Being told you have polycystic metabolic ovarian syndrome (PMOS), can raise lots of questions about your future fertility. Perhaps your periods have always been irregular; maybe you’ve been told you don’t ovulate regularly; or perhaps you’ve been trying to conceive without any luck.

The reassuring news is that having PMOS does not mean you can’t get pregnant. Many women with PMOS conceive naturally, while others may need some assistance to help them ovulate. With a range of treatment options available, there are plenty of reasons to feel hopeful!

In this blog, we’ll explore: how PMOS affects fertility; what you can do to prepare for pregnancy; and the fertility treatments that may help you on your journey to becoming a parent.

What Is PMOS, and How Does It Affect Fertility?

PMOS is a common hormonal and metabolic condition that can affect the menstrual cycle, skin, metabolism, and reproductive health. Up until May 2026, PMOS was known as polycystic ovarian syndrome, or PCOS. You can read this past blog post on the Maven Centre website, which outlines PCOS / PMOS’s symptoms, diagnosis, and management.

One of the main ways in which PMOS affects fertility is by disrupting regular ovulation — ovulation being the process by which an ovary releases an egg, so it is ready for fertilisation by a sperm.

PMOS-related hormonal changes (including increased androgen levels and insulin resistance), can interfere with the development of ovarian follicles. As a result, an egg may not matured or be released every month. This can lead to:

• Irregular or infrequent periods (ie. a long menstrual cycle)
• Infrequent, or no ovulation (called ‘anovulation’)
• Difficulty predicting your fertile window
• It taking longer to become pregnant

Importantly, having PMOS does not mean that you’ll definitely have issues falling pregnant. Some women with PMOS ovulate every month, and conceive without assistance. Others may need treatment to stimulate ovulation.

It is also worth remembering that PMOS is only one possible contributor to fertility difficulties. Age, sperm health, fallopian tube function and other reproductive conditions can all play a role.

Can I Get Pregnant Naturally With PMOS?

Absolutely! Many women with PMOS conceive naturally. If you have a regular monthly period, and ovulate regularly, your chances of conceiving may be similar to those of someone without PMOS.

For women under 35 with regular periods, fertility assessment is generally recommended after 12 months of trying. From age 35 and onwards, assessment is usually recommended after six months. If your periods are irregular (ie. menstrual cycles that are more than 35 days apart, or fewer than 9 periods per calendar year), conception may take longer, simply because there are fewer opportunities each calendar year for an egg to be fertilised. In this context, you do not need to wait 6 or 12 months to seek help: it is worth speaking with your GP or gynaecologist sooner rather than later.

Step 1: Preparing Your Body for Pregnancy

Whether or not your have PMOS, it’s helpful to optimise your health in preparation for pregnancy. This is often called pre-conception care.

Focus on sustainable lifestyle habits

A balanced diet, regular physical activity, adequate sleep, and avoiding smoking support metabolic health and general wellbeing. For some women, these changes may also improve menstrual regularity and ovulation.

If you are living with a higher body weight, even modest weight changes (eg. losing 5% of your body weight) may improve ovulation and fertility. However, weight is only one part of the picture, and not every woman with PMOS is overweight.

There is no single diet or exercise programme proven to be best for everyone with PMOS. The goal is to find sustainable habits that suit your circumstances, without unnecessary restriction or guilt.

Your healthcare team can help you develop a realistic plan, with support from a dietitian or other health professional if useful. This previous blog post by dietician Dr Steph Pirotta explains what simple tweaks can be made to your eating habits, to help manage your PMOS.

Check your metabolic health

PMOS is associated with an increased change of developing insulin resistance, impaired glucose tolerance, and type 2 diabetes. Before pregnancy, your doctor may recommend assessing your blood glucose, blood pressure and other relevant health factors. A glucose tolerance test may be particularly important because PMOS is associated with an increased risk of pregnancy-related diabetes (so-called ‘gestational diabetes’).

Addressing these issues before conception can help improve your health and reduce pregnancy-related risks.

Start folate and review your medications

Folic acid supplementation is recommended before pregnancy to help reduce the risk of neural tube defects. The appropriate dose depends on your individual circumstances, so ask your doctor whether you need a standard or higher dose.

It is also important to review any medications or supplements you are taking, as some treatments used for PMOS may need to be stopped or changed before conception.

Step 2: Investigating Your Fertility

If pregnancy is not happening, the next step is to understand why. A women’s health GP or gynaecologist can begin an initial fertility assessment and help determine whether ovulation is the main issue.

Depending on your history, investigations may include:

• Blood tests: to assess relevant reproductive hormones and investigate other causes of irregular periods, such as thyroid disorders or elevated prolactin
• Ovulation assessment: to establish whether you are releasing eggs regularly
• Pelvic ultrasound: when indicated, to assess the ovaries, uterus and uterine lining
• Semen analysis: because sperm health is an important part of the fertility assessment
• Fallopian tube assessment: if appropriate, to check whether the tubes are open

Not every woman needs every test. The investigations should be guided by your medical history, age, cycle pattern and how long you have been trying to conceive.

