PCOS and pregnancy: getting pregnant and having a healthy pregnancy

PCOS and pregnancy: these two notions are often associated with many questions when a baby project begins. Polycystic ovary syndrome (PCOS) is indeed one of the primary causes of irregular cycles and can sometimes make conception less predictable. However, having PCOS does not mean giving up on having children.

With a structured and personalised approach, it is entirely possible to get pregnant with PCOS and experience a serene pregnancy. It is essential to keep in mind that PCOS and pregnancy are compatible.

Understanding the link between PCOS and fertility helps to put words to what is happening: why cycles can be irregular, why ovulation can be less predictable, and above all, how to act in a progressive and reassuring way. This clarification helps to move away from preconceived ideas and build a clearer baby project, based on simple physiological benchmarks.

PCOS is a complex and common hormonal syndrome that affects approximately 1 in 10 women of childbearing age. It is not just an ovarian problem. Polycystic ovary syndrome is often associated with a metabolic imbalance.

The diagnosis is based on three main criteria:

• irregular or absent cycles,
• excess androgens (so-called "male hormones"),
• a multifollicular appearance of the ovaries on ultrasound.

Not all women experience the same symptoms. Some consult for irregular cycles due to PCOS, others for persistent acne, excessive hair growth, or unexplained resistance to weight loss.

In a pregnancy project with PCOS, the central point is ovulation. In a typical cycle, a follicle matures and then releases an egg. With PCOS, this process can be disrupted: follicles begin their development but struggle to lead to effective ovulation.

As a result, cycles can lengthen (often beyond 35 days) and ovulation becomes more difficult to pinpoint, as it can occur late or unpredictably. In some cases, there may even be anovulation with PCOS, meaning an absence of ovulation. To this is often added insulin resistance. High insulin levels stimulate androgen production, which maintains the vicious cycle of hormonal and metabolic disorders.

Understanding this mechanism is essential: it allows for targeted action in women with PCOS who wish to conceive.

Fortunately, many levers exist. The objective is to de-dramatise and build a progressive and personalised strategy. Early pregnancy support helps to avoid wandering and provides a reassuring framework.

As a general rule, a consultation is recommended after 12 months of trying if the woman is under 35, after 6 months if over 35, and earlier in cases of marked irregularity. If cycles are very spaced out or absent, or in cases of confirmed PCOS, it is advisable to consult quickly, as this helps to clarify the central point: ovulation.

In women with PCOS, early support avoids wandering, provides a reassuring framework, and personalises the steps (age, duration of the baby project, medical history, symptoms, already performed examinations).

Reference table: when to seek advice

Regardless of women's profiles, lifestyle is an integral part of care at all stages of life. 

Improving insulin sensitivity can be enough to restore more regular ovulation.

• When overweight, moderate weight loss can improve certain metabolic parameters and restart ovulation in some women.
• A diet with a moderate glycemic index and balanced can help stabilise insulin.
• Regular physical activity (brisk walking, swimming, cycling, gentle strengthening) improves metabolic function and supports mood and sleep.
• Sleep and stress management support hormonal and metabolic balance.

An often overlooked point: the frequency of intercourse. When cycles are irregular, it is advisable to have intercourse at regular intervals and not wait for ovulation day, as it remains unpredictable in some women with PCOS. The frequency of intercourse for conception is 2 to 3 times per week.

For women with PCOS who wish to conceive, certain nutrients are particularly studied. Supplementation in the preconception period is recommended to support hormonal and metabolic balance and support fertility.

Myo-inositol plays a central role and is one of the most studied active ingredients in the management of PCOS. Scientific literature suggests its interest due to its mode of action: it acts as a second messenger for insulin and could improve the regularity of ovulation. The recognised dose is 4g of myo-inositol per day.

It is recommended to ensure sufficient folic acid intake from the start of the pregnancy project. This B vitamin contributes to cell division and the growth of maternal tissues during pregnancy. Folic acid supplementation before conception is also recommended for all women wishing to conceive to reduce the risk of neural tube defects in the fetus. The dose recommended by authorities to date is 400 micrograms at least one month before conception and during the first trimester of pregnancy. 

In women with polycystic ovary syndrome, it may also be relevant to ensure adequate vitamin D status, a vitamin frequently insufficient in the general population. Vitamin D contributes to the normal functioning of the immune system and the maintenance of normal muscle function. It also participates in the process of cell division, an essential mechanism in the early stages of embryonic development.

Zinc is also an interesting micronutrient to consider in a pregnancy project. This trace element contributes to normal fertility and reproduction, as well as to maintaining a normal metabolism and the normal functioning of the immune system. 

Selenium is a trace element that contributes to protecting cells against oxidative stress and participates in the normal functioning of the immune system as well as the normal functioning of the thyroid gland. 

