Short answer: most women with PCOS who want to conceive do, and the majority will not need IVF. The first medication offered should be letrozole, not clomiphene — that changed, and a lot of information online has not caught up. Pregnancy with PCOS does carry higher risks of gestational diabetes and raised blood pressure, and those risks are worth knowing about early because there is something useful to do about them.
Two things to say before the detail, because both affect how you read everything else.
On 12 May 2026, polycystic ovary syndrome was officially renamed polyendocrine metabolic ovarian syndrome, or PMOS. It was not a rebrand by committee — it came from more than 22,000 survey responses and 56 patient and professional organisations, including Verity, the UK PCOS charity, and it is being phased in over about three years, with full adoption planned for the 2028 update of the international guideline.
The reason matters. “Polycystic ovaries” described the least important feature, was frequently absent, and was never actually cysts. The new name describes what the condition is: a hormonal and metabolic condition that involves the ovaries.
Crucially, the name change does not change the diagnostic criteria or the treatment. If you were diagnosed with PCOS, you have PMOS, and nothing about your care is different.
We will keep saying PCOS through this article, because that is the name you know and the name you will search. Expect to see “PMOS, formerly PCOS” appearing on letters and in clinics over the next couple of years.
This is a genuine gap and worth understanding. When NICE published guideline NG257 in March 2026, replacing the thirteen-year-old CG156, it explicitly removed the PCOS content: “We have removed the recommendations on hypothalamic-pituitary-ovarian dysfunction (predominantly PCOS) because NICE is developing a guideline on polycystic ovary syndrome (PCOS).”
That separate guideline — now titled under the new name, PMOS — is in development and expected in December 2026. Until it lands, the authority is the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, published in 2023 after review by clinicians and patient advocates across 71 countries. Everything below is drawn from it.
Two out of three features, with other causes excluded:
Two practical points people are rarely told.
If you have irregular periods and signs of raised androgens, you do not need a scan. The guideline is explicit: “where irregular menstrual cycles and hyperandrogenism are present, diagnosis is simplified and ultrasound or AMH are not required for diagnosis.” If someone insists on a scan you do not need, ask why.
AMH can now replace the scan, but not on its own. The guideline permits AMH for defining polycystic ovarian morphology in adults, while stating that “serum AMH should not be used as a single test for the diagnosis of PCOS”, that it should not yet be used in adolescents, and that you should have either AMH or ultrasound — not both, specifically “to limit overdiagnosis”. There is no single AMH number that diagnoses PCOS; the supporting meta-analysis could not identify a reliable cut-off.
PCOS affects between 10% and 13% of women of reproductive age — roughly one in eight, more than 170 million worldwide. It is the most common hormonal condition in women of reproductive age, and still frequently missed.
The guideline authors say so themselves: “diagnosis is still delayed, the needs of those with PCOS are not being adequately met.” A survey of 1,385 women found that a third waited more than two years for a diagnosis, and 47% saw three or more health professionals before getting one. Only 15.6% were satisfied with the information they were given.
If you have had irregular periods for years and been told to come back when you want to get pregnant, that is not good enough, and it is worth saying so.
This matters to the families we look after, so we will be precise rather than sweeping.
A large analysis of English primary care records — 41 million patients, using CPRD and hospital data — found that recorded PCOS prevalence in 2019 was 5.21 per 100 among Asian patients, 4.66 among mixed-ethnicity patients, 3.94 among Black patients and 3.18 among White patients. New diagnoses were 2.47 times as common in Asian patients and 1.76 times as common in Black patients compared with White patients. Rates were also higher in more deprived areas.
Two honest caveats, both of which the authors state themselves. These are figures for diagnosed PCOS, so they blend genuine difference with differences in how and when people get diagnosed. And the ethnicity categories are broad — “Asian” in its widest sense, which flattens a great deal.
The international guideline adds that “the presentation of PCOS may vary across ethnic groups”, and that cardiometabolic risk may be higher in some groups.
What we will not tell you is that PCOS is more severe in Black or South Asian women. That claim gets repeated online and we could not find evidence for it. Higher diagnosed prevalence is not the same as worse disease, and we would rather be accurate than dramatic.
The guideline recommends lifestyle intervention for all women with PCOS, and recommends counselling about the effect of excess weight on pregnancy and live birth rates after fertility treatment.
But here is something you may have read elsewhere and should not have: the widely quoted “lose 5–10% of your body weight” target does not appear in the current guideline at all. It prescribes a tailored approach based on your own energy needs and activity levels, and says there is “no one specific regimen that has benefits over others in PCOS”.
More importantly, it says this: “There are benefits to a healthy lifestyle even in the absence of weight loss.” And it instructs clinicians that “weight bias and stigma should be minimized” and that we should seek permission before weighing you. We mention that because plenty of women with PCOS have been handed a weight target and nothing else, and that is not what the evidence supports.
This is the single most important change, and the one most likely to be out of date wherever else you have read about it.
The guideline: “Letrozole should be the first-line pharmacological treatment for ovulation induction in infertile anovulatory women with PCOS, with no other infertility factors.” It carries the guideline’s highest evidence rating. A separate recommendation spells out why: letrozole “should be used rather than clomiphene citrate… to improve ovulation, clinical pregnancy and live birth rates”.
The question everyone asks: is it safe? The guideline states that “current evidence demonstrates no difference in fetal abnormality rates between letrozole or clomiphene citrate ovulation induction or natural conception”.
