How to get pregnant with PCOS

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham

On this page

1. Overview
2. The fertility challenge in PCOS
3. Diet to restore ovulation
4. Inositol and supplements with evidence
5. Exercise and weight
6. Stress and sleep
7. The TCM view
8. Acupuncture for PCOS fertility
9. Chinese herbal medicine
10. Medical options
11. Realistic timeline
12. Frequently asked questions

1. Overview

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility — infertility caused by the absence of regular ovulation. But anovulatory infertility is, in many ways, the most treatable type of infertility, because the fundamental problem — restoring regular ovulation — has clear and effective solutions. Many of my PCOS patients go on to conceive naturally once ovulation is restored. I am Dr (TCM) Attilio D’Alberto, a fertility specialist with over 25 years of clinical experience.

2. The fertility challenge in PCOS

PCOS affects 8–13% of women of reproductive age. The fertility challenges are:

• Irregular or absent ovulation — the primary problem; without ovulation there is no egg to fertilise
• Insulin resistance — drives androgen excess and impairs ovarian function (present in 70–80% of cases)
• Elevated androgens (testosterone, DHEA) — impair egg quality and follicular development
• Poor endometrial receptivity — related to insulin resistance and hormonal imbalance
• Higher miscarriage risk — up to 30–50% in untreated PCOS, vs 10–20% baseline (see PCOS and miscarriage prevention)
• Higher risk of gestational diabetes and pre-eclampsia in pregnancy

The good news: each of these is improvable through targeted treatment.

3. Diet to restore ovulation

Diet is the single most important intervention for PCOS fertility, because reducing insulin directly lowers androgens and restores ovulation in many women.

• Low-glycaemic-load diet — build meals around protein, healthy fat and fibre. Avoid refined carbohydrates and sugar; choose wholegrains, legumes and vegetables for carbs.
• Adequate protein at every meal (25–40 g) — supports satiety, blood sugar and follicular development.
• 30+ g fibre per day — supports insulin sensitivity, oestrogen clearance and the gut microbiome.
• Mediterranean-style anti-inflammatory pattern — oily fish, leafy greens, olive oil, nuts, legumes, berries.
• Reduce dairy and gluten if symptomatic — some women with PCOS find clearer cycles after a 6–8 week trial reduction.
• Eliminate ultra-processed food, sugary drinks and refined sugar.
• Time-restricted eating — 12–14 hour overnight fast helps insulin sensitivity in many.
• Reduce alcohol — impairs sleep, raises insulin and worsens hormonal balance.

4. Inositol and supplements with evidence

• Myo-inositol + d-chiro-inositol (40:1 ratio, 4 g/day total myo) — the strongest single supplement evidence for restoring ovulation and improving egg quality in PCOS. Effects typically seen within 3 cycles.
• NAC (N-acetylcysteine, 600–1200 mg/day) — reduces insulin resistance and inflammation; emerging evidence for PCOS ovulation.
• CoQ10 (ubiquinol, 200–600 mg/day) — supports egg quality, particularly in women aged 35+ or with poor ovarian response.
• Vitamin D — deficiency is widespread in PCOS; supplement to a level of 75–125 nmol/L.
• Methylfolate (400–800 mcg/day) — essential preconception.
• Omega-3 (1,000+ mg combined EPA/DHA) — reduces inflammation and supports ovulation.
• Berberine (500 mg 3x/day) — improves insulin sensitivity comparably to metformin in some studies.
• Vitamin B12 and B-complex — particularly if taking metformin (which can deplete B12).

See also my full vitamins to get pregnant guide.

5. Exercise and weight

• Strength training 2–3 times a week — the highest-leverage exercise for insulin sensitivity and PCOS
• Daily walking — 7,000–10,000 steps
• Moderate aerobic exercise 2–3 times a week
• Avoid excessive HIIT — can raise cortisol and worsen the picture in already-stressed women
• If BMI is above 30, even a 5% reduction in body weight has been shown to restore ovulation in many women with PCOS

6. Stress and sleep

Chronic stress raises cortisol, which worsens insulin resistance, raises androgens and disrupts ovulation. Sleep loss has the same effect. Daily stress management (meditation, breathwork, yoga) and 7–9 hours of consistent sleep are essential. See waking up at the same time every night if you have sleep disturbance.