Omega-3s have beneficial effects on hormonal and metabolic disorders in women with PCOS. In addition, they contribute to proper cardiovascular function (especially EPA) and normal brain function (especially DHA). In the context of a pregnancy project, they are beneficial for the woman and the proper brain and visual development of the child. For women with PCOS, ensuring adequate omega-3 intake can thus be part of a global nutritional approach aimed at supporting dietary balance before and during pregnancy.

Chromium is a trace element that contributes to the maintenance of normal blood glucose levels and the normal metabolism of macronutrients (carbohydrates, lipids, and proteins). In the context of PCOS, where glucose metabolism disorders can be observed in some women, ensuring sufficient nutritional intake of chromium can be part of a global approach aimed at supporting metabolic balance, particularly in the context of a pregnancy project.

In cases of PCOS, ovulation can be irregular or sometimes absent. The support therefore aims to promote more regular and better quality ovulation, while respecting a progressive approach. In practice, management is often organised in several steps, ranging from the most natural measures to medical treatments if necessary.

The first step is to optimise lifestyle: balanced diet, regular physical activity, quality sleep, and stress management. In this context, certain nutritional supplements may be offered to support metabolic and hormonal balance, particularly Myo-inositol, as well as Vitamin D, Zinc, or Omega-3s.

If cycles remain very irregular, ovulation stimulation may be considered. The goal is to adapt the strategy to each woman's journey.

A comprehensive assessment allows for adapting the journey and supporting women at each stage.

A hormonal assessment is often suggested to better understand the cycle's functioning and identify any hormonal imbalances. For women with PCOS, the assessment mentioned here is general, and specific tests may be requested to pinpoint hormonal and metabolic disorders.

A pelvic or transvaginal ultrasound complements this assessment by observing the morphology of the ovaries and looking for a multifollicular appearance, characteristic of PCOS. This examination also helps to assess ovarian reserve.

Together, these examinations offer a global view of hormonal and ovarian function, essential for adapting the support strategy and optimizing the chances of pregnancy.

PCOS is frequently associated with insulin resistance. This is why a metabolic assessment is often proposed before a pregnancy project, including fasting blood glucose and sometimes an oral glucose tolerance test (OGTT) and a lipid panel. Early identification of a glucose metabolism imbalance allows for proactive measures through lifestyle adjustments or medical support, to improve metabolic balance and limit certain risks during pregnancy, such as gestational diabetes.

Fertility is a couple's journey. In almost one-third of cases, a male factor is involved. The partner's assessment is necessary during a pregnancy project.

Once pregnant, most women experience a normal pregnancy. Nevertheless, pregnancy monitoring helps prevent certain disorders.

Throughout pregnancy, regular obstetric monitoring ensures the baby's proper development and the smooth progression of the pregnancy. For women with PCOS, particular attention is often paid to weight gain and certain metabolic parameters. Consultations allow for adjusting advice on diet, physical activity, and lifestyle, in a preventive and benevolent approach.

In women with PCOS, gestational diabetes is slightly more common due to a tendency towards insulin resistance. An OGTT screening is generally offered during pregnancy, most often between the 24th and 28th week of amenorrhea. When identified early, it can most often be well controlled through an adapted diet and regular monitoring. Otherwise, medication may be prescribed.

Blood pressure is also monitored during pregnancy in all women. Women with PCOS may have a slightly higher risk of preeclampsia. Blood pressure is therefore measured at each prenatal consultation to quickly detect any abnormalities.

Living better during pregnancy with PCOS: some tips

Beyond biological parameters, the pregnancy project is also an emotional experience.

Beyond biological parameters, the pregnancy project is also an emotional experience.

Implementing small daily routines during pregnancy can help better manage fatigue and stress. Simple practices such as conscious breathing, regular walking, or heart coherence contribute to calming the nervous system and supporting overall balance during pregnancy.

During pregnancy, the goal is not to follow a strict diet, but to maintain a balanced and varied diet. Structured meals, rich in fiber, protein, and good fats, help sustain energy daily and avoid overly significant glycemic variations.

In the absence of contraindications, regular gentle activity (walking, swimming, prenatal yoga, gentle strengthening) often helps with better sleep and stress management. The best choice is one that respects current energy levels and fits into daily life.

Finally, it is important not to face questions or emotions alone during this period. A healthcare professional (gynecologist, midwife, etc.) helps to understand, reassure, and clarify information. Relatives can lighten the logistical burden, thus reducing mental load. And if anxiety becomes overwhelming, psychological support can be offered. Talk to a healthcare professional.

• Recommendations from the 2023 International Evidence-based Guideline (synthesis and publication).
• Meta-analysis (2024) of pregnancy outcomes in women with PCOS (GDM, hypertension, etc.).
• Systematic review and meta-analysis on inositol in PCOS (JCEM).
• EFSA: folates and maternal tissue growth during pregnancy (2009;1213).
• EFSA: zinc and claims including fertility and reproduction (2009;1229).
• EU/EFSA: selenium and "contributes to normal spermatogenesis" (EU register + EFSA opinion).
• EFSA: chromium and maintenance of normal blood glucose levels (2010;1732).