Polycystic Ovary Syndrome (PCOS) is the most common cause of ovulatory infertility - and one of the most treatable. If you've been diagnosed with PCOS or suspect you might have it, this guide will help you understand the condition, how it affects your fertility, and the paths forward to building your family.

Understanding PCOS: What's Really Happening

PCOS affects an estimated 10-13% of women of reproductive age worldwide, according to the WHO and the 2023 international PCOS guideline, and up to 70% of affected women may not know they have it. The guideline notes that PCOS may be more common in the Eastern Mediterranean region, which includes the UAE. Local figures vary widely depending on how studies were done: a large Dubai hospital records study found a diagnosis in under 2% of women, while a small questionnaire study of Emirati medical students suggested over a quarter might meet the criteria. The true figure for the UAE is not yet known.

In May 2026, an international consensus published in The Lancet agreed a new name for PCOS: polyendocrine metabolic ovarian syndrome (PMOS). The change is being phased in gradually, diagnostic criteria and treatment have not changed, and you will still see "PCOS" on most medical records for now.

What PCOS Is (and Isn't)

The name "Polycystic Ovary Syndrome" is actually misleading. The "cysts" on ultrasound aren't true cysts-they're immature follicles. And you can have PCOS without polycystic-appearing ovaries on ultrasound.

PCOS is fundamentally a hormonal and metabolic condition. It affects:

How your ovaries function
Your hormone balance
Often, how your body processes insulin

The Diagnostic Criteria

Doctors diagnose PCOS in adults using the Rotterdam criteria, as refined by the 2023 international PCOS guideline. You need two of these three features:

1. Irregular or absent ovulation: For adults, cycles shorter than 21 days or longer than 35 days, fewer than 8 periods a year, or no periods at all.

2. Signs of excess androgens (male hormones): This can be clinical (acne, excess hair growth) or biochemical (elevated testosterone on blood tests).

3. Polycystic ovaries on ultrasound, or a raised AMH blood test: On ultrasound, the usual threshold in adults is 20 or more small follicles in at least one ovary. Since 2023, a raised AMH level can be used instead of an ultrasound in adults.

If you have both irregular cycles and signs of excess androgens, an ultrasound or AMH test is not needed for the diagnosis.

You don't need all three features to be diagnosed with PCOS. Other conditions that mimic PCOS must be ruled out first.

The Different "Types" of PCOS

Classic PCOS: Irregular periods, high androgens, and polycystic ovaries. Often associated with insulin resistance.

Non-hyperandrogenic PCOS: Irregular periods and polycystic ovaries, but normal androgen levels.

Ovulatory PCOS: Regular periods, but high androgens and polycystic ovaries.

Lean PCOS: PCOS in women with normal body weight. Not every woman with PCOS is overweight.

How PCOS Affects Fertility

The primary way PCOS impacts fertility is through disrupted ovulation. If you're not releasing eggs regularly, pregnancy opportunities are limited.

The Ovulation Problem

In a typical cycle, several follicles begin developing, but one becomes dominant and releases an egg. In PCOS, hormonal imbalances often prevent this normal selection process. Multiple follicles start developing but none reaches maturity.

It's Not Just About Ovulation

Even when ovulation does occur, PCOS may affect fertility in other ways:

Egg quality: Some research suggests hormonal imbalances may affect egg quality.

Endometrial health: Irregular cycles can affect the uterine lining's receptivity.

Miscarriage risk: The 2023 international guideline recognises a higher risk of miscarriage in women with PCOS.

Despite all this, PCOS is highly treatable. The vast majority of women with PCOS can conceive with appropriate intervention.

PCOS Symptoms: Beyond Fertility

Common Symptoms

Menstrual irregularities: Cycles longer than 35 days, unpredictable cycles, or absent periods
Acne: Often along the jawline, chin, and chest
Hirsutism: Excess hair growth in male-pattern areas (one of the most common signs of PCOS)
Hair thinning: Male-pattern hair loss
Weight and metabolism: Many women struggle with weight management
Skin changes: Darkened skin patches can indicate insulin resistance
Mood: Higher rates of anxiety and depression

PCOS and Your Long-Term Health

PCOS isn't just a reproductive issue-it has implications for lifelong health.

Metabolic Concerns

Insulin resistance: Insulin resistance is a key part of how PCOS develops, in both slim women and those with higher weight. Routine blood tests for insulin are not recommended, because they are not reliable enough to guide care.

Type 2 diabetes risk: Women with PCOS have a higher risk of type 2 diabetes regardless of age and weight. A large review found the risk was about three times higher than in women without PCOS, and the guideline recommends regular checks, ideally with a glucose tolerance test.

Cardiovascular risk: Higher rates of high blood pressure and elevated cholesterol are associated with PCOS.

Lifestyle Modifications: The Foundation

For many women with PCOS, lifestyle changes are the first-and sometimes most effective-treatment step.

Weight Management

For women with excess weight, losing 5-10% of body weight is considered a successful, achievable goal that brings significant clinical improvements. It can:

Restore regular ovulation in some women
Improve insulin sensitivity
Reduce androgen levels
Improve response to fertility treatments

Diet Approaches

Evidence supports approaches that address insulin resistance:

Lower glycemic index foods
Balanced macronutrients
Mediterranean-style eating
Regular meal timing

Exercise

Regular physical activity improves insulin sensitivity-often quickly, even before weight changes occur.

