Trying to conceive can be stressful. Getting pregnant requires a series of events that must each happen at just the right moment.

When you research the whole conception process, you realize that there’s only a very small window in which a woman can get pregnant — a window that can be hard to figure out if your menstrual cycles aren’t exactly clockwork.

If you have a condition that can impact your cycle like polycystic ovary syndrome (PCOS), it’s not impossible to get pregnant — but it can be significantly more difficult. And you may have questions, like:

  • If my cycle isn’t regular, how do I know when my “fertile window” of opportunity is for getting pregnant?
  • I’ve heard that you should take a pregnancy test a couple days after your missed period, but I haven’t had a period in months. How do I know when to test if I don’t even know when my period is due?
  • Can having PCOS result in a false positive on a pregnancy test? A false negative?
  • Whenever I read about pregnancy symptoms, it’s like I’m reading about my usual PCOS experience. How can I tell the difference between pregnancy symptoms and PCOS symptoms?

You’re not alone

Roughly 1 in 10 women in their childbearing years are impacted by PCOS. Many have had successful pregnancies. So, if you’ve been diagnosed with this condition, please know that you’re not alone.

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So why is PCOS an issue when it comes to getting pregnant? Generally speaking, PCOS is a hormonal condition that can impact your fertility. Common symptoms associated with the condition include:

With PCOS, essential hormones necessary for a regular menstrual cycle — estrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) — aren’t present in the necessary levels. This equates to the body not always ovulating (releasing a mature egg) on its own. No ovulation = no egg to fertilize = no pregnancy.

It’s in the few days before ovulation up until the day after that you’re most fertile. Often women with PCOS — who may not ovulate as often as those without — must guess when they think they’re ovulating.

This is because they may not get the same telltale signs that others would use as reliable indicators.

What about using an ovulation monitor or test strips?

Ovulation monitors aren’t ideal if you have PCOS because these tests rely on detecting estrogen and LH, two critical hormones that are often depressed when you have this condition. You may receive inaccurate readings that give a larger number of “high fertility” days in an ovulation monitor.

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With the exception of a missed period or morning sickness, most early pregnancy symptoms are frustratingly similar to regular symptoms of an impending period. These include common symptoms such as:

  • increased fatigue
  • sore or tender breasts
  • abdominal bloating
  • headaches
  • mood swings
  • lower back pain

Sounds familiar, right?

But if you routinely have an irregular menstrual cycle because of PCOS, you might not get those key indicator signals — or you may assume you’re getting your period or just having symptoms of your condition.

Here are a couple of things to remember:

  • Not getting those symptoms doesn’t mean that you aren’t pregnant.
  • If you’ve had unprotected sex 2 to 3 weeks (or more) ago and haven’t had a period, it may be worth taking a test — even if you haven’t had a period in months and aren’t necessarily expecting one.

Women with PCOS are generally advised to avoid using “early result” pregnancy tests — you know, the ones that claim on the front of the box that they can detect pregnancy 6 days before your missed period — as it’s not uncommon to get false negatives with such tests.

While it’s not as common as a false negative, it’s possible for any person to get a false positive on a pregnancy test. However, PCOS is not the culprit if you get one of these rarities.

Specifically, pregnancy tests rely on the presence of human chorionic gonadotropin (hCG) — the “pregnancy hormone” — to determine whether you’re pregnant or not. And that’s not a hormone that’s directly affected by PCOS.

However, if you’re undergoing fertility treatments that require taking certain medications, you may have detectable hCG (from the medication) that can lead to a false positive pregnancy test result. Other common causes of a false positive include:

  • using an expired pregnancy test
  • not following the instructions correctly
  • waiting too long to review the results on a test

There’s one other possibility that we don’t like to talk about: If you have PCOS, your risk of early miscarriage is higher. So it’s possible to initially test positive for pregnancy and then experience a negative result with a later test.

Your hormone levels are irregular when you have PCOS, so false negatives are definitely possible.

You may attempt to test for pregnancy shortly after your missed period and get a negative result even though you’ve conceived. In fact, some women with PCOS may not discover they’re pregnant until many weeks after conception.

So again, avoid those early pregnancy tests. You may even want to test well after your expected period to avoid false positives or negatives.

If getting pregnant is your goal, speak with your physician as there are options to help increase your chances of getting pregnant. These include:

  • Hormonal birth control methods (the pill, shot, intrauterine device, or vaginal ring) to better regulate your menstrual cycle before trying to conceive.
  • Anti-androgen medications to block the impact of increased androgen levels.
  • Metformin, a type 2 diabetes drug that can reduce androgen levels and secondary PCOS symptoms, such as facial hair growth and acne.
  • Weight loss. If you’re currently carrying extra weight, healthy eating and consistent physical exercise can help to regulate your menstrual cycle. (These 13 tips may help.)
  • Ovulation medications — such as clomiphene — to help encourage ovulation.
  • In vitro fertilization (IVF). If medication and lifestyle changes don’t work, IVF is an option in which your eggs are retrieved and fertilized outside your body. A resulting embryo is then placed directly in your uterus.
  • Surgery. If none of the above have worked, a surgery that removes the outer shell of your ovaries (known as the cortex) that is often thicker in women with PCOS can be performed to help restore ovulation. But this option usually only works for 6 to 8 months.

In May 2020, the Food and Drug Administration (FDA) recommended that some makers of metformin extended release remove some of their tablets from the U.S. market. This is because an unacceptable level of a probable carcinogen (cancer-causing agent) was found in some extended-release metformin tablets. If you currently take this drug, call your healthcare provider. They will advise whether you should continue to take your medication or if you need a new prescription.

It’s not a secret that PCOS can make conceiving harder simply because you don’t have the reliability of a predictable menstrual cycle to anchor your timeline. But that doesn’t mean that it’s impossible or that you should give up on pregnancy.

Focus on testing for a positive result well after the date of your expected period has passed. You’ll be more likely to receive an accurate result as opposed to relying on early pre-period testing methods that can lead to faulty results for women with PCOS.

Always confirm pregnancy with a blood test ordered by a doctor. And work with an OB-GYN familiar with PCOS throughout your pregnancy — it’ll give you peace of mind.