PCOS and Fertility: How to Improve Your Chances Naturally

If you've been diagnosed with PCOS and you're wondering whether pregnancy is still possible, you're far from alone — and the answer is genuinely encouraging. Polycystic ovary syndrome affects between 8% and 13% of women of reproductive age worldwide, making it one of the most common — and most treatable — causes of female infertility.¹ PCOS disrupts the hormonal signals that trigger ovulation, but here's the thing: it doesn't mean you can't get pregnant. With the right combination of lifestyle changes, nutritional support, and medical treatment when needed, many women with PCOS conceive successfully — either naturally or with assistance.

We wrote this guide to walk you through how PCOS affects fertility at the biological level, which evidence-based strategies can improve your chances of conceiving, and when it makes sense to seek medical support. Every recommendation here is grounded in peer-reviewed research and current clinical guidelines — because you deserve clear answers, not guesswork.

 

How Does PCOS Affect Your Ability to Get Pregnant?

We hear this question all the time, so let's break it down. PCOS affects fertility primarily by disrupting ovulation — the monthly release of an egg from your ovaries. In a typical cycle, rising levels of follicle-stimulating hormone (FSH) prompt a follicle to mature and release an egg. But when you have PCOS, elevated levels of androgens (male-type hormones such as testosterone) and insulin interfere with this process, causing your follicles to stall at an immature stage rather than completing development.²

Here's what that hormonal disruption looks like in practice. Excess insulin stimulates the ovaries to produce more androgens, which in turn suppress FSH and disrupt the luteinising hormone (LH) surge needed to trigger ovulation.³ The result is irregular or absent periods — a hallmark of PCOS — and fewer opportunities for conception each year. While women with regular cycles may ovulate 12–13 times per year, you may ovulate only a few times, or not at all.

Here's the part I find most reassuring: anovulation in PCOS is not permanent or irreversible. Unlike conditions that reduce your egg reserve, PCOS typically preserves or even elevates anti-Müllerian hormone (AMH) levels, indicating a large pool of follicles available for maturation.⁴ The challenge isn't a lack of eggs — it's a hormonal environment that prevents them from being released. And that's exactly why interventions targeting insulin resistance, androgen levels, or ovulatory signalling can support the return of regular ovulation — often without assisted reproductive technology.

 

What Are the Four PCOS Phenotypes and Why Do They Matter for Fertility?

So many of you have asked why your PCOS experience looks so different from someone else's — and the reason is that not all PCOS presents the same way. The Rotterdam criteria identify four distinct phenotypes based on combinations of three features: hyperandrogenism (excess androgens), oligo-anovulation (irregular or absent ovulation), and polycystic ovarian morphology (PCOM) on ultrasound.⁵ Understanding your phenotype helps predict your fertility outcomes and tailor your treatment strategy.

Phenotype	Features Present	Metabolic Risk	Fertility Impact	Typical Approach
A (Classic)	Hyperandrogenism + Oligo-anovulation + PCOM	Highest — significant insulin resistance	Most severe anovulation	Lifestyle + medication usually needed
B (Classic Non-PCOM)	Hyperandrogenism + Oligo-anovulation	High — similar to Phenotype A	Severe anovulation	Lifestyle + medication usually needed
C (Ovulatory)	Hyperandrogenism + PCOM	Moderate — milder insulin resistance	Mild — often ovulates regularly	Lifestyle changes may suffice
D (Non-Hyperandrogenic)	Oligo-anovulation + PCOM	Lowest — may lack metabolic features	Moderate — irregular ovulation	Lifestyle + supplementation often effective

So what does this mean in practice? Phenotypes A and B carry the highest metabolic risk and are most strongly associated with anovulatory infertility.⁶ Phenotype C, sometimes called "ovulatory PCOS," may not significantly impair fertility at all. Phenotype D, which lacks hyperandrogenism, may have a different underlying mechanism entirely — some researchers question whether it truly represents the same condition.⁷

This matters for your treatment path. If you have Phenotype D, you may respond well to lifestyle modifications and targeted supplementation alone. If you have Phenotype A, you may need ovulation induction medication from the outset. Ask your healthcare provider which phenotype fits your picture — the answer shapes everything that follows.

