Getting Pregnant with PCOS: A Step-by-Step Path

Why does PCOS make conception harder?

Many small follicles develop, but often none matures and ovulation does not happen. Periods become infrequent and fertile days are hard to predict. The problem is usually the regularity of ovulation, not egg numbers, so response to treatment is often good.

Step 1: Preparation

• 5-10% weight loss in women with excess weight can restore ovulation.
• Regular exercise reduces insulin resistance.
• Folic acid is started; glucose, thyroid and prolactin are checked.
• Tubal patency and the partner's semen are assessed.

Step 2: Ovulation induction

Current international guidelines recommend letrozole as first-line medication, taken on days 3-7 with ultrasound follicle tracking. Many women who ovulate conceive within a few cycles. Metformin may be added in suitable patients.

Step 3: Gonadotropins and insemination

If letrozole fails, low-dose gonadotropin injections are used with close ultrasound monitoring, because ovaries in PCOS are sensitive; a cycle may be cancelled if too many follicles develop to prevent multiple pregnancy. Insemination (IUI) is added when needed.

Step 4: IVF

IVF is used if other methods fail or there is a tubal or sperm problem. Women with PCOS usually produce enough eggs. To reduce OHSS risk, an antagonist protocol, agonist trigger and freezing all embryos for later transfer are preferred.

During pregnancy

Gestational diabetes, gestational hypertension and pre-eclampsia are more common, so early glucose assessment, a glucose tolerance test at 24-28 weeks and blood pressure monitoring are important. Regular, approved physical activity helps reduce these risks.

Prof. Dr. İkbal Kaygusuz is a co-author of numerous studies on metabolic and cardiovascular risk markers in PCOS and on gestational diabetes.

Frequently Asked Questions

The information on this website is for general information only and does not replace a medical consultation.

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