What PCOS does to fertility
In PCOS, hormones such as insulin and androgens are out of balance. The ovaries develop many small follicles, but often none of them grows to release an egg. Without ovulation, there is no egg to fertilise, and periods become irregular. That is why many women with PCOS find it harder to conceive, even though their egg reserve is often good.
How PCOS is diagnosed
Doctors usually look for at least two of three things: irregular or absent ovulation, signs of high male hormones (in blood tests or as acne and hair growth), and a polycystic look of the ovaries on ultrasound. Other causes such as thyroid problems or high prolactin are ruled out first. A simple sugar and insulin check is often added, since insulin resistance is common in PCOS.
Treatment, one step at a time
- Lifestyle changesFor women who are overweight, losing even 5 to 10 percent of body weight can bring back regular ovulation. Regular movement, better sleep and fewer refined carbs all help.
- Ovulation induction with tabletsLetrozole is now the usual first choice for PCOS. Scans track the follicle so intercourse or IUI can be timed well.
- Metformin when suitableIt can help women with insulin resistance and is sometimes combined with ovulation medicines.
- Low-dose injectionsIf tablets do not work, gentle hormone injections are used with close scan monitoring to avoid too many eggs.
- IUI or IVFIVF is considered if other steps fail, or if there are other factors such as blocked tubes or a male factor. Protocols are chosen carefully to lower the risk of OHSS, which is higher in PCOS.
What you can do every day
PCOS without weight gain
Not every woman with PCOS is overweight. Lean PCOS is common in India. In these women weight loss is not the focus, and ovulation induction is usually the starting point. Dr. Prachi tailors the plan to your body type, reports and how long you have been trying.
Questions couples ask
Can I get pregnant naturally with PCOS?
Yes, many women do, especially once periods become regular through lifestyle changes or medicines. Others need help with ovulation.
Does PCOS mean I need IVF?
Usually not. Most women with PCOS conceive with ovulation induction, sometimes with IUI. IVF is kept for when simpler steps have not worked or there are other factors.
Is letrozole safe for trying to conceive?
Letrozole is widely used for ovulation induction in PCOS and is supported by current guidelines. It should be taken only with medical supervision and scans.
Will PCOS affect my pregnancy?
PCOS can raise the risk of gestational diabetes and high blood pressure. Good pre-pregnancy care and regular check-ups help manage these risks.
This page gives general information only. Dr. Prachi will advise on what suits you after reviewing your history and reports.
Medically reviewed by Dr. Prachi Benara, MS, DNB, MRCOG (London). Last updated October 2026.