A Guide to Managing PCOS
for Fertility and Pregnancy

If you have polycystic ovary syndrome (PCOS), you may be wondering how it will affect your fertility journey. We’ve created this comprehensive guide to help you navigate your symptoms, treatment options, and tips to support fertility and healthy pregnancy with PCOS. Here’s what you need to know.

Table of Contents

What is PCOS?

What are the most common symptoms of PCOS?

What causes PCOS?

Why is PCOS so common today?

How to get diagnosed with PCOS?

How do you treat PCOS?

Can I get pregnant with PCOS?

PCOS and Pregnancy

PCOS and Postpartum Care

What is PCOS?

PCOS is a pattern of symptoms related to an imbalance of hormones—in particular, an excess of male sex hormones known as androgens.1

Androgens are responsible for typically “male” characteristics such as facial hair and muscle mass. However, women also produce androgens, albeit at lower levels than men. These hormones help with bone density, muscle development and sexual function. Some androgens are converted into estradiol, a form of estrogen that helps to regulate the menstrual cycle and aids in conception and pregnancy.

But women with PCOS often have higher-than-normal levels of androgens, which can lead to common symptoms such as irregular periods, excess body hair, acne and fertility issues.

What Are the Most Common Symptoms of PCOS?

Three of the most common symptoms of polycystic ovary syndrome are:

  • Absent or irregular periods caused by an absence of ovulation

  • Hyperandrogenism (high levels of androgens)

  • Multiple small cysts on the ovaries (visible on ultrasound)2

However, the symptoms of PCOS aren’t the same for everyone. In fact, many women with PCOS don’t have the namesake cysts—and up to 25 percent of women who don’t meet the criteria for PCOS have polycystic ovaries.3

Because symptoms can vary so widely, doctors often rely on a set of criteria known as the Rotterdam criteria to gauge whether someone may have PCOS.4 This requires the presence of at least two of these three symptoms to consider a PCOS diagnosis.

Additional PCOS Symptoms

In addition to the hallmark symptoms above, women with PCOS may experience:

  • Excess hair growth on the face and body, also known as hirsutism

  • Acne and/or oily skin

  • Weight gain (sometimes dubbed “PCOS belly”) and/or obesity

  • Dark patches of skin

  • Infertility5

Women with PCOS also have an increased risk of the following health conditions:

  • Metabolic syndrome (a group of conditions that can increase the risk for heart disease, diabetes and stroke)

  • Obstructive sleep apnea

  • Insulin resistance

  • Type 2 diabetes

  • Heart disease

  • Mood disorders

  • Inflammation6

What Causes PCOS?

Experts aren’t entirely sure what causes PCOS.7 Genetic and environmental factors may contribute to a woman’s risk of developing PCOS, but beyond that, it gets a bit complicated.

Up to 75 percent of women with PCOS have insulin resistance, a condition in which the cells become less responsive to insulin. This can lead to higher blood glucose levels and an increased risk of developing type 2 diabetes. Insulin resistance is also linked to some of the common symptoms of PCOS.

However, excess androgen can affect insulin sensitivity—so does PCOS cause insulin resistance, or does insulin resistance cause PCOS? The answer is still unclear. Experts sometimes refer to this as a “chicken or egg” problem with PCOS.8

Why Is PCOS So Common Today?

If you’ve been diagnosed with PCOS, you’re not alone. According to the CDC, PCOS affects up to 5 million women in the U.S.—somewhere between six and 12 percent of reproductive-aged women—which makes it one of the most common endocrine disorders among women.9

But PCOS was a relatively unknown condition until fairly recently. The condition was first described in 1935 by gynecologists Irving Freiler Stein and Michael Leventhal. Stein and Leventhal reported a series of patients who were experiencing polycystic ovaries, hirsutism and irregular cycles.10

However, it wasn’t until 1990 that the National Institutes of Health established a clinical definition for PCOS. The NIH criteria defined PCOS as the combined presence of high androgen levels and irregular periods.11

A turning point came in 2003 at a conference in Rotterdam, where experts expanded the criteria for PCOS to include hyperandrogenism, polycystic ovaries, irregular cycles and common features such as obesity and insulin resistance.12 This is the Rotterdam criteria that is still commonly used today. This standardized set of criteria has made it easier to get a diagnosis for PCOS.

How to Get Diagnosed with PCOS

Getting a PCOS diagnosis may take time and patience.

Self-assessment for PCOS can sometimes be tricky because certain symptoms—like irregular cycles, hormonal acne and weight gain—are fairly commonplace among women. If you’re experiencing multiple symptoms of PCOS, talk to a doctor.

Of course, PCOS is a complicated condition, so you may be wondering which doctor to talk to. Your primary care physician is a good place to start, as they can take note of your symptoms and refer you to specialists if needed. From there, you may be referred to an endocrinologist, who can diagnose and treat hormone imbalances. And if you’re trying to get pregnant with PCOS, a reproductive endocrinologist can guide you through fertility options.