7. The TCM view

In traditional Chinese medicine, PCOS is most commonly understood as:

• Phlegm-dampness obstructing the uterus — the foundational pattern, manifesting as small ovarian cysts, weight gain, sluggishness, oily skin and irregular periods
• Kidney yang deficiency — underlying constitutional weakness, with cold lower body, low libido, fatigue
• Liver qi stagnation — stress-driven worsening; PMS, irritability, breast tenderness
• Damp-heat in the lower jiao — in patients with marked acne, oily skin and hirsutism
• Spleen qi deficiency — underlying digestive weakness producing dampness

8. Acupuncture for PCOS fertility

Acupuncture has specific clinical evidence for restoring ovulation in PCOS — Swedish research demonstrated that electroacupuncture significantly improved ovulation frequency in PCOS women compared to controls. Proposed mechanisms include:

• Regulation of the hypothalamic-pituitary-ovarian axis
• Reduction of the LH:FSH ratio
• Improvement of insulin sensitivity
• Reduction of testosterone and other androgens
• Lowering of cortisol
• Improvement of ovarian blood flow

Treatment is typically weekly for 3–6 cycles, with continuation through any IVF cycle.

9. Chinese herbal medicine

Chinese herbal medicine addresses the underlying TCM pattern. Common formulas:

• Cang Fu Dao Tan Tang — for phlegm-damp PCOS with weight gain and irregular cycles
• You Gui Wan — for Kidney yang deficiency
• Xiao Yao San — for Liver qi stagnation pattern
• Gui Zhi Fu Ling Wan — for blood stasis with cysts

I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, individually tailored. Treatment is typically over 3–6 cycles before a planned conception attempt.

10. Medical options

• Letrozole — first-line ovulation induction for PCOS in modern fertility care; superior to clomiphene
• Metformin — reduces insulin resistance; supports ovulation in PCOS
• Clomiphene citrate — older first-line ovulation induction
• Gonadotrophin injections — if oral options fail
• IVF — PCOS women generally have good IVF outcomes
• Ovarian drilling — surgical option in resistant cases

Acupuncture and Chinese herbal medicine combine well with all of these.

11. Realistic timeline

For natural conception with PCOS:

• 3 months of preparation — diet, exercise, stress management, supplements, acupuncture and Chinese herbs to restore ovulation
• 6 months of trying with restored ovulation — the realistic timeframe in which natural conception typically occurs
• If not pregnant after 6 months of regular ovulation — consider further investigation (sperm analysis, tubal patency) and discuss medical options with your GP or fertility specialist

Women aged 35+ should seek fertility specialist input sooner.

12. Frequently asked questions

Can I get pregnant naturally with PCOS?

Yes. Many women with PCOS conceive naturally once ovulation is restored. The keys are diet (low-glycaemic, anti-inflammatory), inositol supplementation, weight management where appropriate, stress reduction, and acupuncture and Chinese herbal medicine to address the underlying pattern.

What is the best supplement for PCOS fertility?

Inositol (myo-inositol + d-chiro-inositol in a 40:1 ratio, 4 g/day) has the strongest evidence for restoring ovulation and improving egg quality in PCOS. Effects typically seen within 3 cycles. Best combined with vitamin D, omega-3 and methylfolate.

How long does it take to get pregnant with PCOS?

Allow 3 months of preparation (diet, supplements, acupuncture, herbs) to restore ovulation, then 6 months of trying with regular ovulation. If not pregnant after that, consider further investigation and medical options.

Does acupuncture help with PCOS?

Yes. Multiple studies show acupuncture restores ovulation, reduces testosterone, improves insulin sensitivity and lowers cortisol in PCOS. Most patients see meaningful change within 3 cycles of weekly treatment.

What is the best diet for PCOS fertility?

A low-glycaemic-load Mediterranean-style anti-inflammatory diet with adequate protein at every meal, 30+ g fibre, plenty of vegetables, oily fish and olive oil. Avoid refined carbohydrates, sugar and ultra-processed food.

Should I lose weight before trying to conceive with PCOS?

If your BMI is above 30, even a 5% weight reduction has been shown to restore ovulation in many women. However, weight is not the only factor — lean PCOS exists, and many women with normal BMI also need targeted treatment.

To discuss PCOS and fertility, contact me or book a consultation at my Wokingham, Berkshire clinic.

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13. My Fertility Guide