PCOS and trying to conceive: where to actually start.

PCOS is diagnosed when at least two of three signs are present and look-alike conditions have been ruled out.

The three signs are irregular or absent ovulation, raised male-type hormones (on a blood test, or as acne and extra hair), and ovaries with many small follicles on a scan. Thyroid problems and a raised prolactin can cause the same irregular cycles, and they are treated differently, so both are checked first. PCOD is the same condition under an older name. In 2026 an international consensus renamed it PMOS (polyendocrine metabolic ovarian syndrome), to show that it affects the whole body, not only the ovaries.

Because PCOS explains the ovulation, not the whole picture, and a tube or sperm problem changes which treatment makes sense.

Tablets and injections help an egg to be released. They cannot help if the tubes are blocked or the sperm cannot reach the egg. So his semen analysis and a tube check come before any plan, not after three failed cycles.

Yes. Lean PCOS is PCOS in a woman of healthy weight, and it is diagnosed with the same signs.

Insulin resistance can be present even when weight is normal, and the ovulation problem is the same. The difference is the plan. Weight loss is not the first step, and it can make things worse if eating is already light. Regular meals, activity and good sleep still help, and treatment usually starts directly with ovulation tablets and scans. If your scans also show a thin lining, that is a separate question with its own answers.

For women carrying extra weight, a modest, steady loss can bring ovulation back on its own, and it makes every later step work better.

This is the only step that treats the cause, and it is the step couples are most tempted to skip. You do not need a crash diet or an expensive programme. Regular meals, fewer refined carbs and sweets, daily activity and about seven hours of sleep are the core. Targets are set with your doctor, not from a chart, and metformin is sometimes added when insulin resistance is marked. You do not have to finish this step before starting tablets; the two often run together.

Tablets come first, then low-dose injections, and IVF only if those do not work or there is another reason for it.

Ovulation tablets such as letrozole are taken for a few days early in the cycle, and scans check that one follicle grows, so intercourse or IUI can be timed. The international PCOS guideline names letrozole as the first-line tablet. If tablets do not work after an agreed number of cycles, low-dose injections follow, again with scans. IVF is the last step, or the first one when tubes are blocked, sperm numbers are very low or time is short. In IVF, women with PCOS often make many eggs, so embryos are usually frozen and transferred in a later cycle.

If your periods are irregular, don't wait a full year: see a doctor after about 6 months of trying, or now.

Irregular cycles mean you cannot be sure you ovulate, and you cannot time intercourse to a day you cannot predict. Coming early does not mean starting IVF early. It usually means a scan, a few blood tests, his semen analysis and a clear first step.