Some 70%-80% of women with PCOS experience infertility – an inability to conceive after at least 12 months of regular unprotected sex. It’s very common and extremely distressing but, thankfully, doesn’t mean that pregnancy is an impossibility (in fact, research has found that the majority of people with PCOS trying to conceive will fall pregnant and give birth without any fertility treatment at least once).

There are lots of factors that come into play where fertility is concerned – and many will require the support of medical experts. However, there are some lifestyle habits that, when adopted, can optimise fertility outcomes for those with PCOS trying to become pregnant.

What’s PCOS got to do with infertility?

There’s still lots that experts don’t understand about the causes and symptoms of PCOS, however, it’s widely thought that infertility in women with PCOS is caused by a hormonal imbalance.

Hormonal imbalances (high levels of androgens – commonly called “male” hormones, such as testosterone – and high levels of lutenizing hormone (LH)) are found to be present in many women with PCOS. Androgens and LH are key players in stimulating ovulation – the process which enables a mature follicle to be released by the ovaries ready for fertilisation if it comes into contact with sperm. However, if LH and androgen levels are too high, this can disrupt ovulation. And if ovulation doesn’t occur, neither can pregnancy.

If you’re experiencing fertility difficulties as a symptom of PCOS, talk to your GP about treatment options available to you to help you conceive. In the meantime, here are 5 fertility-promoting lifestyle changes to give you the best chance of falling pregnant.

5 ways to improve female fertility 

1. Eat well by loading up on nutrients

Let’s squash a rumour first and foremost: there isn’t one singular diet for improving fertility. That said, there’s evidence to suggest that following a Mediterranean diet could improve your chances of conceiving.

In a nutshell, eating a Mediterranean diet involves: loading up on fruits, vegetables, and plant-based protein, incorporating whole grains, eggs, dairy (a moderate amount), and unsaturated fats (such as olive oil and nuts) into meals and getting your omega 3 fatty acids (from oily fish and some seeds).

Omega-3 has also been linked with supporting fertility. In a study from 2022, researchers found that women taking omega-3 supplements were more than two times more likely to conceive in a given menstrual cycle. 

A paper from Reproductive Biology and Endocrinology in 2018 found that omega-3 fatty acid may improve insulin resistance and decrease total cholesterol in people with PCOS. 

Current advice from the NHS is to get enough omega-3 from food by having one portion of oily fish a week (around 140g). Be wary of eating too much fish that may contain pollutants and fish oil supplements that can be high in vitamin A, both of which can be harmful during pregnancy. 

2. Supplement where necessary

Fertility-promoting nutrients include:

• Folate/folic acid
• Iron
• Vitamin E
• Vitamin C
• Zinc
• Selenium
• Choline
• Iodine
• B vitamins

'Everyone who is trying to conceive should be taking folic acid,' reminds Okell. While this nutrient is mainly taken to reduce the risk of problems in the baby’s development in the early weeks of pregnancy, 'folic acid supplementation has also been seen in some studies to help conception rates in people with PCOS.'

She also recommends pairing that with inositol, a B-like vitamin that is naturally produced in the body and can improve symptoms of PCOS by helping lower insulin and testosterone levels. 

In a study from 2018, 3602 people with PCOS who couldn’t get pregnant were given 4000mg of myoinositol and 400mcg of folic acid every day. 70% of the participants restored their ovulation and 545 people (over 15% of the study) fell pregnant. 

Finally, in the winter months, everyone in the UK should be supplementing with vitamin D, too. 'Vitamin D levels play a role in fertility and affect the outcomes of IVF, in people with and without PCOS,' adds Okell. 

You can get most of these nutrients by following a nutritious and varied diet. However, if you’re pregnant or trying to conceive, the NHS recommends taking:

• A folic acid supplement – 400 micrograms every day from pre-conception right up until you’re 12 weeks pregnant to reduce the risk of developmental problems in the early stages of pregnancy.
• A daily vitamin D supplement – at least 10 micrograms a day. Research indicates that adequate levels are associated with more positive pregnancy tests and live births.

3. Cut back on alcohol

Evidence suggests that alcohol can negatively impact fertility, though it isn’t yet fully understood how. The NHS advises not exceeding 1-2 units of alcohol once or twice a week if you’re trying to conceive.

4. Move your body

Regular exercise is essential for everyone, but people with PCOS need to be more cautious about their training. While many workouts can be a stress reliever, doing too much or too intense exercise can have the opposite effect, warns Alex Okell, Alex Okell, a registered associate nutritionist and founder of non-diet education hub The PCOS Collective.

'High-intensity workouts a few times a week are great if you enjoy them but if all your movement is high intensity then the amount of stress on your body will increase. This means that there may be higher circulating levels of cortisol (a stress hormone) which negatively impacts PCOS and fertility by boosting insulin levels and disrupting the balance of female hormones in the body,' she says. 

Instead, balance your workouts between intense movement and gentle activity like walking and yoga that reduce blood sugar and stress levels. Strength training is also brilliant for metabolic health which can support hormone levels.

5. Prioritise rest and mental wellbeing

Often burning the candle at both ends? Stop! Research has found a link between lack of quality sleep and fertility issues in women.

To step up your sleep game, get into the habit of following a nighttime routine. Turn devices off an hour or so before bed, get tucked up at the same time every night, and enjoy a calming activity (think: reading, journaling, meditating) before drifting off.

Try to minimise stress and prioritise your mental wellbeing throughout the day too, by taking regular rest breaks, setting boundaries with friends and colleagues, and steering clear of habits (such as social-scrolling) that increase feelings of stress or anxiety. Although these haven’t necessarily been directly linked to infertility, high levels of stress can interfere with sleep quality and have a negative impact on mental wellbeing.

Reducing stress is easier said than done when struggling with something like fertility issues. But the catch-22 is that the more stressed you are, the harder it might be to conceive. 'Stress massively impacts fertility. Continued cortisol production increases insulin levels, affecting female hormone balance. Focus on prioritising your sleep and rest and reducing external stress levels where possible,' says Okell. 

That might mean being stricter with your work/life balance, cancelling plans that mean you’re booked back-to-back without any rest or spending extra time around loved ones who make you feel good. Most importantly, if you are worried about your chances of conceiving always talk to your doctor or healthcare provider who can support you.

6. Try to regulate your periods

To enable conception, you need to be regularly ovulating and this means having a regular menstrual cycle.  It is well known that if you suffer from PCOS it is likely that your periods are either absent or very irregular.  Myo-inositol can help by regulating your insulin levels which in turn can balance your body and help regulate your cycle.

When is the best time to make fertility-promoting lifestyle changes?

If you’re planning a pregnancy, then three months prior to conception is the opportune time to begin making fertility-promoting lifestyle changes. This is because it takes 90 days for an egg to develop and mature before it’s released during ovulation.

That said, introducing fertility-promoting habits at any time can be beneficial for optimising your chances of conceiving and having a healthy pregnancy.

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