Aim for: The 2023 guideline suggests 150-300 minutes per week of moderate activity (or 75-150 minutes of vigorous activity), plus muscle-strengthening activities on two non-consecutive days. For modest weight loss, aim for at least 250 minutes of moderate activity a week.

Medical Treatment for PCOS Fertility

For a detailed exploration of all treatment approaches, see our comprehensive guide to PCOS treatment options.

Ovulation Induction: The First Step

Ovulation induction medications are typically the first approach for PCOS-related infertility.

Letrozole (Femara): Recommended by the 2023 international PCOS guideline as the first-line medicine for PCOS-related anovulation (its use for fertility is off-label in many countries).

Why letrozole for PCOS?

Higher ovulation rates compared to clomiphene
Higher pregnancy and live birth rates, confirmed in a 2022 Cochrane review
A similar, low rate of multiple pregnancy to clomiphene

Clomiphene citrate (Clomid/Serophene): The traditional first-line treatment, still commonly used.

When First-Line Treatment Doesn't Work

Metformin: An insulin-sensitizing medication that can:

Help restore ovulation in some women (though it is less effective than letrozole or clomiphene on its own)
Improve the effectiveness of clomiphene when the two are combined
During IVF using a long agonist protocol, reduce the risk of ovarian hyperstimulation; evidence that it prevents miscarriage otherwise is limited

Gonadotropins (injectable FSH): If oral medications don't produce ovulation, injectable FSH directly stimulates the ovaries. This requires closer monitoring because PCOS ovaries are very sensitive to stimulation.

IUI for PCOS

Intrauterine insemination (IUI) is often combined with ovulation induction for women with PCOS.

Combined with ovulation induction, IUI can work well for women with PCOS whose tubes are open and whose partner's semen results are normal. Success rates vary with age and other factors, so ask your clinic for its own figures.

The number of IUI cycles before IVF varies; many clinics suggest a few cycles, and your age and other factors will guide the decision. Learn more about choosing between these options in our IUI vs IVF guide.

IVF for PCOS

When simpler treatments don't work, IVF is highly effective for PCOS.

Why IVF Works Well for PCOS

High responders: Women with PCOS typically have many antral follicles and respond well to stimulation.

Bypasses ovulation issues: Eggs are retrieved directly, so natural ovulation doesn't need to happen.

PCOS-Specific IVF Considerations

Risk of OHSS: The same high response that produces many eggs also increases the risk of ovarian hyperstimulation syndrome. To minimize this:

Lower medication doses may be used
GnRH agonist trigger instead of hCG
Freeze-all cycles allow the body to recover

IVF is effective for women with PCOS, and the 2023 guideline recommends it if first- or second-line ovulation treatments have failed.

Managing PCOS During Pregnancy

Women with PCOS need additional monitoring during pregnancy.

Increased Risks

The 2023 international guideline lists higher risks of:

Gestational diabetes
High blood pressure in pregnancy and preeclampsia
Preterm birth, and smaller babies
Miscarriage and caesarean section

What Helps

Preconception weight management
A glucose tolerance test before pregnancy or early in pregnancy, and again at 24-28 weeks
Close prenatal care

Frequently Asked Questions

Can I get pregnant naturally with PCOS?

Yes, many women with PCOS conceive naturally-it may just take longer, especially if ovulation is irregular. If you've been trying for 12 months (or 6 months if over 35) without success, see a specialist.

Is PCOS hereditary?

PCOS tends to run in families. If your mother or sister has PCOS, your risk is higher. However, genetics isn't the whole story-environmental factors also play a role.

Will losing weight cure my PCOS?

Weight loss won't "cure" PCOS, but if you have excess weight it can significantly improve symptoms and fertility. Some women begin ovulating regularly after losing 5-10% of body weight.

Do I need IVF if I have PCOS?

Not necessarily. Many women with PCOS conceive with simpler interventions like letrozole or clomiphene. IVF is typically considered if first-line treatments don't work.

Your Next Steps

PCOS is just one of several conditions that can affect fertility. For information on other conditions that may impact conception, explore our comprehensive fertility conditions guide.

If you have PCOS and are trying to conceive:

Get a clear diagnosis: Make sure other conditions have been ruled out
Understand your specific pattern: Which criteria do you meet? Do you have insulin resistance?
Optimize lifestyle factors: Even small improvements can help
Work with a specialist: A reproductive endocrinologist understands PCOS fertility treatment
Be patient but proactive: Treatment often works, but it may take several cycles

Sources

WHO: Polycystic ovary syndrome fact sheet (2026) (checked October 2026)
Teede et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS. Hum Reprod, 2023 (checked October 2026)
Teede et al. 2018 International Evidence-based PCOS Guideline recommendations. Hum Reprod, 2018 (checked October 2026)
Franik et al. Aromatase inhibitors (letrozole) for ovulation induction in PCOS. Cochrane Review, 2022 (checked October 2026)
Kakoly et al. Prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: systematic review. Hum Reprod Update, 2018 (checked October 2026)
Prevalence of PCOS at a major women's hospital in Dubai. Int J Environ Res Public Health, 2023 (checked October 2026)
Prevalence of PCOS among medical students in the UAE and Oman. Int J Environ Res Public Health, 2024 (checked October 2026)
Yale Medicine: PCOS is renamed PMOS (2026) (checked October 2026)

This content is for educational purposes only and should not replace professional medical advice. If you have PCOS and fertility concerns, please consult with a qualified healthcare provider for personalized guidance.

PCOS and Fertility: Everything You Need to Know