So you have PCOS, what does that mean for your fertility?

Introduction

It is believed that 70% of women with PCOS deal with infertility issues. The biggest question that we see is: can you get pregnant with PCOS? Yes of course; it is important to note that infertility does not mean that you will never be able to get pregnant. Infertility truly means that you have not been able to conceive naturally for at least 12 months’ worth of trying to conceive.

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS is characterized by an imbalance in reproductive hormones, leading to a variety of symptoms. The term “polycystic” refers to the presence of multiple small cysts on the ovaries, but not all women with PCOS have these cysts, and their presence isn’t necessary for a diagnosis. The exact cause of PCOS remains unknown, but factors like genetics and insulin resistance play significant roles.

Common Symptoms of PCOS:

• Menstrual Irregularities: Experiencing infrequent, irregular, or prolonged menstrual cycles.
• Excess Androgen Levels: Elevated male hormones can lead to physical signs such as hirsutism (excess facial and body hair), severe acne, and male-pattern baldness.
• Polycystic Ovaries: Enlarged ovaries containing numerous small fluid-filled sacs (follicles) that surround the eggs.
• Weight Gain: Many women with PCOS struggle with weight gain or find it challenging to lose weight.
• Skin Changes: Darkening of the skin, particularly along neck creases, groin, and underneath breasts; skin tags in the armpits or neck area.

Can You Get Pregnant with PCOS?

Yes, there are women that are able to get pregnant by trying to conceive naturally, some women are able to make better lifestyle changes for their PCOS, and some need additional support by working with a fertility specialist. PCOS is a complex condition but there are still many families out there that are able to start their families whilst they have the condition. 

How does insulin resistance affect PCOS fertility?

Insulin resistance is increasingly common in the United States for several reasons such as high-carb diets, living in a high-stress environment, etc. It doesn’t mean that you have diabetes or pre-diabetes but it does mean your body is struggling to produce healthy levels of insulin.

High levels of insulin are also associated with high testosterone. In women with PCOS, high levels of insulin contribute to raising testosterone levels which impact the body’s ability to develop healthy levels of estrogen that are necessary for ovulation. This is why some women with PCOS can deal with infertility however, improving testosterone levels have been shown to improve ovulation and fertility rates of women with PCOS.

Medical Treatments for PCOS Fertility

Not every path is “natural”—and that’s okay. There’s no shame in using medical support to help your body do what it’s struggling to do on its own. The right plan depends on your specific symptoms, labs, and how long you’ve been trying.

Ovulation Induction

If your cycles are irregular or you’re not ovulating consistently, your provider may recommend:

• Letrozole (Femara) – Considered the first-line medication for PCOS-related infertility. It works by encouraging ovulation and has shown higher pregnancy rates than Clomid in recent studies.
• Clomid (Clomiphene Citrate) – An older, well-established fertility drug that stimulates ovulation.
• These meds are often taken for 5 days at the start of your cycle and monitored through bloodwork or ultrasound.

Metformin

Originally a diabetes medication, Metformin helps lower insulin and androgen levels in women with PCOS. It may:

• Help restore ovulation
• Improve menstrual regularity
• Support weight loss (in some cases)

It’s sometimes used alongside Letrozole or Clomid for even better outcomes.

IUI & IVF

If ovulation meds alone don’t do the trick—or if you’ve been trying for 6+ months with no success—your doctor may recommend:

• Intrauterine Insemination (IUI) – Sperm is placed directly into the uterus during your fertile window.
• In Vitro Fertilization (IVF) – Eggs are retrieved, fertilized in a lab, and transferred back into the uterus.

Women with PCOS may be at a slightly higher risk of Ovarian Hyperstimulation Syndrome (OHSS) during IVF, so clinics typically use “low and slow” protocols to reduce the risk.

PCOS Infertility Treatments

Supplements That Actually Do Something

Let’s talk supplements—not the trendy stuff that shows up on your TikTok feed, but the ones that are actually backed by open-source clinical research and show real promise for women with PCOS who are trying to conceive.

1. Inositol (Myo-Inositol + D-Chiro-Inositol)

Inositols are probably the most well-studied supplements for PCOS—and honestly, they’re kind of a big deal.

What the research says:
A meta-analysis from 2016 published in International Journal of Endocrinology found that myo-inositol supplementation significantly improved ovulation rates, menstrual regularity, and insulin sensitivity in women with PCOS.¹ Even more compelling? Some studies show inositol works similarly to Metformin (the insulin resistance drug), but with fewer side effects.

Why it matters for fertility:
Myo-inositol helps restore ovulatory function, especially in insulin-resistant PCOS patients. Combining it with D-chiro-inositol in a 40:1 ratio seems to mimic the body’s natural inositol balance.

Coffee convo vibe:
If you’ve been told to “just lose weight” or “wait and see,” this supplement might be a gentle nudge in the right direction—no prescription required.

2. Vitamin D

Women with PCOS are frequently low in vitamin D—and this isn’t just a “winter blues” issue.

What the research says:
A 2020 study in Reproductive Biology and Endocrinology showed that vitamin D supplementation in vitamin D-deficient PCOS patients led to improvements in menstrual cycle regularity and metabolic markers.

Why it matters for fertility:
Vitamin D is involved in follicle development, ovulation, and hormone balance. And since PCOS can interfere with all three, keeping your levels optimal matters big time.

