Do you need fertility treatment or can you conceive naturally with PCOS?

Although PCOS is the single most common cause of infertility in young women, it’s important to know that not everyone with PCOS struggles to conceive. Over 80% of couples will conceive within their first year of trying, so although 12 months may sound like a long time it’s still considered ‘normal’ for conception to take this long.

In the UK you can be referred for fertility investigations if you have been unsuccessful in trying to conceive for 12 months (or 6 months if you are over 35).

Before starting fertility treatment, it’s important to consider whether you have made the correct lifestyle changes to support conception, including:

- Quitting smoking

- Reducing your alcohol intake

- Choosing foods that nourish your body (and making sure that you are eating enough)

- Exercising most days of the week

- Not consuming too many foods high in fats and sugars

- Reducing/managing your stress levels

- Getting enough sleep

- Having sex every 2-3 days

This may sound like very basic advice, however, if done correctly these changes can have a very positive impact on fertility and can even restore fertility in those with anovulatory PCOS (those with PCOS who don’t ovulate). And remember, it takes two to tango so both you and your partner should be making these changes together.

What happens once you’ve been referred for fertility treatment?

The first step is to have further investigations done. For men this includes a semen analysis, for women it includes extensive blood tests to ensure there are no other causes of infertility, beyond your PCOS. You will then be monitored to see whether you ovulate during your next cycle and assessed for any tube blockages. 

For more information on the next steps and process around semen analysis, read more on male infertility here.

The process may be different based on your location and the
NHS protocol in your area, however most areas follow the NICE (National institute for Health & Care excellence) guidelines which make the following recommendations for women with PCOS: 

- Clomifene citrate (Clomid) OR

- Metformin OR

- A combination of the two

How do Clomid & Metformin work?

Clomid is a medication (taken orally) which stimulates the ovaries to produce a mature egg (ovulation). You will be told to start taking Clomid on day 2 of your cycle for five days. You will usually be started on a dose of 50mg, but this may be increased if you do not ovulate on 50mg. Whilst taking Clomid you will be asked to go in for a scan to observe if your body is responding to the medication. Treatment with Clomid is repeatable for up to 6 cycles.

There are side-effects associated with taking Clomid which include hot flushes, breast discomfort, headaches, bloating, dizziness, and mild depression. But these stop when you stop taking the medication.

Metformin can be administered instead of, or alongside, clomid in those with PCOS. This is to help treat the insulin resistance that is so often seen in PCOS which results in elevated insulin levels. These elevated insulin levels can impact the maturation of follicles in the ovaries and result in anovulation (a month where you don’t ovulate), therefore the thinking is that as metformin can increase sensitivity to insulin it can help lower insulin levels and therefore allow for ovulation to occur. It’s important to note that there are unpleasant side-effects to taking metformin and lifestyle changes including taking supplements like inositol can improve sensitivity to insulin without the nasty side-effects.

What about your BMI and the impact that has on treatment?

If you have a BMI above 25kg/m2 you may have trouble accessing clomid. Some believe that Clomid is less successful in those with larger bodies. This is usually because people in larger bodies require larger doses for the medication to be as effective, and most studies don’t take this into account. There are studies where the dose has been adjusted according to body size and conception rates were the same in all body sizes once ovulation occurred. 

If you are struggling to gain access to Clomid due to your body size, then I’d recommend taking the studies by Lobo et al., and Dickey et al., along with you to show your practitioner that it can be used successfully if the dose is adjusted accordingly.

What if Clomid or Metformin are not successful?

If these options are unsuccessful, then you may be offered other treatments (depending on the reason why the above options were deemed unsuccessful) or assisted conception such as intrauterine insemination or IVF.

Accessing support during fertility treatment

Undergoing fertility treatment can be incredibly stressful, this may have a negative impact on your relationship with your partner and result in decreased libido – kind of the last thing you need whilst trying to conceive, right? It’s important to remember that this isn’t an easy journey, and you don’t have to go it alone. It is recommended that all couples undergoing fertility treatment join a fertility support group and receive counselling – don’t hesitate to ask your practitioner to refer you for counselling or other forms of support that they have available. There are also amazing communities like The PCOS Collective where you can connect with other with PCOS who may be on a similar journey.


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Franca Fruzzetti, Daria Perini, Marinella Russo, Fiorella Bucci & Angiolo Gadducci (2016): Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS), Gynecological Endocrinology, DOI: 0.1080/09513590.2016.1236078

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about the author

Jodie Relf is a registered dietitian and qualified Pilates instructor who is passionate about empowering women to take control of their PCOS symptoms naturally.

Having personally experienced the challenges of being diagnosed with PCOS in her early twenties and feeling frustrated with the lack of evidence-based advice and treatment available, Jodie made it her mission to specialise in this area.