Creator: Dr. Devang Patel
Published: 2026-09-19

Polycystic ovary syndrome (PCOS, often called PCOD in India) is one of the most common hormonal conditions in women of reproductive age, and one of the most common reasons women come to a gynaecologist when they are planning a family. A diagnosis can make conception feel uncertain. In reality, most women with PCOS who want a baby are able to have one - some naturally, and many with simple, well-tested treatment. Planning ahead also lowers the chance of complications such as gestational diabetes during pregnancy.

Why PCOS can make conception slower

PCOS is diagnosed when at least two of three features are present (the Rotterdam criteria): irregular or absent ovulation, signs of high male hormones such as acne or excess facial hair, and ovaries with many small follicles on ultrasound. The main reason for difficulty conceiving is that ovulation - the release of an egg - happens irregularly or not at all. Insulin resistance, which is common in PCOS whether or not a woman is overweight, makes this worse.

Irregular periods are the clearest clue. If your cycles are longer than 35 days, or you have fewer than eight to nine periods a year, you are probably not ovulating every month.

Step 1: prepare your body before trying

Start folic acid at least three months before trying to conceive; your doctor may advise a higher dose if your BMI is above 30
If you are overweight, losing even 5 to 10 percent of your body weight can restore regular ovulation in many women
Aim for at least 150 minutes of moderate activity a week - brisk walking, cycling, swimming or yoga - plus some strength exercises
Cut down on sugar, sweets, refined flour, sweetened drinks and fried snacks; choose millets, dal, vegetables, curd and paneer
Get a pre-pregnancy check: blood sugar (HbA1c or glucose tolerance test), thyroid, haemoglobin, vitamin D, BP and rubella immunity
Stop smoking and avoid alcohol; your partner should do the same

Step 2: understand your cycle

Knowing when, or whether, you ovulate is useful. Ovulation usually happens about 14 days before the next period, not 14 days after the last one, so with long cycles it comes later.

Ovulation predictor kits can help, but may give false positives in PCOS because the LH hormone can be high all the time
A blood progesterone test about seven days before the expected period confirms whether ovulation happened
Follicle-tracking ultrasound scans show the egg follicle growing and releasing, and are commonly used during treatment
Regular intercourse every two to three days through the cycle removes the need to time it exactly

Step 3: treatment to help ovulation

If periods remain irregular after lifestyle changes, or if you have been trying for some months without success, medicines to induce ovulation are usually the next step. According to the 2023 international evidence-based PCOS guideline:

Letrozole tablets are the first-line medicine to induce ovulation in PCOS, taken for five days early in the cycle, with ultrasound monitoring
Clomiphene is an alternative, sometimes combined with metformin
Metformin improves insulin resistance and can help ovulation in some women, particularly those with a higher BMI
Gonadotrophin injections or laparoscopic ovarian drilling are options if tablets do not work
IVF is considered when other treatments have not succeeded or when there are other factors, such as blocked tubes or a low sperm count

Before starting treatment, a semen analysis for your partner and, in some cases, a test of the fallopian tubes are advised, so that time is not lost on treatment that cannot work.

Do not take fertility tablets from a pharmacy or a relative’s prescription without monitoring. Ovulation medicines need ultrasound follow-up to check the response and to lower the chance of twins or over-stimulation of the ovaries.

Step 4: a healthy pregnancy with PCOS

Once pregnant, women with PCOS have a higher chance of some complications, and the antenatal plan takes this into account.

Gestational diabetes: an early sugar test in the first trimester, repeated at 24 to 28 weeks
High blood pressure and pre-eclampsia: regular BP checks, and low-dose aspirin if your risk assessment suggests it
Miscarriage: the risk is slightly higher, linked mainly to weight and insulin resistance
Preterm birth and a baby that is either larger or smaller than expected: monitored with growth scans
Continue a balanced diet and gentle activity throughout pregnancy

Whether metformin should be continued once you are pregnant is decided individually - do not stop or start it on your own. An early dating scan at around 7 weeks is useful, especially after ovulation induction, to confirm the pregnancy is in the uterus, check the number of babies and set an accurate due date when cycles were irregular.

PCOS is also a long-term condition. After pregnancy, maintaining a healthy weight, staying active and having periodic checks of sugar, cholesterol and blood pressure lower the risk of type 2 diabetes and heart disease later in life. If periods stay very infrequent after you finish breastfeeding, treatment to protect the lining of the uterus may be recommended.

When to see a doctor

If you have PCOS and are under 35, see a doctor if you have not conceived after 12 months of trying, or sooner if your periods are very irregular or absent - there is no benefit in waiting a year if you are not ovulating. If you are 35 or older, seek advice after six months. At Divine Women’s Hospital, Gota, Dr. Devang Patel and the team manage PCOS from pre-pregnancy planning and ovulation induction through to antenatal care and delivery.

More patient guides

This guide is general information for patients and does not replace a consultation with your own doctor.

PCOS and pregnancy: how to plan, conceive and stay healthy