PCOS and Fertility: How to Improve Your Chances Naturally

Polycystic ovary syndrome (PCOS) is a hormonal condition that 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 normal hormonal signals that trigger ovulation, but the condition does not mean you cannot 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.

This guide explains how PCOS affects fertility at the biological level, which evidence-based strategies can improve your chances of conceiving, and when to seek medical support. Every recommendation is grounded in peer-reviewed research and current clinical guidelines.

 

How Does PCOS Affect Your Ability to Get Pregnant?

PCOS affects fertility primarily by disrupting ovulation — the monthly release of an egg from the ovaries. In a typical menstrual cycle, rising levels of follicle-stimulating hormone (FSH) prompt a follicle to mature and release an egg. In women with PCOS, elevated levels of androgens (male-type hormones such as testosterone) and insulin interfere with this process, causing follicles to stall at an immature stage rather than completing development.²

This hormonal disruption creates a cascade of effects. 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 a woman with regular cycles may ovulate 12–13 times per year, a woman with PCOS may ovulate only a few times, or not at all.

However, anovulation in PCOS is not permanent or irreversible. Unlike conditions that reduce 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 is not a lack of eggs but a hormonal environment that prevents them from being released. This distinction is important because it means that interventions targeting insulin resistance, androgen levels, or ovulatory signalling can restore fertility — often without assisted reproductive technology.

 

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

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 fertility outcomes and tailor treatment strategies.

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

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 because a woman with Phenotype D may respond well to lifestyle modifications and targeted supplementation alone, while a woman with Phenotype A may need ovulation induction medication from the outset. Discuss your specific phenotype with your healthcare provider to guide your treatment plan.

 

Can Lifestyle Changes Alone Restore Fertility with PCOS?

For many women with PCOS — particularly those with elevated body weight — lifestyle modifications are the recommended first step before any medical treatment, and research suggests they can be remarkably effective. A caloric deficit of 500–1,000 kcal per day leading to 5–10% body weight loss has been shown to restore ovulation in approximately 50% of anovulatory women with PCOS.⁸

The mechanisms are well-established. 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 studies.¹⁰

What Should You Eat to Support Fertility with PCOS?

No single diet has been proven superior for PCOS, but the evidence consistently supports dietary patterns that improve insulin sensitivity.¹¹ Key principles include:

• 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?

Regular physical activity improves insulin sensitivity independently of weight loss — meaning it benefits women with PCOS 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 particularly beneficial because muscle tissue is a major site of glucose uptake, directly reducing insulin resistance.

Does Stress Affect Fertility with PCOS?

Chronic stress elevates cortisol, which can worsen insulin resistance and disrupt the hypothalamic-pituitary-ovarian axis.¹⁵ A study in BMC Endocrine Disorders found that structured stress-reduction programmes improved menstrual regularity in women with PCOS. Aim for 7–8 hours of quality sleep per night, as sleep deprivation independently impairs insulin sensitivity and increases hunger hormones.

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?

Several nutritional supplements have been studied for their effects on PCOS-related fertility, though it is important to note that supplements support — rather than replace — lifestyle modifications and medical treatment. The evidence varies considerably by nutrient.

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, reduced oxidative stress18	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	1–3 g/day	Reduced inflammation, improved lipid profiles20	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 insulin signalling pathways, helping cells respond more effectively to insulin. By improving insulin sensitivity, it may reduce the downstream androgen excess that suppresses ovulation.¹⁶ 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 authors noted that overall evidence remains limited and the 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. However, some researchers have questioned whether this ratio is optimal for all women, particularly those with different PCOS phenotypes.²³

Why Is Vitamin D Important for PCOS Fertility?

Studies suggest 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 Vitamin D receptors are present on ovarian granulosa cells, and their activation enhances steroidogenesis, regulating the production of oestradiol and progesterone needed for follicular maturation.²⁴ A 2023 meta-analysis found that vitamin D supplementation improved ovulation rates in PCOS patients, though it did not significantly affect IVF-specific outcomes such as fertilisation rate or embryo quality.²⁵

If you have PCOS and have not had your vitamin D level tested, it is worth requesting a 25-hydroxyvitamin D blood test. Supplementation should be guided by your actual levels.

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?