3. N-Acetyl Cysteine (NAC)

This one flies under the radar, but it deserves some spotlight.

What the research says:
A randomized controlled trial published in Fertility and Sterility (2007) found NAC to be as effective as Metformin in improving insulin sensitivity and ovulation in women with PCOS.

Bonus: It’s also a powerful antioxidant, which means it may support egg quality—a growing concern for many women TTC (trying to conceive).

4. Omega-3 Fatty Acids (EPA/DHA)

Fish oil isn’t just for your heart—it’s fertility gold for women with PCOS.

What the research says:
Supplementation with omega-3s has been shown to improve insulin resistance, reduce testosterone levels, and support a more regular cycle. A 2013 study in Iranian Journal of Reproductive Medicine showed a reduction in serum testosterone and improved menstruation patterns.

5. CoQ10 (Ubiquinol)

If you’re exploring IVF or IUI, this supplement might already be on your radar.

What the research says:
CoQ10 has been shown to improve mitochondrial function in eggs, support energy production, and increase ovulation and pregnancy rates, particularly when taken with Letrozole in PCOS patients.

Lifestyle Changes for PCOS Fertility

Let’s start with the good news: lifestyle changes are one of the most powerful tools you have to improve fertility with PCOS. And no, this doesn’t mean crash dieting or running 5 miles a day. It means working with your body—not against it.

Nutrition

Food is foundational. Research shows that lower-carb, higher-protein diets can improve insulin sensitivity, hormone balance, and ovulation in women with PCOS. This doesn’t mean keto is the answer for everyone, but it does mean being mindful of blood sugar spikes.

Try this instead:

• Focus on whole foods: lean proteins, vegetables, healthy fats, and low-glycemic carbs like quinoa, oats, and legumes.
• Reduce ultra-processed foods and added sugars.
• Experiment with anti-inflammatory staples: olive oil, turmeric, leafy greens, berries, and fatty fish.

Movement (Not Overtraining)

The goal isn’t to burn out—it’s to support hormone balance. Studies show that moderate, consistent movement helps lower insulin resistance and supports ovulation.

Best options for PCOS:

• Strength training (improves insulin sensitivity and supports metabolic health)
• Walking, cycling, and low-impact cardio
• Yoga or pilates (help regulate cortisol, which can also impact ovulation)

Stress Management

High cortisol levels (your stress hormone) can throw off reproductive hormones and worsen insulin resistance.

What helps:

• Mindfulness practices (journaling, breathwork, meditation)
• Quality sleep (7–9 hours per night is non-negotiable)
• Boundary setting (especially when you’re navigating the stress of TTC)

What to Ask Your Doctor About PCOS & Fertility

Knowing what questions to ask can make all the difference. If you have PCOS and are trying to conceive (or thinking about it), walking into your appointment with clarity and confidence matters. Here’s what you should consider bringing up—especially if you’ve felt dismissed or unheard before.

1. “Am I ovulating regularly?”

Not every irregular period means you’re not ovulating, but many women with PCOS experience anovulatory cycles(where no egg is released). You can ask about:

• Progesterone testing (typically done 7 days after suspected ovulation)
• Ovulation predictor kits and their reliability with PCOS
• Ultrasound monitoring if you’re doing treatment

2. “Should we test for insulin resistance or blood sugar issues?”

Even if you’re not diabetic, it’s worth asking about:

• Fasting insulin
• HbA1c (a longer-term look at blood sugar)
• Glucose tolerance test

Why? Because insulin resistance impacts hormones, ovulation, and overall fertility—and it’s often missed unless you ask directly.

3. “What lifestyle interventions should I focus on first?”

There’s a lot of noise online. A good provider will help tailor changes based on your lab results, symptoms, and goals. Ask:

• Should I get help from a nutritionist or specialist?
• Is weight loss necessary for me to conceive—or are there other priorities?

4. “What medications or supplements could support my fertility?”

Your doctor might recommend:

• Letrozole, Clomid, or Metformin (and when to try each)
• Inositol, Vitamin D, or other targeted supplements
• Whether you should test nutrient levels first before supplementing

5. “When should we consider fertility treatments?”

You don’t have to wait 12 months if you have a known diagnosis like PCOS. It’s totally fair to ask:

• At what point should we consider IUI or IVF?
• What kind of monitoring or testing can we do now to plan ahead?

Bonus Tip: Bring a list

You’re not being “too much” by writing it all down. You deserve answers, options, and a provider who helps you build a plan—not just tells you to “wait and see.”

You’re Not Alone — And You Deserve Clear Answers

If you’ve been navigating PCOS and wondering whether your fertility journey will ever feel “normal,” take a deep breath. You are not alone. Whether you’re just starting to think about growing your family or you’ve been trying for a while, your questions, your symptoms, and your struggles are valid—and they deserve more than vague answers or generic advice.

What we know is this: PCOS looks different for every woman. But with the right combination of information, support, and medical care, pregnancy is absolutely possible. There are real tools, treatments, and lifestyle changes that can help your body move toward balance—and your story isn’t over just because it’s starting off differently.

At Plum, we believe that fertility support should be clear, empowering, and community-driven. We built this platform to help women like you connect, ask better questions, and get real, research-backed answers—without the overwhelm.

If you’re looking for more support, conversations that actually go somewhere, and a space where fertility meets clarity: you belong here.

Join us on Plum. Let’s figure this out together.

Citations

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