 

Can Lifestyle Changes Alone Restore Fertility with PCOS?

If you're wondering where to start, this is it. For many women with PCOS — particularly those carrying extra weight — lifestyle modifications are the recommended first step before any medical treatment. And this genuinely surprised me when I first saw the data: in one study of 33 women, a caloric deficit of 500–1,000 kcal per day leading to just 5–10% body weight loss restored ovulation in approximately 50% of anovulatory participants, a finding broadly supported by subsequent research.⁸

Here's how that works in your body: weight loss reduces circulating insulin levels, which lowers ovarian androgen production, which allows FSH to function normally and trigger follicular maturation.⁹ Even modest reductions of 2–5% body weight have been associated with spontaneous ovulation in some studies¹⁰ — so you don't need to reach a specific number on the scale before changes start to happen.

What Should You Eat to Support Fertility with PCOS?

No single diet has been proven superior for PCOS, but the evidence consistently points to dietary patterns that improve insulin sensitivity.¹¹ Here are the principles worth building your meals around:

• Prioritise low-glycaemic-index (GI) foods: Whole grains, legumes, non-starchy vegetables, and most fruits release glucose slowly, reducing insulin spikes. A 2021 meta-analysis found that low-GI diets significantly improved insulin resistance markers in women with PCOS.¹²
• Include adequate protein at each meal: Protein slows gastric emptying and helps stabilise blood glucose. Aim for 1.2–1.6 g/kg body weight daily from lean meats, fish, eggs, legumes, and dairy.
• Choose anti-inflammatory fats: Omega-3 fatty acids from oily fish, walnuts, and flaxseeds may reduce chronic low-grade inflammation associated with PCOS.¹³ (If you take blood-thinning medication or have a bleeding disorder, consult your doctor before high-dose omega-3 supplementation.)
• Limit refined carbohydrates and added sugars: These trigger rapid insulin release and can worsen androgen excess.

How Does Exercise Help PCOS Fertility?

Here's something worth knowing: regular physical activity improves insulin sensitivity independently of weight loss — meaning it benefits you at any body size.¹⁴ Current evidence supports 150 minutes per week of moderate-intensity activity (brisk walking, swimming, cycling) or 75 minutes of vigorous activity. Resistance training is especially worth adding because your muscle tissue is a major site of glucose uptake, directly reducing the insulin resistance that drives so much of PCOS.

Does Stress Affect Fertility with PCOS?

Chronic stress elevates cortisol, which can worsen insulin resistance and disrupt the hypothalamic-pituitary-ovarian axis.¹⁵ Trials found that structured stress-reduction programmes improved menstrual regularity in women with PCOS. Aim for 7–8 hours of quality sleep per night — sleep deprivation independently impairs your insulin sensitivity and ramps up hunger hormones, so this really isn't a small detail.

TL;DR: Lifestyle changes — particularly achieving a 5–10% weight reduction through balanced nutrition and regular exercise — can restore ovulation in a substantial proportion of women with PCOS and should be the foundation of any fertility strategy, regardless of whether medical treatment is also needed.

 

Which Supplements Have Evidence for Improving Fertility in PCOS?

This is one of the areas you ask us about most, so let's look at what the research actually says. Several supplements have been studied for their effects on PCOS-related fertility — and some of the findings are genuinely promising. That said, it's important to remember that supplements support rather than replace lifestyle changes and medical treatment. The evidence varies considerably by nutrient, so let's break it down.

