PMOS (Formerly Known as PCOS) and Infertility: Treatment Options
Updated on July 9, 2026
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Editor’s Note: In May 2026, the Endocrine Society and other international experts officially renamed polycystic ovary syndrome (PCOS) polyendocrine metabolic ovarian syndrome (PMOS). This change better reflects the condition’s nature as a systemic metabolic disorder. This article has been updated to reflect the new terminology.
When a woman receives a diagnosis of polyendocrine metabolic ovarian syndrome (PMOS) — formerly known as polycystic ovary syndrome (PCOS) — one of the first things she may be told is that getting pregnant will be a challenge. Indeed, PMOS is one of the most common causes of infertility. It affects up to five million women in the United States, many of whom first learn they have PMOS when they go to the doctor because they’ve been trying to get pregnant without success.
Among women who have trouble getting pregnant because of ovulation problems, it’s estimated that 75 percent have PMOS. Because the struggle to get pregnant can be devastating for women, it’s important to understand how PMOS leads to infertility, and how to treat it, so a woman can take the appropriate steps to take control of her reproductive health.
How PMOS Can Cause Infertility in Women
PMOS is incredibly common, affecting as many as 1 in 10 women of reproductive age. A woman with PMOS has a hormonal imbalance: The body overproduces androgens, which are typical male hormones (though they’re still normally present in females in smaller amounts), as well as insulin. This hormonal imbalance may impair the signals sent out from the pituitary gland that directs the ovaries to develop eggs. When an egg isn’t released, ovulation doesn’t occur — and pregnancy won’t happen on its own.
Many women are not aware that a problem like PMOS is preventing them from becoming pregnant. In fact, more than 50 percent of women with PMOS are undiagnosed. PMOS symptoms — such as acne, hair loss, mood problems — are easy to miss or misinterpret as other problems. And unless a woman is using an ovulation kit, she can’t be sure if she’s ovulating or not.
Having a period doesn’t necessarily mean ovulation has occurred, notes Loren Wissner Greene, MD, a professor of endocrinology and ob-gyn at New York University Langone Health in New York City. Irregular periods, no periods, skipping periods, or especially heavy periods can be a sign that something is off, she adds.
Treating PMOS for Pregnancy
There are several routes a woman can take when she wants to get pregnant with PMOS, says David A. Ehrmann, MD, the director of the University of Chicago Center for PCOS.
Weight Loss
Weight loss is one common approach, since as many as 80 percent of women with PMOS are overweight or obese, and weight loss can be an important step toward successful ovulation. “Sometimes weight loss is enough [to help a woman get pregnant]” says Dr. Ehrmann. And it’s not necessary to drop it quickly via fad diets, either. Some research indicates that a 5 to 10 percent weight loss over six months will help induce ovulation.
Clomiphene and Letrozole
Oral medication that stimulates ovulation is the next step, he says. One traditional PMOS treatment is clomiphene (Clomid). But another drug, letrozole (Femara), is now considered the first-line medication treatment to induce ovulation in people with PMOS. Letrozole is an aromatase inhibitor, which can help target the hormone imbalance that is the root cause of PMOS.
Whether you take letrozole or clomiphene depends on your circumstances. And it’s important to note that neither is a sure-fire path to pregnancy. One landmark double-blind trial from 2014 followed 750 women with PMOS who were trying to get pregnant. The study found that treatment with letrozole led to a 61.7 percent ovulation rate and a 27.5 percent live birth (delivering a baby) rate after five cycles, compared to 48.3 percent and 19.1 percent for clomiphene, respectively. Both medications can cause side effects, such as hot flashes (more common with clomiphene), dizziness, and fatigue (more common with letrozole).
Metformin
Metformin (Fortamet, Glucophage) is a medication to help control blood sugar in those who have type 2 diabetes. It’s also used off-label as a PMOS treatment, especially for those who have insulin resistance. Though metformin has a long history as a PMOS treatment, and it can help regulate menstrual cycles, it isn’t considered a first-line treatment option to induce ovulation.
According to a narrative review of the research, metformin increased success rates for ovulation, pregnancy, and live births better than a placebo. Success rates were even higher when metformin was combined with other medications, such as clomiphene. The results also suggested that metformin was most helpful for women who also have insulin resistance. Around 40 percent of participants reported side effects, though these were categorized as mild. Nausea, diarrhea, and vomiting were the most common side effects. More research is needed to understand the long-term health effects of metformin and its possible effects during pregnancy.
Another review also found that metformin was most effective when combined with other medications. The study, which analyzed 17 studies to summarize the most reliable PMOS infertility treatments, reported better outcomes when metformin was prescribed alongside letrozole or clomiphene.
