Polycystic ovary syndrome (PCOS) is a common hormone imbalance that affects up to 10 percent of women during childbearing years. PCOS causes changes that may increase male hormones (androgens) and may make you less responsive to insulin. These changes can lead to decreased egg production or failure of your ovaries to release eggs regularly (ovulation). You may have irregular periods and difficulty becoming pregnant (infertility). 
Not all women with PCOS need help getting pregnant. About 60 percent of women with PCOS get pregnant without fertility treatment.  But if you have PCOS, and you are struggling to become pregnant, there are several treatment options that can help. These options include losing weight, medications, surgery, and in vitro fertilization (IVF). [1,2,3]
Many women with PCOS are overweight because resistance to insulin causes weight gain and high blood sugar. Studies show that losing just 10 percent of your body weight can help balance your hormone levels and improve ovulation. Weight loss through exercise and a healthy diet is often the first option for improving fertility with PCOS. [1,2,3]
PCOS can also cause problems during pregnancy. You may have an increased risk for loss of your pregnancy, high blood pressure (preeclampsia), and pregnancy diabetes (gestational diabetes). Getting to a healthy weight before pregnancy and maintaining a recommended weight during pregnancy can reduce these risks. 
If weight loss does not help, the next step might be medication. Medications can stimulate ovulation. The most common medication is an oral medication called clomiphene citrate. You take this medication early in your menstrual cycle. Studies show that clomiphene increases ovulation and increases fertility. [2,3]
The risk of taking clomiphene is that you may release more than one egg. This increases your risk for multiple births (twins or triplets). About 10 percent of women who become pregnant on clomiphene have multiple births.  Side effects can include headaches, blurred vision, and mood swings. Your doctor may want you to lose weight before you start clomiphene. 
Another drug that may be used is a diabetes drug called metformin. This oral drug can be used alone or added to clomiphene. Metformin increases ovulation by improving insulin function and decreasing male hormone, but there is not as much evidence that increases fertility. Side effects include bloating, nausea, and vomiting. This drug may be an option if you are unable to use clomiphene because of your weight. 
Gonadotropins are injection hormone drugs that stimulate ovulation. These drugs may be used when other medications have not helped. Your doctor will need to check your ovulation and your ovaries during treatment with blood tests and ultrasound imaging. There is a higher risk of multiple pregnancy with this treatment. [2,3] This treatment is also more expensive. 
If weight loss and medication do not work, surgery may be the next step. The surgery is called ovarian drilling. A surgeon makes small holes through the wall of your ovary. The walls of your ovaries are thicker with PCOS. Drilling holes may help release eggs and may reduce the levels of androgens. [1,2]
For this procedure, you need to be asleep. The surgeon makes a small incision in your belly and inserts an operating telescope (laparoscope). Through the scope, small holes are made with a heated needle or a laser. [1,2,3] There is less risk of multiple pregnancy with surgery. The improvement in fertility only last for several months. There is some risk of scarring and the small risks that go along with any general anesthesia. 
IVF is another option when medication and weight loss fail. During IVF, you go to a special clinic where eggs are removed from your ovary. The eggs are combined with sperm from your partner or from a sperm donor. When an egg become fertilized in the clinic laboratory, it can be placed into your womb to grow. By using only one egg, multiple pregnancy can be prevented.
IVF fertility rates are higher than with medication. [1-3] The main drawback is time and expense. 
- PCOS can decrease your ability to become pregnant.
- Most women with PCOS become pregnant without treatment.
- If you need fertility treatment, the first choice is diet and exercise to achieve a healthy weight and normal blood sugar.
- If weight loss does not work, the most common medical treatment is clomiphene. Other medical treatments may also be tried.
- If other treatments fail, both surgery and IVF have high success rates.
- gov, Polycystic ovary syndrome, https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
- Jean Hailes for Women’s Health, PCOS, Fertility – management & treatment, https://jeanhailes.org.au/health-a-z/pcos/fertility-management-treatment
- NIH, Treatments for Infertility from PCOS, https://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/infertility.aspx