Supplement	Dosage Studied	Key Evidence	Evidence Strength	Fertility-Specific Outcome
Myo-inositol	2–4 g/day	Improved ovulation rate (~58%), menstrual regularity (~65%)16	Moderate (multiple RCTs, but guidelines note limitations)	Ovulation restoration, improved oocyte quality in IVF
Vitamin D	1,000–4,000 IU/day	Improved ovulation rate; 67–85% of PCOS women are deficient17	Moderate (meta-analyses show benefit, optimal dose unclear)	Improved ovulation, enhanced follicular development
CoQ10	100–600 mg/day	Improved ovarian response in IVF (studied primarily in women with diminished ovarian reserve; PCOS-specific data limited)18	Moderate (smaller studies, promising IVF data)	Higher oocyte retrieval, improved embryo quality
NAC	1,200–1,800 mg/day	Improved ovulation when combined with clomiphene19	Low–Moderate (limited RCTs)	May enhance ovulation induction response
Omega-3 fatty acids	1–2 g/day	Reduced inflammation, improved lipid profiles13	Moderate for metabolic outcomes, limited for fertility	Indirect — improves metabolic environment
Folate	400–800 mcg/day	Essential for neural tube defect prevention21	Strong (universal recommendation)	Pre-conception essential, not PCOS-specific

How Does Myo-Inositol Work for PCOS?

Myo-inositol acts as a second messenger in your insulin signalling pathways, helping your cells respond more effectively to insulin. By improving insulin sensitivity, it may reduce the downstream androgen excess that suppresses ovulation.¹⁶ What did the latest research find? A 2024 systematic review informing the international PCOS guidelines found potential benefits for ovulation from D-chiro-inositol and improvements in some metabolic measures from myo-inositol, though the review authors explicitly concluded that current evidence for inositol in PCOS is "limited and inconclusive," and the 2023 international PCOS guidelines do not recommend inositol as a first-line treatment for PCOS-related infertility.²²

The commonly studied ratio is 40:1 myo-inositol to D-chiro-inositol, which mirrors the natural ratio found in the body. That said, some researchers have questioned whether this ratio is optimal for everyone — particularly women with different PCOS phenotypes — so don't assume one product fits every situation.²³

Why Is Vitamin D Important for PCOS Fertility?

This one's worth paying attention to. Studies show that a large proportion of women with PCOS — estimates range from 67% to 85% depending on the population studied — have vitamin D deficiency, which is significantly higher than in the general population.¹⁷ Here's why that matters for your fertility: vitamin D receptors sit on your ovarian granulosa cells, and their activation enhances steroidogenesis, helping regulate the oestradiol and progesterone your follicles need to mature.²⁴ A 2023 meta-analysis found that vitamin D supplementation improved ovulation rates in women with PCOS, though it did not significantly affect IVF-specific outcomes such as fertilisation rate or embryo quality.²⁵

If you have PCOS and haven't had your vitamin D level tested, it's worth requesting a 25-hydroxyvitamin D blood test from your GP. Supplementation should be guided by your actual levels rather than guesswork.

TL;DR: Myo-inositol and vitamin D have the strongest supplement evidence for PCOS fertility, but neither is a standalone treatment. They work best as part of a comprehensive approach including lifestyle changes and medical support when needed.

 

What Medical Treatments Are Available for PCOS-Related Infertility?

If you've been making lifestyle changes and trying supplements but your cycles still aren't regular after 3–6 months — or if other factors are in play (such as being over 35 or having additional fertility concerns) — medical treatment is the next step. The good news is that the treatment pathway follows a well-established escalation approach recommended by international guidelines, and most women don't need to go through every stage.²⁶

First-Line: Letrozole (Aromatase Inhibitor)

Letrozole has replaced clomiphene citrate as the recommended first-line ovulation induction medication for women with PCOS — and the data behind this shift is compelling. The landmark NICHD trial published in the New England Journal of Medicine found that letrozole produced significantly higher live birth rates compared to clomiphene (27.5% vs 19.1%, p=0.007).²⁷ The 2023 international evidence-based PCOS guidelines confirmed letrozole as the recommended first-line ovulation induction agent, citing its superior ovulation rates and pregnancy outcomes compared to clomiphene.²⁶

