring on ovulation, then other tablets, injections or ovarian surgery if needed, and IVF as a third step. IVF in PCOS is planned to keep the risk of ovarian hyperstimulation low.

This page follows the International Evidence-based Guideline for the Assessment and Management of PCOS (2023), written by an international panel led by Monash University with ESHRE, ASRM, the Endocrine Society and the European Society of Endocrinology. The sources are at the end.

How common is PCOS?

The guideline puts PCOS at 10–13% of women of reproductive age worldwide, in every ethnic group, and notes it may be more common in South-East Asia. It affects periods, fertility, weight, skin and hair, mood, and long-term health.

How is PCOS diagnosed?

In adults, you need two of these three, after other causes have been ruled out:

1. Irregular or absent ovulation. More than three years after your first period, cycles shorter than 21 days or longer than 35 days, or fewer than 8 periods a year, count as irregular. Ovulation can still be irregular with regular periods; a blood progesterone test can check.
2. High male hormones (androgens), either signs such as excess hair growth or acne, or a raised total or free testosterone on a blood test.
3. Polycystic ovaries on an ultrasound (20 or more follicles in at least one ovary on a modern vaginal scan) or a raised AMH level.

If you already have irregular cycles and high androgens, you have PCOS without needing a scan or AMH.

Other conditions are excluded first: the guideline recommends blood tests for thyroid (TSH), prolactin and 17-hydroxyprogesterone.

What is new about AMH?

AMH (anti-Müllerian hormone) is a blood test that reflects the number of small follicles in the ovaries. Since 2023 it can be used instead of an ultrasound for the third criterion in adults. The guideline is careful about it:

• AMH should not be used on its own to diagnose PCOS.
• Use either AMH or a scan, not both, to avoid over-diagnosis.
• AMH is not used in teenagers, whose levels overlap with normal development.
• Levels vary with age (highest around 20–25), weight, recent use of the contraceptive pill, ovarian surgery and the laboratory method, so results must be read against the lab's own cut-offs.

AMH is also measured before IVF for a different reason: to estimate how the ovaries will respond. See IVF after 40 and low AMH for what AMH can and can't tell you.

Does losing weight help?

Healthy eating and physical activity are recommended for every woman with PCOS, whatever her size, and help even without weight loss. If you are above a healthy weight, the guideline says to explain that extra weight lowers the chance of pregnancy and raises the risk of miscarriage after fertility treatment, and that managing weight, including modest weight loss, can bring real improvements. No particular diet has been shown to beat others, so choose one you can keep up.

Before trying to conceive, the guideline also recommends:

• a 75 g oral glucose tolerance test (OGTT), because PCOS raises the risk of diabetes in pregnancy;
• folic acid (a higher dose if your BMI is over 30);
• attention to blood pressure, smoking, alcohol, sleep and emotional health.

What is the first treatment for getting pregnant?

Letrozole. The guideline recommends it as the first medicine for women with PCOS who don't ovulate and have no other fertility problem, because, compared with clomiphene (Clomid), it gives better rates of ovulation, pregnancy and live birth.

Some things to know:

• Its use for fertility is off-label in many countries, meaning it is not officially licensed for this. Your doctor should explain this to you.
• It must not be taken if you might already be pregnant. The guideline found no evidence that it causes more birth defects than other ovulation medicines or natural conception.
• Take ovulation tablets only under a doctor's care. They are meant for women with no other fertility problem, so your husband's semen analysis should be checked first and, depending on your history, a tube test (see fertility testing).

Where does metformin fit?

Metformin is a diabetes medicine that improves insulin resistance. For fertility, the guideline says it can be used alone, but that more effective ovulation medicines exist. It can also be added to clomiphene. Its main use in PCOS is for weight and metabolic health. Side effects are usually mild stomach upset. Inositol supplements are considered experimental for fertility, with uncertain benefits and unknown safety.

What if tablets don't work?

The second-line options are:

• Gonadotrophin injections (FSH), at a low dose, increased slowly, with frequent scans. The aim is to grow one follicle. The guideline advises cancelling the cycle, or avoiding unprotected sex, if more than two follicles grow larger than 14 mm, to avoid triplets or twins.
• Laparoscopic ovarian surgery ("ovarian drilling"), a keyhole operation to restore ovulation. It has a lower risk of twins than injections, but a lower chance of a baby, and carries the risks of surgery. See keyhole surgery.
• Clomiphene, alone or with metformin, also still has a place.

IUI may be combined with ovulation treatment in some couples. See IUI or IVF?

When is IVF used for PCOS?

The guideline calls IVF third-line when ovulation is the only problem and first- and second-line treatments have failed. IVF comes earlier if there is another reason for it, such as blocked tubes or a low sperm count. Putting back one embryo at a time keeps the risk of twins low. See IVF.

Why is OHSS a concern, and how is it prevented?

Ovaries with many follicles can over-respond to IVF injections. This is ovarian hyperstimulation syndrome (OHSS): the ovaries swell and fluid leaks into the abdomen, causing bloating, pain, nausea and, rarely, serious complications such as blood clots. Women with PCOS are at higher risk, and the guideline says they should be told about this before IVF and offered ways to reduce it:

• an antagonist protocol, which allows the final "trigger" injection to be a GnRH agonist instead of hCG, lowering the risk;
• freezing all embryos and transferring one in a later cycle (see frozen embryo transfer), which the guideline says doesn't reduce the overall chance of a baby;
• if a long agonist protocol is used instead, metformin may be added to lower the risk.

In vitro maturation (IVM), collecting immature eggs without stimulation, avoids OHSS but is less effective and only offered where there is expertise.

Contact your clinic straight away if you have increasing bloating, pain, vomiting, very little urine, or difficulty breathing during or after IVF.

Is pregnancy with PCOS higher-risk?

Yes. The guideline lists higher risks of gestational diabetes, high blood pressure and pre-eclampsia, miscarriage, preterm birth and a small baby, so your antenatal team should know you have PCOS. IVF itself doesn't seem to add to these risks.

Things to know in Malaysia

• Fertility treatment, including IUI and IVF, is only for legally married couples using their own eggs and sperm. See what Malaysian law allows.
• LPPKN's BuAI programme subsidises IUI for eligible couples, and EPF Akaun Sejahtera can be used for IUI, IVF and ICSI. See paying for fertility treatment.
• We found no Ministry of Health clinical practice guideline specific to PCOS; the international guideline is the main reference.
• If you have PCOS and are planning a pregnancy, ask your doctor about an OGTT.

For care beyond pregnancy (periods, skin, long-term health), see PCOS. If you are unsure when to seek help, see when to see a fertility specialist.

Sources

• Teede HJ et al., Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, Human Reproduction 2023;38(9):1655–79 (open copy), sections 1, 3, 4 and 5.
• Manchester University NHS Foundation Trust, Ovarian Hyperstimulation Syndrome, patient information, updated January 2026.
• Malaysian Medical Council, Medically Assisted Reproduction, 2025.
• LPPKN, Program BuAI, and KWSP, Fertility treatment withdrawal.

This page is general information, not a diagnosis or a substitute for advice from your own doctor.