One thing to know: letrozole is used off-label for this in many countries, including the UK. That means it is prescribed for a purpose outside its original licence, which is common and legitimate in medicine, but you are entitled to have it explained to you rather than discovered on the packet.
Metformin can be used alone for ovulation, but the guideline attaches an unusually candid caveat: do so “whilst informing women that there are more effective ovulation agents”. Combined with clomiphene it improves ovulation and pregnancy rates over clomiphene alone.
Two things worth correcting. There is no guideline recommendation for combining metformin with letrozole — the combination recommendations are with clomiphene only. And metformin in pregnancy has not been shown to prevent gestational diabetes, late miscarriage, hypertension, pre-eclampsia or a large baby, despite often being described as if it does.
Where metformin has a clear fertility role is in IVF: as an add-on before or during stimulation in a long protocol, to reduce the risk of ovarian hyperstimulation and miscarriage.
Inositol comes up in every consultation, so here is the guideline’s position for fertility specifically. Inositol “should be considered experimental therapy in women with PCOS with infertility, with benefits and risks currently too uncertain to recommend the use of these agents as fertility therapies”. It adds that “side effects and safety are not known”.
For general metabolic health outside fertility it is treated more kindly — it could be considered, with limited harm and limited clinical benefit. But if you are taking it to help you conceive, you should know the evidence does not currently support that, and no specific dose or combination can be recommended.
IVF is for when ovulation induction has not worked: “IVF could be offered in women with PCOS and anovulatory infertility, if first- or second-line ovulation induction therapies have failed.” It works well, and with single embryo transfer the risk of twins is minimised.
The specific issue in PCOS is ovarian hyperstimulation syndrome. Because PCOS ovaries hold a large pool of small follicles, they can over-respond. The guideline requires that you be counselled about this before starting, and offered ways to reduce the risk. In practice that means a GnRH antagonist protocol, which the guideline recommends for PCOS because it allows an agonist trigger and freezing all embryos if needed — without compromising your cumulative chance of a live birth.
If a clinic proposes a stimulation plan for PCOS without discussing hyperstimulation risk with you, that is a reason to ask more questions.
A 2024 meta-analysis of 104 studies and 106,690 pregnancies gives the clearest picture available. Compared with women without PCOS:
The finding that matters most: these risks remained raised when the studies were matched for age and for BMI. PCOS is not simply a proxy for weight, and being told to lose weight is not a complete answer to it.
Now the reassuring half, which is rarely given equal billing. The same guideline states that assisted reproduction in women with PCOS “should be considered as not conferring additional risk of miscarriage, preterm birth, impaired fetal growth, and caesarean section, over that observed in women without PCOS”, and that women with PCOS “should be considered as not having an increased risk of large for gestational age babies, macrosomia and instrumental delivery”. In the meta-analysis, eclampsia and instrumental delivery were not raised at all.
So: a higher-risk pregnancy that needs proper monitoring, not a dangerous one.
An oral glucose tolerance test. The guideline recommends it “to all women with PCOS when planning pregnancy or seeking fertility treatment” — and if not done beforehand, at the first antenatal visit and again at 24 to 28 weeks. It is the single most useful thing on this page, because gestational diabetes found early is manageable and found late is not.
It also asks that PCOS is identified in your antenatal notes, so the team caring for you knows.
PCOS is one of the conditions we see most, and the pattern we see most often is someone who has had it for years without anyone joining up the periods, the hormones and the plan.
A female fertility assessment is £390 and includes AMH, an ultrasound and a consultation with the results explained by a person. Ovulation induction is £850 per cycle. IUI with partner sperm starts at £1,250, or £3,250 for three cycles. Simple IVF™ is £2,900 and Conventional IVF from £4,500. Every price is on our prices page.
A note on our pathways: Simple IVF requires AMH above 10 pmol/L, and PCOS often produces a high AMH, so many women with PCOS qualify. But a high AMH also means a higher risk of over-response, which is exactly what we watch for. Qualifying on paper and being right for you are two different questions, and we will tell you which is which.
Yes, and many women do. Irregular ovulation means it can take longer and timing is harder to predict, not that it will not happen. If you have been trying for a year — or straight away if you are 36 or over, or your periods are very irregular — get assessed rather than waiting.
Clinics differ, and NHS funding criteria often set a BMI limit. Clinically, weight does affect pregnancy and live birth rates, and lifestyle change helps — but the current guideline explicitly recognises benefits even without weight loss, and sets no percentage target. If you are handed a number and nothing else, ask what else is being offered.
Yes, on the current evidence, and that is the guideline’s position: letrozole first-line, better ovulation, clinical pregnancy and live birth rates, with no difference in fetal abnormality rates.
For fertility, the guideline calls it experimental with uncertain benefits and unknown safety. If you want to take it, that is your call — but it should not delay treatment that does have evidence behind it.
It means a pregnancy that should be monitored properly. The main things to watch are blood sugar and blood pressure. Get the glucose tolerance test, make sure PCOS is in your notes, and most pregnancies go well.
The symptoms often shift over time, and periods can become more regular with age. PCOS is a long-term metabolic condition rather than only a fertility one, which is why the glucose and cardiovascular side of it deserves attention well beyond the years you are trying to conceive.
For diagnosis, often you do not — see above. For treatment, a scan does a different job: counting follicles before and during stimulation, checking your womb lining, and watching for over-response. Those are monitoring scans, not diagnostic ones.
If you have PCOS and want to know where you actually stand, start with a free 15-minute consultation with a Fertility Specialist — no referral needed, no obligation. Book a free consultation, or read about our fertility assessments and IUI.
