What You Need to Know About Polycystic Ovary Syndrome (PCOS) and Fertility

If you have acne, irregular periods, and trouble losing weight, you may have polycystic ovary syndrome (PCOS). PCOS is caused by hormone imbalances that can affect different parts of the body, including your skin, metabolism, and reproductive system. It’s one of the most common causes of infertility (difficulty getting pregnant) in women.

The good news is that there are many effective treatments available, and you can get pregnant even if you have PCOS. 

What is PCOS?

PCOS is a hormone imbalance that affects 1 in 10 women of reproductive age. It’s usually diagnosed in young adulthood. But the symptoms can continue through menopause and beyond. 

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High levels of androgens can cause irregular periods, fertility problems, and excess facial or body hair. You may hear androgens called “male hormones,” since males make more of it. But it’s normal and healthy for female bodies to make some androgens. In PCOS, androgen levels are too high. 

With PCOS, people typically have 2 out of the following 3 issues: 

• Irregular or absent periods (called ovulatory dysfunction)

• Signs of too much androgen hormone (like acne or hair growth in certain areas)

• Small cysts on the ovaries

PCOS is associated with other health conditions too, like: 

• Type 2 diabetes

• Obstructive sleep apnea

• Excess weight

• High blood pressure 

• Stroke 

PCOS symptoms

PCOS symptoms are caused by high levels of androgen hormones and something called “insulin resistance.” This is when the body doesn’t respond to insulin effectively. Insulin helps your body control blood glucose (sugar) levels. So, when the body can’t use insulin properly to balance glucose levels, glucose levels rise. This is what happens in metabolic disorders like Type 2 diabetes — and PCOS. 

Common symptoms of PCOS include:

• Irregular periods or no periods

• Fertility problems (trouble getting pregnant)

• Increased hair growth on the face, chest, stomach, or upper thighs (called hirsutism)

• Acne that can be severe and hard to treat

• Excess body weight (especially around the waist) or difficulties losing weight

• Pelvic (lower stomach) pain

• Oily skin

• Patches of thick, dark, velvety skin, usually around the neck, armpits, or genitals (called acanthosis nigricans)

Quiz: Could I Have PCOS?

How does PCOS affect fertility?

PCOS affects reproduction in a couple of ways. With PCOS, it’s harder to get pregnant. There’s also a higher risk for certain complications during pregnancy. Here’s why. 

During normal ovulation, ovaries develop and release an egg once every menstrual cycle, or about every 28 days. 

But in PCOS, high levels of androgen hormones prevent ovulation. This means the egg doesn’t develop or get released the way it should. This leads to problems getting pregnant. It also causes cysts (small sacs with fluid) to form in the ovaries.

If you do get pregnant with PCOS, you have a higher risk of the following complications:

• Miscarriage (losing the pregnancy early)

• Gestational diabetes (pregnancy-induced diabetes)

• Pregnancy-induced high blood pressure and preeclampsia (sudden increase in blood pressure late in the pregnancy that can cause damage to other organs)

• Preterm birth (infant born before 37 weeks of pregnancy)

How common is infertility in people with PCOS?

PCOS is one of the most common causes of infertility. Almost 8 in 10 women with PCOS experience infertility. 

Is it possible to get pregnant if you have PCOS? 

Yes, you can get pregnant if you have PCOS. Some studies have shown that about 65% of women with PCOS can get pregnant at least once without any treatment. Fertility treatment can increase those odds: The same study showed that about 85% of women with PCOS (including those using fertility treatment) gave birth to at least one child.

EXPERT PICKS: WHAT TO READ NEXT

• Best diet for PCOS: Certain foods can worsen symptoms for polycystic ovary syndrome (PCOS), while low glycemic foods rich in fiber and antioxidants can help regulate hormones and prevent health complications. 

• Ozempic and PCOS: This health coach shares her personal journey with PCOS, and how she lost 90 lbs over 2 years through diet, exercise, and medications. 

• Can weight-loss medications help you get pregnant? Possibly, but it’s not safe. Learn about so-called "Ozempic babies" and what to do if you get pregnant while taking semaglutide or tirzepatide.

• Do you need a fertility test? In some situations, basic fertility tests can be helpful. But many are expensive, painful, and unnecessary. See which fertility tests are and aren’t recommended.

What treatments are available to help with fertility in people with PCOS?

Different treatments are available to treat infertility in PCOS, including: 

• Lifestyle changes

• Weight loss

• Fertility medications

• In vitro fertilization (IVF) 

Lifestyle changes

Lifestyle modifications — like making changes to your diet and lifestyle — can improve fertility in some women with PCOS. In fact, it’s common for healthcare professionals to recommend that everyone with PCOS make healthy lifestyle changes before and alongside medication. 