Here's how it works: letrozole temporarily blocks oestrogen production, which prompts your pituitary gland to release more FSH and recruit a follicle. Unlike clomiphene, it doesn't thin the endometrial lining or dry out cervical mucus — which likely explains its superior pregnancy rates.²⁷

Second-Line: Clomiphene Citrate or Metformin

Clomiphene citrate remains an option when letrozole isn't available or you can't tolerate it. The evidence shows it achieves ovulation in approximately 60–80% of women with PCOS, though pregnancy rates are lower due to its anti-oestrogenic effects on the uterine lining.²⁹ Metformin, an insulin-sensitising medication, may be used alongside ovulation induction drugs — particularly if you have significant insulin resistance — though it isn't generally effective as a sole ovulation induction agent.²⁹

Third-Line: Gonadotropins

Injectable gonadotropins (FSH injections) directly stimulate follicular development and come into play when oral medications haven't worked for you. They do require careful monitoring with ultrasound scans because women with PCOS are at higher risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies. The good news? Low-dose step-up protocols have reduced these risks significantly.²⁶

When Is IVF Recommended for PCOS?

In vitro fertilisation (IVF) is recommended when other treatments haven't worked or when additional fertility factors are present (such as tubal damage or severe male factor infertility). The encouraging part? Women with PCOS often respond well to IVF because of their typically high egg reserves, though your team will manage OHSS risk carefully.³⁰ Laparoscopic ovarian drilling (LOD) — a surgical procedure that makes small punctures in the ovarian surface to reduce androgen production — is an alternative to gonadotropins in some cases, though it's less commonly performed today.

TL;DR: The treatment escalation pathway for PCOS fertility moves from lifestyle changes to letrozole (first-line), then clomiphene or metformin (second-line), gonadotropins (third-line), and IVF (fourth-line). Most women achieve pregnancy before reaching the later stages.

 

When Should You Seek Medical Help for PCOS and Fertility?

Knowing when to ask for help can save you months of uncertainty. The general recommendation is to try conceiving for 12 months before seeking fertility investigation if you're under 35, or 6 months if you're 35 or older.³¹ However, if you have PCOS with irregular or absent periods, this timeline changes — don't wait. Seek evaluation sooner because irregular cycles already indicate ovulatory dysfunction.

Consider seeing a fertility specialist if you experience any of the following:

• Absent periods (amenørrhøa) for three or more consecutive months
• Irregular cycles (fewer than 8 periods per year) despite 3–6 months of lifestyle modifications
• Age 35 or older — fertility declines more steeply after 35, and earlier intervention improves outcomes
• Additional fertility factors — known tubal issues, endometriosis, or male partner fertility concerns
• Recurrent pregnancy loss — PCOS is associated with slightly higher miscarriage rates, which may warrant investigation³²

Your GP can order initial blood tests (FSH, LH, testosterone, thyroid function, prolactin, AMH, fasting glucose, and insulin) and a pelvic ultrasound. Based on results, they may refer you to a reproductive endocrinologist or fertility clinic for specialised treatment.

 

What Are the Risks of Pregnancy with PCOS?

Once you do conceive, there are a few things worth being aware of. Women with PCOS who become pregnant face a somewhat higher risk of certain pregnancy complications, which is why your care team will want to keep a closer eye on things.³² Being aware of these risks puts you in a stronger position to plan with your healthcare team.

Specifically, research indicates higher risks of gestational diabetes (2–3 times higher than the general population), pre-eclampsia (pregnancy-induced high blood pressure), preterm birth, and delivery by caesarean section.³² These risks are partially mediated by insulin resistance and are more pronounced in women with higher BMI at conception — meaning the lifestyle work you do before pregnancy continues to pay dividends during it.

