What is PCOS and How Does It Affect Fertility?
Polycystic Ovary Syndrome (PCOS) is a hormonal imbalance that affects how your ovaries function. It can disrupt the regular release of an egg (ovulation), which is the most common reason for fertility challenges in women with the condition.
If you've been diagnosed with Polycystic Ovary Syndrome (PCOS), the first thing we want you to know is that you are not alone. PCOS is incredibly common, affecting approximately 10% of women of reproductive age. It is a complex condition involving an imbalance of reproductive hormones, specifically higher levels of androgens (often called 'male' hormones, though all women have them) and often insulin resistance.
In a typical menstrual cycle, your ovaries develop several small follicles, one of which becomes dominant and releases a mature egg. With PCOS, the hormonal signal to release that egg is often muffled or missing. Instead, many small follicles (cysts) may develop but never reach the point of ovulation. This clinical state is known as anovulation. If an egg isn't released, conception cannot occur.
At Viva Eve, we see PCOS not just as a fertility 'hurdle,' but as a whole-body health condition. We look at your symptoms—which might include irregular periods, excess hair growth (hirsutism), or acne—alongside your desire to conceive. Understanding the root cause of your specific PCOS symptoms is the key to unlocking your fertility potential.
Can I Get Pregnant with PCOS Naturally?
Yes, it is possible to get pregnant naturally with PCOS, especially if you have occasional spontaneous ovulation. However, many women require some level of medical support to ensure consistent, predictable ovulation.
The 'natural' path to pregnancy with PCOS often starts with lifestyle modifications. Because PCOS is closely linked to how your body processes insulin, even small changes in nutrition and activity can have a profound impact on your reproductive hormones. We often find that for women with a higher Body Mass Index (BMI), losing just 5% to 10% of body weight can be enough to kickstart regular ovulation.
However, we also know that for many, 'just lose weight' is frustrating and incomplete advice. PCOS makes weight loss biologically harder due to insulin resistance. This is why we integrate nutritional counseling into our fertility planning. Our goal is to help you lower your insulin levels, which in turn lowers androgen levels and allows your ovaries to function more normally.
Tracking your cycle is still valuable, but it can be trickier with PCOS. Traditional ovulation predictor kits (OPKs) may sometimes give 'false positives' because women with PCOS often have high levels of luteinizing hormone (LH) throughout their cycle. We recommend using multiple tracking methods, such as cervical mucus monitoring or basal body temperature (BBT), to get a clearer picture of your fertile window.
The Role of Insulin Resistance in PCOS Fertility
Insulin resistance affects up to 70% of women with PCOS. High levels of insulin can trigger the ovaries to produce excess testosterone, which prevents the development and release of mature eggs.
Insulin is the hormone that helps your cells use sugar for energy. When you have insulin resistance, your cells don't respond well to insulin, so your pancreas pumps out more to compensate. This 'extra' insulin is a major driver of PCOS symptoms. It acts directly on the ovaries to increase androgen production, creating a hormonal environment that stalls the ovulation process.
Managing insulin levels is often a key factor in achieving pregnancy with PCOS. For this reason, medications that improve the body’s response to insulin are commonly used—even in people without diabetes. By helping the body use insulin more effectively, these treatments can lower excess testosterone and support more regular menstrual cycles.
In addition to medication, focusing on a low-glycemic diet can be transformative. By choosing foods that don't cause sharp spikes in blood sugar, you keep your insulin levels stable. This isn't about restriction; it's about nourishing your body in a way that supports your hormonal balance. Our on-house dietitian, Tamsin Jordan, specializes in this 'food as medicine' approach for our PCOS patients.
Don't rely solely on apps to predict ovulation if your periods are irregular. Instead, look for physical signs like 'egg white' cervical mucus or a sustained rise in your basal body temperature (BBT).
What Medications Help You Conceive with PCOS?
Ovulation‑inducing medications used for PCOS work by stimulating the ovaries to mature and release an egg. By encouraging more predictable ovulation, these treatments can help restore regular cycles and significantly improve the chances of conception.
When lifestyle changes alone aren’t enough, ovulation induction may be recommended. These medications work by strengthening the hormonal signals between the brain and ovaries, encouraging the development and release of a mature egg. By promoting more consistent ovulation, they can significantly improve the chances of pregnancy for women with PCOS.
These medications are typically taken for five days at the beginning of your cycle. We then monitor you—often using ultrasound—to see how your ovaries are responding. This ensures that you are developing a healthy follicle and helps us time intercourse for the best possible chance of success.
In some cases, we may also use 'trigger shots' (HCG injections) to precisely control the timing of egg release. This takes the guesswork out of the process and can be a huge relief for couples who have been struggling with the uncertainty of irregular cycles. If these oral medications don't work, we may discuss injectable gonadotropins or a referral for IVF, but many of our patients conceive before reaching that step.
How Does PCOS Affect Pregnancy Once You Conceive?
Women with PCOS have a slightly higher risk of certain pregnancy complications, including gestational diabetes, preeclampsia, and preterm birth. Early and consistent prenatal care is essential to manage these risks.
Conceiving is the first big milestone, but your PCOS requires continued attention during pregnancy. Because of the underlying insulin resistance, you may have an increased risk of developing gestational diabetes (high blood sugar during pregnancy). We often screen our PCOS patients earlier for this condition to ensure both you and your baby stay healthy.
Preeclampsia (a sudden rise in blood pressure) is another risk factor we monitor closely. While this can sound scary, please know that most women with PCOS go on to have perfectly healthy pregnancies and babies. The key is having an OB-GYN team that understands the intersection of PCOS and obstetrics.
At Viva Eve, we don't 'hand you off' once you get pregnant. We continue to monitor your hormonal health throughout your trimesters. We may recommend continuing Metformin through the first trimester to help reduce the risk of early pregnancy loss, though we decide this on a case-by-case basis based on the latest clinical evidence and your personal history.
When Should You See a Specialist for PCOS Fertility?
If you have a known diagnosis of PCOS, you should seek a fertility consultation as soon as you decide to start trying to conceive. You do not need to wait the standard 12 months.
The standard advice for healthy couples under 35 is to try for one year before seeing a doctor. However, if you know you have PCOS and your periods are irregular, that clock doesn't apply to you. Waiting a year when you aren't ovulating regularly only adds unnecessary stress and delays your journey.
A preconception visit at Viva Eve allows us to run blood work, check your hormone levels (like AMH, LH, and FSH), and perform a baseline ultrasound of your ovaries. This gives us the data we need to create a proactive plan immediately. We can start with cycle-regulating support or jump straight to ovulation induction if that's what's right for you.
Remember, PCOS is not a diagnosis of infertility; it's a diagnosis of *ovulatory dysfunction*. This means the eggs are there, they just need a bit of help getting out. With the right support, the path to parenthood is wide open to you.