Examples of these lifestyle changes are physical activity, healthy living habits, and a nutritious diet. Medical professionals recommend these life changes to anyone trying to become pregnant. That’s because they have significant health benefits before, during, and after pregnancy and childbirth.

Weight loss

Most women with PCOS have a body mass index (BMI) that’s considered obese. And studies show that even a small amount of weight loss of 5% to 15% can help improve the menstrual cycle and ovulation. 

“Lifestyle changes” used to be the recommended treatment for weight loss in people with PCOS. However, there are now other treatment options alongside lifestyle improvements.

In 2023, the American Society for Reproductive Medicine (ASRM) updated its guidelines for the diagnosis and treatment of PCOS. These guidelines exist to help physicians make better clinical decisions for their patients, based on the latest science. 

These PCOS guidelines now include weight loss medications in their treatment recommendations. These medications include:

• Weight loss pills like Xenical (orlistat)

• Newer weight-loss injectables like semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro, Zepbound)

The weight loss from these medications can help improve your chances of getting pregnant. But it's generally recommended to stop taking them if you do become pregnant, especially if they aren’t treating another health condition. 

In the case of weight-loss injections, experts advise using birth control while taking them. Also, it's recommended to stop the injections at least 2 months before trying to conceive.

Fertility treatments for PCOS

One of the main reasons that women with PCOS have a hard time getting pregnant is that they don’t ovulate normally. This means they don’t ovulate at all or don’t ovulate regularly. Many of the fertility treatments for PCOS work by increasing ovulation, which helps improve the chance of pregnancy. 

Here are some of the medications commonly used in the treatment of infertility in PCOS. Letrozole is a typical first-step treatment. But in some cases, a combination of clomiphene and metformin may be a good alternative. 

If that doesn’t work, then you may choose to step up to gonadotropin injections. 

Letrozole

Letrozole (Femara) is a pill that slows estrogen production and increases levels of follicle-stimulating hormone, which is needed for ovulation. It’s a medication sometimes used to treat breast cancer. But it’s also the first step in treating infertility in PCOS.

Clomiphene

Clomid (Clomiphene) is a pill that helps eggs to mature and be released from the ovary. The gold standard for PCOS treatment (ASRM guidelines) recommends its use along with metformin, as an alternative to letrozole. 

Metformin

Metformin (Glucophage, Fortamet) is a pill used to treat diabetes. It works by lowering the production and absorption of sugar and helping the body respond to insulin better. 

Metformin can be used by itself or in combination with clomiphene. But some studies show that it may not be very effective for improving fertility. Talk to your healthcare professional to see what’s right for you.

Gonadotropin injections

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), also called gonadotropins, are hormones that occur naturally in the body. They play a role in normal ovulation. Several fertility drugs contain either FSH, LH, or a combination of both, to stimulate ovulation. 

Gonadotropins are considered a second-step treatment. You may choose to step up to this treatment if the first-choice treatments mentioned above haven’t worked. Most people don’t start out on them. That’s because they’re given as shots, require clinic visits, and are more likely to result in more than one pregnancy.

Some examples of gonadotropins include:

• Follistim AQ (follitropin beta)

• Gonal-f RFF (follitropin alfa)

• Menopur (menotropin)

IVF

Sometimes, these first- and second-step fertility medications may not result in a pregnancy. In that case, you may need assisted reproductive technologies like IVF (in vitro fertilization) to help you to get pregnant. 

If a couple is facing male fertility issues, too, your reproductive care team may recommend assisted conception earlier on in the journey, instead of working your way up through the fertility medications outlined above. 

Are fertility treatments for people with PCOS covered by insurance?

It depends. Unfortunately, there’s no answer that’s true for everyone. Insurance coverage of any fertility treatment — including for women with PCOS — varies with each plan and can depend on your state.

As of June 2024, 22 states and the District of Columbia have laws that require health plans to cover at least some fertility treatments. Only 14 of those states (plus Washington, D.C.) include requirements for IVF coverage. 

Even then, there’s still a lot of variability between states when it comes to what specific treatments are and aren’t covered, and who’s eligible. And the laws don’t apply to all employers either. In some states, certain employers may be exempt from providing coverage for fertility treatment — for example, religious employers, self-funded employers, and small employers. 

A couple of states also have a “mandate to offer” law. This requires that certain group health plans at least offer one policy with fertility treatment coverage. But employers don’t have to choose that plan.

Fertility treatments can be expensive. And figuring out your insurance coverage can feel like an uphill battle. Here are some suggestions to help you learn about your options:

• Talk to your human resources (HR) department at work to see how your policy handles fertility treatments.

• Call the insurance member services number (usually on the back of your health insurance card) and speak with someone to learn about what’s offered.

• RESOLVE: The National Infertility Association has a helpful guide that walks you through the basics. 

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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