PCOS and Fertility: When Should You Consider Seeking Specialist Advice?
Updated: 9 hours ago
Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age, and one of the most frequent causes of irregular ovulation. For women trying to conceive, a diagnosis can raise many questions, including when it is time to ask for help.
The reassuring news is that many women with PCOS do conceive, naturally or with
treatment. Understanding the link between PCOS and fertility can help you recognise when specialist advice may be worthwhile.
What Is PCOS?
The NHS estimates that PCOS affects around 1 in every 10 women in the UK. International guidelines published in 2023 recommend that, in adults, it is diagnosed when at least two of the following are present and other causes have been ruled out:
Irregular or absent periods
Signs of raised androgens (“male” hormones), such as excess hair growth or acne, or
raised levels on a blood test
Polycystic ovaries on ultrasound, or a raised anti-Müllerian hormone (AMH) level
Despite the name, the “cysts” seen on ultrasound are actually small follicles containing
immature eggs.
How Does PCOS Affect Fertility?
PCOS mainly affects fertility through ovulation. When ovulation is irregular or absent, there are fewer opportunities to conceive and it is harder to identify the fertile window. PCOS is also linked with insulin resistance and a higher risk of type 2 diabetes and gestational diabetes, which is why pre-pregnancy health checks matter.
However, PCOS varies a great deal. Some women ovulate regularly and conceive without
treatment, while others need help. Having PCOS does not mean a person is infertile.
Can Lifestyle and Nutrition Help?
The 2023 international guideline recommends healthy eating and regular physical activity for all women with PCOS, whatever their weight. For women with a higher weight, even modest weight loss may help restore ovulation in some cases. The guideline does not recommend any one type of diet over another and highlights the importance of avoiding weight stigma, so a balanced, sustainable approach is generally more helpful than restrictive dieting. A registered dietitian can offer personalised advice.
Lifestyle changes are not always enough on their own, and waiting a long time to see if they work may not suit everyone, particularly as age also affects fertility.
When Should You Consider Seeking Specialist Advice?
NICE guidance generally recommends a fertility assessment after a year of trying to conceive, but also advises earlier referral for women aged 36 or over and for people with known factors that may affect fertility, such as irregular or absent periods. So if you have PCOS, you may not need to wait a full year. Consider speaking to your GP or a fertility specialist if:
Your periods are irregular, infrequent or absent and you are trying to conceive
You have been trying without success, particularly if you are in your mid-thirties or older
You have not ovulated despite first-line treatment
There are other factors, such as endometriosis, previous pelvic surgery or concerns about sperm health
Your GP can also check your blood pressure and blood glucose before you start trying, and advise on folic acid, as some women may be advised to take a higher dose.
What Happens at a Specialist Assessment?
An assessment usually involves a review of your cycle and medical history, hormone and
metabolic blood tests, a pelvic ultrasound scan, a check of the fallopian tubes where
appropriate and semen analysis for a male partner. The results help the specialist decide which treatment, if any, is most suitable.
What Treatments May Be Considered?
Treatment usually follows a stepwise approach. The 2023 guideline recommends letrozole as the first-line tablet to help women with PCOS ovulate, after a large trial found higher live birth rates than with clomifene. Letrozole is not licensed for fertility use in the UK, so your specialist will explain your options. If tablets do not work, gonadotrophin injections or, in some cases, keyhole ovarian surgery may be considered.
IVF is generally considered when other treatments have not worked or there are additional fertility factors. Women with PCOS have a higher risk of ovarian hyperstimulation syndrome (OHSS), which specialists can reduce by adjusting the medication protocol and, in some cases, freezing embryos for a later transfer.
How Does Cyprus IVF Centre Approach PCOS and Fertility?
Cyprus IVF Centre plans each PCOS case individually, taking account of medical history,
previous treatment and test results. Recognising that PCOS can make weight management more difficult, the clinic does not use BMI alone as an automatic reason to refuse treatment, although every patient still needs appropriate medical and anaesthetic assessment.Stimulation protocols are tailored with OHSS risk in mind, and patients may be advised to stay slightly longer for additional monitoring scans, provided at no extra cost.
An individualised approach cannot guarantee a pregnancy or live birth. You can read more about PCOS and fertility treatment at Cyprus IVF Centre.
PCOS Doesn’t Have to Delay Getting Advice
PCOS can affect fertility, but it can often be managed with the right support. If you have
PCOS, or symptoms that suggest it, and are thinking about pregnancy, speaking to your GP or a fertility specialist is a sensible first step.
Medical Review
Medically reviewed by the Cyprus IVF Centre Medical and Embryology Team
Last medically reviewed: 4th November 2026
Team page: https://cyprusivfcentre.com/meet-the-team-2/
References
1. Cyprus IVF Centre. Polycystic Ovary Syndrome (PCOS) & IVF in Cyprus.
clinic section (individualised protocols, approach to BMI, additional monitoring scans).
2. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 International
Evidence-based Guideline for the Assessment and Management of Polycystic Ovary
Syndrome. Fertil Steril. 2023;120(4):767–793. Supports: diagnostic criteria including
AMH, lifestyle for all women with PCOS, no single recommended diet, avoiding weight
stigma, letrozole as first-line ovulation induction, IVF as later-line treatment, OHSS risk
reduction.
3. NHS. Polycystic ovary syndrome (PCOS). https://www.nhs.uk/conditions/polycystic-
ovary-syndrome-pcos/ Supports: prevalence of around 1 in 10 women in the UK;
symptoms; long-term health risks.
4. National Institute for Health and Care Excellence. Fertility problems: assessment and
treatment (CG156). 2013, updated 2017. Supports: assessment after one year of trying;
earlier referral for women aged 36 or over or with known predisposing factors.
5. Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in
the polycystic ovary syndrome. N Engl J Med. 2014;371(2):119–129. Supports: higher live
birth rates with letrozole than clomifene.
6. NHS. Vitamins, supplements and nutrition in pregnancy. nhs.uk. Supports: higher-
dose folic acid for some women, including those with diabetes or a higher BMI.