It is particularly important not to assume that PMOS is the only cause of infertility. Identifying any additional factors helps ensure that treatment is directed at the right problem. Seeing a women’s health GP, such as Maven Centre’s Dr Amy Sinclair-Thomson can help you to investigate and clarify what fertility challenges you may be facing.

This previous blog post outlines what investigations your women’s health GP may organise, to investigate which factors may be contributing to your challenges conceiving.

Step 3: Ovulation Induction — Helping Your Ovaries Release an Egg

For women with PMOS who are not ovulating regularly, medication to stimulate ovulation can often make a significant difference. So-called ‘ovulation induction’ involves using medications to encourage an egg to mature, and be released from its ovary. It is commonly one of the first fertility treatments considered, when irregular ovulation is the main barrier to conception, and there are no other identified factors contributing to infertility.

Letrozole

Letrozole is generally recommended as the first-line medication for ovulation induction in women with PMOS-related anovulatory infertility. It works by temporarily reducing estrogen production, prompting the brain to increase signals that stimulate follicle development in the ovaries.

Treatment is usually taken orally over several days early in the menstrual cycle, according to a prescribed regimen. Your fertility specialist may recommend blood tests or ultrasound monitoring to assess your response, depending on your circumstances and treatment protocol. A fertility specialist such as Maven Centre and Melbourne IVF’s Dr Melissa Cameron can guide this process.

Letrozole is not suitable if there is a possibility of an existing pregnancy, so pregnancy must be excluded before treatment begins. In Australia, its use for ovulation induction is ‘off-label’, and your clinician should discuss this with you.

Clomiphene citrate

Clomiphene citrate is another oral medication that can stimulate ovulation. It has been used for many years and remains an option when clinically appropriate.

Letrozole is generally preferred as first-line treatment in the relevant circumstances, but your fertility specialist will consider your individual history and response to treatment.

Metformin

Metformin is a medication that improves insulin sensitivity. It may be useful for some women with PMOS, particularly where metabolic issues are present, and can sometimes improve menstrual regularity and ovulation.

However, metformin is not a substitute for every fertility treatment. Ovulation-inducing medications  (such as letrozole) are more effective for achieving pregnancy when anovulation is the primary problem.

Your fertility specialist can discuss whether metformin is appropriate alone or alongside other treatments.

Step 4: What If Ovulation Induction Doesn’t Work?

If oral medication does not result in successful ovulation or pregnancy, there are other options.

Gonadotrophin injections

These medications contain hormones that stimulate ovarian follicle development. They can be effective when oral treatments have not worked, but they require careful supervision by a fertility specialist.

Monitoring is important because treatment can increase the risk of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS), a potentially serious complication involving an exaggerated response of the ovaries.

In vitro fertilisation (IVF)

IVF may be considered: if other treatments have been unsuccessful; if there are additional fertility factors; or if there are other clinical reasons to proceed directly to assisted reproductive treatment.

During IVF, eggs are collected from the ovaries, and a sperm donation is made. The egg and sperm are then combined together (‘fertilised’) in a laboratory. An embryo is then transferred back into the uterus.

Women with PMOS may respond strongly to ovarian stimulation, so fertility specialists take particular care to minimise the risk of OHSS. Treatment protocols can be tailored to individual needs, and strategies such as freezing embryos for transfer in a later cycle may be appropriate.

Importantly, IVF is not automatically necessary just because you have PMOS. Many women conceive with simpler treatments (such as ovulation induction alone): the most suitable approach depends on your overall fertility assessment.

Does PMOS Affect Pregnancy?

PMOS can increase the risk of certain pregnancy complications, including gestational diabetes, high blood pressure and pre-eclampsia. The degree of risk varies between individuals and is influenced by factors such as age, metabolic health and other medical conditions.

This does not mean you should expect complications. Rather, it highlights the importance of preparing for pregnancy and receiving appropriate antenatal care. Your healthcare team may recommend additional screening or monitoring based on your individual risk factors.

When Should I See a Specialist?

Consider booking an appointment with a women’s health GP if:

• Your periods are very irregular or have stopped
• You suspect you are not ovulating
• You have been trying to conceive without success.
• You would like to understand your fertility before starting a family
• You have previously experienced fertility difficulties or pregnancy loss
• You would like advice about your options before pursuing IVF

A women’s health GP can help with initial investigations, preconception planning and appropriate treatment. If more specialised fertility care is needed, they can coordinate referral to a fertility specialist, such as Maven Centre’s Dr Melissa Cameron.

The Bottom Line

A diagnosis of PMOS does not mean that pregnancy is out of reach. Although irregular ovulation can make conception more challenging, many women conceive naturally, and effective treatments are available if extra help is needed!

From preconception health and ovulation induction to more advanced fertility treatments, the aim is to identify the factors affecting your fertility and develop a plan that suits your individual circumstances.

If you have PMOS and are thinking about pregnancy, you do not need to navigate the process alone. Speak with your women’s health GP or one of our gynaecologists at Maven Centre to discuss your cycle, assess your reproductive health and explore the options available to help you on your journey to parenthood.