Depending on your symptoms, you may also be referred to a:13

  • Gynecologist. An OB/GYN can help you get an irregular cycle back on track.

  • Dermatologist. Your derm can help with any skin issues related to PCOS.

  • Mental health specialist. Research suggests women with PCOS are at an increased risk of being diagnosed with anxiety, depression and other mood disorders.14 A mental health specialist can provide emotional support and help you navigate any symptoms.

Be aware that there’s no single test that can diagnose or rule out PCOS. Instead, your doctor may recommend a series of tests to get a better idea of whether PCOS may be causing your symptoms.15 These tests may include:

  • Physical exam. Your doctor will likely ask about your menstrual cycle, weight changes, and any family history of PCOS. They’ll also look for visible symptoms such as excess hair growth or acne.

  • Blood tests. Your doctor will check your androgen levels, blood glucose, and cholesterol, which can help point toward a PCOS diagnosis.

  • Pelvic exam. This can help to check for any abnormalities in your ovaries.

  • Ultrasound. An ultrasound can help your doctor check the thickness of your endometrium (the tissue that lines your uterus) for any abnormalities. An ultrasound may also reveal small cysts that are often compared to a “string of pearls.

Your healthcare providers will use the results of these tests to rule out other possible causes for your symptoms and to gain a clearer picture of your overall health.

How Do You Treat PCOS?

If you’ve been diagnosed with PCOS, your doctor may prescribe certain medications to help manage specific symptoms. This may include hormonal birth control to help regulate your menstrual cycle; medications to manage blood glucose levels or cholesterol levels; or fertility treatments to encourage ovulation, if you’re trying to get pregnant.16

However, certain lifestyle changes can also help you manage PCOS naturally. If you’re dealing with PCOS, make these healthy habits a priority:

1. Stress Management

Stress relief techniques such as meditation, acupuncture, or deep breathing can have a ripple effect that benefits your hormone balance, sleep habits and overall health.

2. Sleep

Research suggests poor sleep quality is associated with an increased risk of obesity and insulin resistance17—which makes good sleep vital for those with PCOS.

3. Exercise

Regular exercise can help to manage your stress levels, hormones, and blood sugar levels. If you don’t feel up to a high-intensity workout, opt for gentle movement like a long walk.

4. Nutrition

Maintaining healthy blood sugar levels is key when you have PCOS. To help avoid blood sugar spikes and crashes, minimize refined carbs and balance your plate with protein, fiber, healthy fats and anti-inflammatory foods.

(Need more tips? Here’s what to eat with PCOS.)

5. Supplements

Certain supplements can help you manage PCOS symptoms naturally. Perelel’s PCOS Support can help to maintain your hormonal balance, mood, and menstrual cycles and promote healthy ovulation.

PCOS Support*

PCOS Support helps to maintain your hormonal balance, mood, regular menstrual cycles, and promote healthy ovulation and ovarian function.*


6. Support

Don’t do it alone. Build a team of healthcare providers who understand the complexity of PCOS and treat you as an individual. You can also find a community by reaching out to other women with PCOS for support and advice.

Can I Get Pregnant with PCOS?

Yes! PCOS may make it more challenging to get pregnant because higher androgen levels can interfere with ovulation.18 However, it’s still possible to have a healthy pregnancy with PCOS.

Making healthy adjustments to your sleep, nutrition, and exercise habits can help to support hormone balance, ovulation and fertility. If needed, your doctor may also prescribe a fertility medication to help induce ovulation. In rare cases, IVF may be recommended to help you grow your family.

5 Tips for Supporting Fertility with PCOS

If you’re trying to conceive, you may be wondering how PCOS will affect your family planning. Good news: There are steps you can take to help increase your chances of pregnancy.

1. Maintain a Healthy Weight

Keeping your BMI within a healthy range can help to improve cardiovascular risk factors and support ovulation.20

2. Exercise

Regular exercise has been linked to improvements in menstrual regularity, ovulation, weight loss, and reduced insulin resistance.21

3. Eat to Support Fertility

Research suggests a low-glycemic diet can help to improve insulin sensitivity and maintain healthy blood glucose levels.22 To get the most out of your diet, load up your plate with foods that support fertility by providing important nutrients like folate, omega-3 fatty acids, iron and antioxidants.

4. Supplement Your Diet

Fill in any nutritional gaps in your diet with a supplement designed to support fertility. Perelel’s Conception Support Pack can help prepare your body for pregnancy with a core prenatal vitamin plus omega DHA and EPA, CoQ10 and folate.

Conception Support Pack*

Help prepare your body for pregnancy with antioxidant support, added omegas, additional folate and a full-spectrum prenatal vitamin.*


5. Talk to Your Doctor

Some women with PCOS require medication to induce ovulation or regulate hormones. If these treatments don’t help, your doctor may recommend egg retrieval and IVF.