We know seeing a list like this can feel alarming, so let's pause on something important: these are statistical elevations in risk, not certainties. Many women with PCOS go through entirely uncomplicated pregnancies and deliver healthy babies. What makes the biggest difference is early and consistent prenatal care — including glucose tolerance testing, blood pressure monitoring, and appropriate weight management throughout your pregnancy.

 

How Long Does It Take to Get Pregnant with PCOS?

This is one of the hardest questions to sit with, and there's no single answer — because outcomes depend heavily on your specific phenotype, age, weight, whether you ovulate (even irregularly), and what treatments you use. But the research does give us some helpful frameworks for setting realistic expectations.

If you ovulate irregularly (but not absently), conception may take 1–2 years naturally compared to the 6–12 months typical for women without PCOS. That extended timeline isn't a sign of reduced fertility per cycle — it simply reflects fewer ovulatory cycles per year.³³

With medical treatment, the picture changes substantially. The NICHD letrozole trial showed cumulative live birth rates of 27.5% over 5 treatment cycles (approximately 5 months) — roughly 1 in 4 women achieved a live birth within that window.²⁷ Success rates rise further with additional cycles or escalation to stronger treatments.

Here's the long view, which often gets lost when you're in the middle of the month-to-month wait: studies tracking long-term outcomes show that family size in women with PCOS is ultimately similar to women without the condition, though conception may take longer and more women with PCOS use fertility treatments along the way.³³

TL;DR: Conception with PCOS often takes longer than average, but most women ultimately achieve pregnancy with appropriate support. Setting realistic expectations and working with a knowledgeable healthcare team helps manage the emotional journey.

 

Frequently Asked Questions

Can you get pregnant naturally with PCOS?

Yes — many women with PCOS conceive without any medical intervention, particularly those with milder phenotypes (C or D) or those who see lifestyle-related improvements in ovulation. Even with irregular periods, you may ovulate occasionally, which keeps natural conception possible — it can simply take longer than average.

Does PCOS get worse with age?

Interestingly, the hormonal features of PCOS — particularly irregular periods and elevated androgens — often improve with age as androgen levels naturally decline. The catch is that fertility itself also declines with age independently of PCOS, so if you're planning pregnancy, earlier intervention is generally the better strategy.³⁴

Is metformin or letrozole better for PCOS fertility?

They do different jobs. Letrozole is the first-line ovulation induction medication, directly stimulating egg release. Metformin is an insulin sensitiser that may improve ovulatory function indirectly and is sometimes paired with letrozole — particularly if you have significant insulin resistance. As a standalone fertility treatment, letrozole is more effective.²⁷

How much myo-inositol should I take for PCOS?

Research most commonly examines 4 g of myo-inositol per day, often combined with 50–100 mg of D-chiro-inositol (maintaining a 40:1 ratio). Some studies have observed benefit at 2 g per day. That said, current international guidelines note that evidence isn't yet strong enough to recommend inositol as a first-line PCOS treatment.²² Speak with your healthcare provider about whether supplementation can be appropriate for your situation — especially if you take metformin, since the combination may affect B12 absorption.²²

Does losing weight cure PCOS?

PCOS isn't curable, but weight loss of 5–10% can meaningfully improve symptoms — restoring ovulation in up to 50% of anovulatory women, lowering androgen levels, and improving insulin sensitivity.⁸ If you're already at a healthy weight (often Phenotype C or D), this lever won't apply to you — but other interventions still can.

Can PCOS cause miscarriage?

Research suggests women with PCOS have a modestly elevated miscarriage rate compared to the general population, possibly related to insulin resistance, inflammation, or endometrial factors. The reassuring part is that the absolute risk increase is small, and appropriate medical management can mitigate these factors — so this is something to discuss with your provider, not something to lose sleep over.³²

What is the best diet for PCOS fertility?