In Vitro Treatments
If ovarian-stimulating drugs aren’t effective (or they’re not the best option for you), your doctor may recommend exploring in vitro fertilization (IVF), which offers a higher chance of success than medication alone.
Another possible treatment for PMOS women is in vitro maturation (IVM). Unlike IVF, which involves collecting mature eggs, IVM harvests eggs before they are matured via a surgical procedure.
IVM may be the best alternative for women with PMOS who also need to manage a condition known as ovarian hyperstimulation syndrome (OHSS), which is a known risk for women with PMOS. One meta-analysis of eight studies involving participants with PMOS reported similar fertilization and pregnancy rates between IVF and IVM, and found that IVF resulted in more live births.
Pregnancy Is Possible for Women With PMOS
With so many options available for treatment, there is hope. Don’t listen if other people, including doctors, say it won’t happen, says Amy Medling, a certified health coach in Nashua, New Hampshire, the founder of PCOS Diva, and the author of Healing PCOS: A 21-Day Plan for Reclaiming Your Health and Life With Polycystic Ovary Syndrome. “For many of those women who are told this, it becomes a self-fulfilling prophecy,” she says. “Women can and do get pregnant.”
It’s also important to keep in mind that just because a woman has PMOS doesn’t mean that she also has infertility. Many women under age 35 have improved their fertility through lifestyle changes only, and fertility treatments have a generally high rate of success for women with PMOS. If a woman with PMOS hasn’t gotten pregnant after six months of trying, it’s recommended that she seek the advice of her doctor.
When a woman does get pregnant, she’ll have to work closely with her ob-gyn. According to the National Institutes of Health, women with PMOS are more at risk for complications during pregnancy, including a 3 times greater risk of miscarriage, as well as gestational diabetes, preeclampsia (dangerously high blood pressure during pregnancy), preterm birth, and cesarean sections. Drugs like metformin, which improve insulin sensitivity, may lead to better outcomes, but research isn’t conclusive. The ob-gyn will consider a woman’s unique health history and suggest steps to get the right care to reduce these risks and support a healthy, safe pregnancy.
Resources We Trust
- Mayo Clinic: Polyendocrine Metabolic Ovarian Syndrome (PMOS)
- MedlinePlus: Polycystic Ovary Syndrome
- PCOS Awareness Association: Research and Medically Supported Treatments for PCOS
- Planned Parenthood: Polycystic Ovary Syndrome (PCOS)
- Center for Young Women’s Health: PCOS (Polycystic Ovary Syndrome): General Information
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- Diabetes and Polycystic Ovary Syndrome (PCOS). Centers for Disease Control and Prevention. May 15, 2024.
- Katyal G et al. Systematic Review of the Roles of Inositol and Vitamin D in Improving Fertility Among Patients With Polycystic Ovary Syndrome. Clinical and Experimental Reproductive Medicine. April 11, 2024.
- Polycystic Ovary Syndrome. Office on Women’s Health. October 24, 2025.
- What Is PCOS? PCOS Challenge.
- Polycystic Ovary Syndrome (PCOS). American College of Obstetricians & Gynecologists. April 2025.
- Sung N et al. Polycystic Ovary Syndrome: An Update on Diagnosis and Management. Cleveland Clinic Journal of Medicine. March 2026.
- Franik S et al. Aromatase Inhibitors (Letrozole) for Ovulation Induction in Infertile Women With Polycystic Ovary Syndrome. Cochrane Database of Systematic Reviews. September 27, 2022.
- Legro RS et al. Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome. The New England Journal of Medicine. July 10, 2014.
- Notaro ALG et al. The Use of Metformin in Women With Polycystic Ovary Syndrome: An Updated Review. Journal of Assisted Reproduction and Genetics. February 14, 2022.
- Mahoney A et al. Treatment Options for Managing Anovulation in Women with PCOS: An Extensive Literature Review of Evidence-Based Recommendations for Future Directions. Life (Basel). May 27, 2025.
- IVM: In Vitro Maturation. American Pregnancy Association. February 20, 2026.
- Xu Y et al. Comparison of In Vitro Maturation and In Vitro Fertilization for Polycystic Ovary Syndrome Patients: A Systematic Review and Meta-Analysis. Annals of Translational Medicine. August 9, 2021.
- Hosseinzadeh P. PMOS and Infertility. Johns Hopkins Medicine. February 2, 2026.
- Other PCOS FAQs. Eunice Kennedy Shriver National Institute of Child Health and Human Development. August 21, 2024.
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