PCOS and Pregnancy

PCOS can increase the risk of certain pregnancy complications, but you can help to mitigate these risks with healthy lifestyle changes.

Women with PCOS have an increased risk of developing gestational diabetes23—so continue to maintain a healthy diet throughout your pregnancy, with a focus on low-glycemic foods that won’t spike your blood sugar and insulin levels.

Prenatal care is vital to a healthy pregnancy with PCOS, so be sure to adhere to any scheduled appointments and bloodwork. Your doctor will monitor you for complications like high blood pressure and gestational diabetes and can recommend pregnancy-safe exercises to help manage PCOS symptoms.

Taking a prenatal vitamin designed for your current stage of pregnancy can also help to ensure you’re getting the nutrients you need to support you and your baby, every step of the way.

Can PCOS Pose Any Health Risks During Pregnancy?

In addition to the general health risks associated with PCOS, women with PCOS are also at a higher risk for certain pregnancy complications.19 These may include:

  • Miscarriage or early pregnancy loss

  • Gestational diabetes

  • Preeclampsia

  • Pregnancy-induced high blood pressure

  • Preterm birth

  • Cesarean delivery

  • Time spent in the NICU after delivery

If you’re currently pregnant or trying to conceive, talk to your doctor about what steps you can take to promote a healthy pregnancy and delivery with PCOS.

PCOS and Postpartum Care

PCOS is a lifelong condition, so while you’re basking in the glow of new motherhood, it’s important to continue monitoring and managing your PCOS symptoms.

Hormonal fluctuations after pregnancy and while breastfeeding can affect your PCOS symptoms, so it may take some time for your body to readjust.24

However, PCOS is associated with an increased risk for certain postpartum complications, including cardiovascular risks, postpartum preeclampsia, and postpartum depression25—so if you experience any worrisome symptoms, let your doctor know.

As you adjust to life with a new baby, continue to follow a nutrient-rich, low-glycemic diet and fill in any nutritional gaps with a postpartum supplement. When you feel ready, ease into gentle exercises like walking or restorative yoga.

Above all, make self-care a priority as you adapt to your new role as a mom. Take a relaxing bath, connect with a friend, practice mindfulness exercises, or read a good book. These simple steps can help you maintain your mental well-being and your self-identity as you continue to navigate life with PCOS.

Mom Multi Support Pack

Support throughout motherhood with a full-spectrum multivitamin, added omegas for mood support, a beauty blend for hair and skin support, and an anti-stress blend.*


*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any diseases.

1 Cleveland Clinic: Androgens

2 National Institutes of Health: About Polycystic Ovary Syndrome (PCOS)

3 Sydney Chang MD and Andrea Dunaif MD; Diagnosis of Polycystic Ovary Syndrome: Which Criteria to Use When?; Mar 2021

4 Weixuan Chen and Yanli Pang; Metabolic Syndrome and PCOS: Pathogenesis and the Role of Metabolites; Dec 2021

5 National Institutes of Health: About Polycystic Ovary Syndrome (PCOS)

6 National Institutes of Health: Are there disorders or conditions associated with PCOS?

7 National Institutes of Health: Polycystic Ovary Syndrome (PCOS)

8 P Moghetti and F Tosi; Insulin resistance and PCOS: chicken or egg?; Feb 2021

9 CDC: PCOS (Polycystic Ovary Syndrome) and Diabetes

10 Ricardo Azziz and Eli Y Adashi; Stein and Leventhal: 80 years on; Feb 2016

11 Marla E Lujan et al; Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies; Aug 2008

12 Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS); Jan 2004

13 PCOS Awareness Association: What Types of Health Providers Understand PCOS?

14 Claire Brutocao et al; Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis; Nov 2018

15 National Institutes of Health: How do healthcare providers diagnose PCOS?

16 NHS: Polycystic Ovary Syndrome Treatment

17 Maryam Bahman et al; The Importance of Sleep Hygiene in Polycystic Ovary Syndrome from the View of Iranian Traditional Medicine and Modern Medicine; Oct 2018

18 CDC: PCOS (Polycystic Ovary Syndrome) and Diabetes

19 National Institutes of Health: Does PCOS affect pregnancy?

20 Shital Sawant and Priya Bhide; Fertility Treatment Options for Women With Polycystic Ovary Syndrome; Dec 2019

21 Shital Sawant and Priya Bhide; Fertility Treatment Options for Women With Polycystic Ovary Syndrome; Dec 2019

22 Homeira Hamayeli Mehrabani et al; Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study; Apr 2012

23 Xiaocui Li MD et al; The risk factors of gestational diabetes mellitus in patients with polycystic ovary syndrome; Aug 2021

24 PCOS Awareness Association: PCOS Pregnancy and Delivery Complications

25 Snigdha Alur-Gupta MD MSCE et al; Postpartum complications increased in women with polycystic ovary syndrome; Aug 2020