No single "PCOS diet" has been proven superior, but evidence consistently supports patterns that reduce insulin resistance: low-glycaemic-index foods, adequate protein, anti-inflammatory fats (omega-3s), and limited refined carbohydrates and added sugars. The Mediterranean way of eating fits these principles closely, which is why it's often recommended.¹¹

Should my partner also be tested?

Yes. Male factor infertility contributes to approximately 40–50% of all infertility cases, so your fertility picture is genuinely a couple's picture. Before starting ovulation induction treatment, your partner should have a semen analysis to identify any issues that might affect your chances of conception.³¹

 

 

Supporting Your Fertility with FertilitySmart

If you have PCOS, building the right nutritional foundation can make a real difference alongside your lifestyle changes and medical care. Key nutrients like myo-inositol, CoQ10, vitamin D, and folate all play supporting roles in ovulatory function and egg quality.

At FertilitySmart, we offer both fertility supplements for women and fertility supplements for men that contain a range of evidence-based ingredients — including several of the nutrients discussed in this guide. Explore our range of fertility supplements, or read more about ways to increase ovulation naturally.

 

Citations

1. World Health Organization. Polycystic ovary syndrome. WHO Fact Sheet. Published June 2023. Accessed March 2026. who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
2. Azziz R, Carmina E, Chen Z, et al. Polycystic ovary syndrome. Nat Rev Dis Primers. 2016;2:16057. doi.org/10.1038/nrdp.2016.57
3. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33(6):981-1030. doi.org/10.1210/er.2011-1034
4. Pigny P, Merlen E, Robert Y, et al. Elevated serum level of anti-Müllerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab. 2003;88(12):5957-5962. doi.org/10.1210/jc.2003-030727
5. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25. doi.org/10.1016/j.fertnstert.2003.10.004
6. Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106(1):6-15. doi.org/10.1016/j.fertnstert.2016.05.003
7. Guastella E, Longo RA, Carmina E. Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes. Fertil Steril. 2010;94(6):2197-2201. doi.org/10.1016/j.fertnstert.2010.02.014
8. Crosignani PG, Colombo M, Vegetti W, Somigliana E, Gessati A, Ragni G. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod. 2003;18(9):1928-1932. doi.org/10.1093/humrep/deg367
9. Pasquali R, Gambineri A, Cavazza C, et al. Heterogeneity in the responsiveness to long-term lifestyle intervention and predictability in obese women with polycystic ovary syndrome. Eur J Endocrinol. 2011;164(1):53-60. doi.org/10.1530/EJE-10-0692
10. Kiddy DS, Hamilton-Fairley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992;36(1):105-111. doi.org/10.1111/j.1365-2265.1992.tb02909.x
11. Barrea L, Arnone A, Annunziata G, et al. Adherence to the Mediterranean diet, dietary patterns and body composition in women with polycystic ovary syndrome (PCOS). Nutrients. 2019;11(10):2278. doi.org/10.3390/nu11102278
12. Kazemi M, Hadi A, Pierson RA, Lujan ME, Zello GA, Chilibeck PD. Effects of dietary glycemic index and glycemic load on cardiometabolic and reproductive profiles in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr. 2021;12(1):161-178. doi.org/10.1093/advances/nmaa092
13. Yang K, Zeng L, Bao T, Ge J. Effectiveness of omega-3 fatty acid for polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2018;16(1):27. doi.org/10.1186/s12958-018-0346-x
14. Harrison CL, Lombard CB, Moran LJ, Teede HJ. Exercise therapy in polycystic ovary syndrome: a systematic review. Hum Reprod Update. 2011;17(2):171-183. doi.org/10.1093/humupd/dmq045