When lifestyle modifications and supplementation do not restore regular ovulation within 3–6 months, or when other factors are present (such as age over 35 or additional fertility issues), medical treatment is the next step. The treatment pathway follows a well-established escalation approach recommended by international guidelines.²⁶

First-Line: Letrozole (Aromatase Inhibitor)

Letrozole has replaced clomiphene citrate as the recommended first-line ovulation induction medication for women with PCOS. 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 A 2024 review of 50 randomised controlled studies enrolling over 75,000 women confirmed that letrozole treatment resulted in higher ovulation rates, thicker endometrial lining, and better pregnancy rates.²⁸

Letrozole works by temporarily blocking oestrogen production, which prompts the pituitary gland to release more FSH. Unlike clomiphene, letrozole does not negatively affect the endometrial lining or cervical mucus, which likely explains its superior pregnancy rates.²⁷

Second-Line: Clomiphene Citrate or Metformin

Clomiphene citrate remains an option when letrozole is unavailable or not tolerated. It achieves ovulation in approximately 80% of women with PCOS, though pregnancy rates are lower (~40%) due to its anti-oestrogenic effects on the uterine lining.²⁸ Metformin, an insulin-sensitising medication, may be used alongside ovulation induction drugs — particularly in women with significant insulin resistance — though it is generally not effective as a sole ovulation induction agent.²⁹

Third-Line: Gonadotropins

Injectable gonadotropins (FSH injections) directly stimulate follicular development and are used when oral medications fail. They require careful monitoring with ultrasound scans because women with PCOS are at higher risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies. 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 have failed or when additional fertility factors are present (such as tubal damage or severe male factor infertility). Women with PCOS often respond well to IVF due to their typically high egg reserves, though OHSS risk requires careful management.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 but is 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?

The general recommendation is to try conceiving for 12 months before seeking fertility investigation if you are under 35, or 6 months if you are 35 or older.³¹ However, if you have PCOS with irregular or absent periods, this timeline changes — 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?

Women with PCOS who become pregnant face a somewhat higher risk of certain pregnancy complications, which is why additional monitoring is recommended.³² Being aware of these risks allows you and your healthcare team to plan appropriate surveillance.

Research indicates that women with PCOS have increased 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.

However, these are statistical elevations in risk — not certainties. Many women with PCOS have uncomplicated pregnancies and healthy babies. The key is early and consistent prenatal care, including glucose tolerance testing, blood pressure monitoring, and appropriate weight management during pregnancy.

 

How Long Does It Take to Get Pregnant with PCOS?

There is no single answer because outcomes depend heavily on your specific phenotype, age, weight, whether you ovulate (even irregularly), and what treatments you use. However, research provides some general frameworks for setting realistic expectations.

Women with PCOS who ovulate irregularly (but not absent) may take 1–2 years to conceive naturally compared to the average 6–12 months for women without PCOS. This extended timeline reflects fewer ovulatory cycles per year rather than reduced fertility per cycle.³³

With medical treatment, outcomes improve substantially. The NICHD letrozole trial showed cumulative live birth rates of 27.5% over 5 treatment cycles (approximately 5 months), meaning roughly 1 in 4 women achieved a live birth within that timeframe.²⁷ Success rates increase with additional cycles and escalation to stronger treatments.

Studies tracking long-term fertility outcomes in women with PCOS show reassuring results: 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.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 medical intervention, particularly those with milder phenotypes (C or D) or those who achieve lifestyle-related improvements in ovulation. Even women with irregular periods may ovulate occasionally, making natural conception possible though potentially slower.

Does PCOS get worse with age?

The hormonal features of PCOS — particularly irregular periods and elevated androgens — often improve with age as androgen levels naturally decline. However, fertility also decreases with age independently of PCOS, so earlier intervention is generally advisable for women planning pregnancy.³⁴

Is metformin or letrozole better for PCOS fertility?

They serve different roles. 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 used alongside letrozole, particularly in women with significant insulin resistance. Letrozole is more effective as a standalone fertility treatment.²⁷

How much myo-inositol should I take for PCOS?

Research most commonly examines 4 g of myo-inositol per day, often combined with 100–150 mg of D-chiro-inositol (maintaining a 40:1 ratio). Some studies have observed benefit at 2 g per day. However, current international guidelines note that evidence is not yet strong enough to recommend inositol as a first-line PCOS treatment.²² Speak with your healthcare provider about whether supplementation is appropriate for your individual situation, especially if you are taking metformin (which may affect B12 absorption when combined with inositol).²²

Does losing weight cure PCOS?

PCOS cannot be cured, but weight loss of 5–10% can significantly improve symptoms — restoring ovulation in up to 50% of anovulatory women, reducing androgen levels, and improving insulin sensitivity.⁸ Lean women with PCOS (Phenotype C or D) may not benefit from weight loss but may respond to other interventions.

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. However, the absolute risk increase is small, and appropriate medical management can mitigate these factors.³²

What is the best diet for PCOS fertility?

No single "PCOS diet" has been proven superior, but evidence supports dietary 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 diet pattern aligns well with these principles.¹¹

Should my partner also be tested?

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

 

 

Boost Your Fertility with FertilitySmart

If you have PCOS, the right nutritional foundation can complement your lifestyle changes and medical care. Key nutrients like myo-inositol, CoQ10, vitamin D, and folate 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 for those trying to conceive. Try our supplements today to support your fertility, and explore our site to learn about more 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
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. 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
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. Günalan E, Yaba A, Yîlmaz B. 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. Gao Y, Wang Y, Chen A, 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