15. Benson S, Arck PC, Tan S, et al. Disturbed stress responses in women with polycystic ovary syndrome. Psychoneuroendocrinology. 2009;34(5):727-735. doi.org/10.1016/j.psyneuen.2008.12.001
16. Unfer V, Carlomagno G, Dante G, Facchinetti F. Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecol Endocrinol. 2012;28(7):509-515. doi.org/10.3109/09513590.2011.650660 [COI note: lead author V. Unfer has disclosed affiliations with Lo.Li. Pharma, a manufacturer of inositol products. Findings are corroborated by independent researchers.]
17. Krul-Poel YHM, Snackey C, Louwers Y, et al. The role of vitamin D in metabolic disturbances in polycystic ovary syndrome: a systematic review. Eur J Endocrinol. 2013;169(6):853-865. doi.org/10.1530/EJE-13-0617
18. Xu Y, Nisenblat V, Lu C, et al. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reprod Biol Endocrinol. 2018;16(1):29. doi.org/10.1186/s12958-018-0343-0
19. Thakker D, Raval A, Patel I, Walia R. N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled clinical trials. Obstet Gynecol Int. 2015;2015:817849. doi.org/10.1155/2015/817849
20. [Duplicate of Ref 13 — removed.]
21. De-Regil LM, Peña-Rosas JP, Fernández-Gaxiola AC, Rayco-Solón P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2015;(12):CD007950. doi.org/10.1002/14651858.CD007950.pub3
22. Fitz V, Graca S, Mahalingaiah S, et al. Inositol for polycystic ovary syndrome: a systematic review and meta-analysis to inform the 2023 update of the international evidence-based PCOS guidelines. J Clin Endocrinol Metab. 2024;109(6):1630-1655. doi.org/10.1210/clinem/dgad762
23. Facchinetti F, Bizzarri M, Benvenga S, et al. Results from the international consensus conference on myo-inositol and D-chiro-inositol in obstetrics and gynecology: the link between metabolic syndrome and PCOS. Eur J Obstet Gynecol Reprod Biol. 2015;195:72-76. doi.org/10.1016/j.ejogrb.2015.09.024
24. Irani M, Merhi Z. Role of vitamin D in ovarian physiology and its implication in reproduction: a systematic review. Fertil Steril. 2014;102(2):460-468.e3. doi.org/10.1016/j.fertnstert.2014.04.046
25. Yang M, Shen X, Lu D, et al. Effects of vitamin D supplementation on ovulation and pregnancy in women with polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol. 2023;14:1148556. doi.org/10.3389/fendo.2023.1148556
26. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. doi.org/10.1210/clinem/dgad463
27. Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371(2):119-129. doi.org/10.1056/NEJMoa1313517
28. Wang L, Wen X, Lv S, Zhao J, Yang T, Yang X. Comparison of endometrial receptivity of clomiphene citrate versus letrozole in women with polycystic ovary syndrome: a meta-analysis of randomized controlled trials. Gynecol Endocrinol. 2019;35(11):949-954. doi.org/10.1080/09513590.2019.1617267
29. Morley LC, Tang T, Yasmin E, Norman RJ, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2017;11(11):CD003053. doi.org/10.1002/14651858.CD003053.pub6
30. Heijnen EMEW, Eijkemans MJC, Hughes EG, Laven JSE, Macklon NS, Fauser BCJM. A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12(1):13-21. doi.org/10.1093/humupd/dmi036
31. National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. NICE guideline CG156. Updated September 2017. nice.org.uk/guidance/cg156
32. Palomba S, de Wilde MA, Falbo A, Koster MPH, La Sala GB, Fauser BCJM. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update. 2015;21(5):575-592. doi.org/10.1093/humupd/dmv029
33. Joham AE, Teede HJ, Ranasinha S, Zoungas S, Boyle J. Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: data from a large community-based cohort study. J Womens Health. 2015;24(4):299-307. doi.org/10.1089/jwh.2014.5000
34. Carmina E, Campagna AM, Lobo RA. A 20-year follow-up of young women with polycystic ovary syndrome. Obstet Gynecol. 2012;119(2 Pt 1):263-269. doi.org/10.1097/AOG.0b013e31823f7571