Getting pregnant with PMOS (formerly PCOS)

PCOS was renamed polyendocrine metabolic ovarian syndrome (PMOS) in May 2026. Both names refer to the same condition. Around 1 in 10 women have PMOS1, with higher instances in communities including Aboriginal and Torres Strait Islanders. In this blog, Dr Divya Gurram, Fertility Specialist at Adora Fertility Sydney, explains what PMOS is, the symptoms associated with PMOS, why it impacts fertility, and getting pregnant with PMOS.

What is PMOS?

PMOS is a complex hormonal condition with potential metabolic consequences. Women with PMOS may experience irregular menstrual cycles, excess body hair, weight gain, and skin changes. However, many women have no symptoms – it is estimated around 70% of women with PMOS remain undiagnosed.

Although PMOS is a cause of infertility for some women, it can be overcome, often without the need for IVF.

Fertility and PMOS

PMOS can make it more challenging to fall pregnant. This can be due to:

Lack of ovulation:

Anovulation is the main reason many women with PMOS struggle to get pregnant. This is because with PMOS, the ovaries are typically enlarged with many immature follicles (fluid-filled egg sacs) around the edge, which do not mature and release an egg. This appearances is referred to as ‘polycystic,’ which was how PCOS got its name originally.

Irregular menstrual cycles:

Irregular cycles make it harder to track fertile days and therefore understand when you should time intercourse in order to conceive.

Growth of polyps inside the uterus:

The lack of ovulation caused by PMOS may lead to thickening of the lining of the uterus and development of endometrial polyps, affecting embryo implantation.

Weight gain:

Some women with PMOS have a high BMI, which in itself makes it harder to conceive and also exacerbates the symptoms of PMOS.

Can you get pregnant naturally with PMOS (PCOS)?

Having PMOS does not mean you cannot get pregnant or that you need fertility treatment – it all depends on how PMOS affects you.

A Fertility Specialist will be able to advise the right pathway to pregnancy. Fertility Specialists are highly experienced in understanding and treating the varying effects of PMOS. They will conduct initial fertility tests, including a pelvic ultrasound scan, to accurately assess your current reproductive health as well as assess your general health, BMI, and well-being.

If your BMI is high, you may be advised to reduce it to a healthy level before trying to get pregnant, either through exercise, diet changes and/or weight loss medication.

For patients with a normal BMI, avoiding excess weight gain can be helped by switching to a high protein, low carbohydrate diet maintaining portion control and combining this with regular exercise.

You may required medication to assist with ovulation, and to help time intercourse for when ovulation is imminent, you may use either cycle tracking with blood tests and ultrasound scans, or home ovulation predication kits. Your Fertility Specialist can advise when you should start testing for ovulation.

Fertility treatments for PMOS

If lifestyle changes and weight loss do not help you to conceive, you may benefit from a fertility treatment called Ovulation Induction (OI). This may include a course of oral medication to try to stimulate ovulation (ovulation induction - OI), such as Clomid, Letrozole, or Metformin (Metformin reduces insulin levels and this alone may help regulate your periods for some time).

For some women with PMOS, OI can involve injections of fertility medication, such as Follicle Stimulating Hormone (FSH), which stimulates your ovaries to produce a mature egg. You will be carefully monitored throughout your OI cycle to ensure you are safely responding to the medication. This is because women with PMOS at higher risk of developing a condition called Ovarian Hyperstimulation Syndrome (OHSS), which is where the ovaries ‘over respond’ to fertility medication with potential serious consequences.

You may also be offered IVF (In-Vitro Fertilisation). IVF also involves the use of fertility medication at a carefully planned dose to ensure you produce a good number of mature eggs. These eggs are then fertilised in the laboratory with either partner sperm or donor sperm, with the most suitable embryo transferred into your uterus. Any additional suitable embryos can be frozen for future use.

What causes PMOS?

The exact cause of PMOS is not known. Studies point to lifestyle, environment and genetics as the key factors. High energy, high carbohydrates, a fatty diet and lack of exercise are strongly associated with the rise in incidence of PMOS.

It has been shown that up to 80% of women with PMOS are ‘insulin resistant’. Insulin is a hormone that helps cells take up glucose from carbohydrates in meals. Insulin resistance is when cells in the body become less responsive to insulin and start to produce insulin in excess.

These high insulin levels cause the body to produce more androgens (male sex hormones) and less oestrogens (female sex hormones), which disrupts the menstrual cycle and ovulation, making it harder to get pregnant. High androgens also lead to weight gain and excess body hair.

PMOS affects the whole body, not just the ovaries. Unmanaged PMOS can lead to an increased risk of diabetes, hypertension, increased cholesterol levels and heart disease.

PMOS symptoms

PMOS symptoms vary from person to person and range in severity, making PMOS difficult to diagnose. Common symptoms include:

• Menstrual problems - irregular periods or no periods at all
• Excessive facial and body hair caused by high levels of androgens
• Weight gain
• Thinning hair and hair loss at the front and sides of the scalp
• Acne and dark pigmentation of the skin
• Difficulty falling pregnant
• Anxiety and depression

If you have one or more of these symptoms, it is worth seeing your healthcare provider or a Fertility Specialist, as an early diagnosis of PMOS is important to help manage the condition.

How to get tested and diagnosed for PMOS

PMOS testing and diagnosis involves an examination of your medical history, overall health, and specific blood tests and scans. These tests may include:

• Hormonal profile blood tests including pituitary and ovarian hormones, testosterone levels, and Sex Hormone-Binding Globulin (SHBG), which controls the amount of testosterone in your blood
• Tests to check for metabolic issues - BP monitoring, fasting glucose levels, fasting insulin levels, HbA1c and/or FGTT (Full glucose tolerance text) and lipid studies.
• Pelvic ultrasound scan to examine the ovaries, antral follicular count, and endometrial thickness

For a diagnosis of PMOS, other common causes of PMOS symptoms are typically ruled out first. According to new internationally recognised clinical guidelines released in 2023, to confirm PCOS, now PMOS, women must generally have two of the following three symptoms:

• Biochemical or clinical evidence of excessive androgen levels – such as blood results that show excessive testosterone levels, or the signs of it, such as abnormal hair growth
• Ovulatory dysfunction – irregular periods or no periods at all
• Polycystic ovaries as seen on an ultrasound scan or elevated Anti-Mullerian Hormone (AMH) levels (ovarian reserve)

Next steps

If you have PMOS and are trying to conceive or are worried about PMOS symptoms and your fertility, we are here to help.

At Adora Fertility, our Fertility Specialists would welcome the opportunity to discuss your situation with you. Please contact us to find out how we can help.

Sources

1.https://pubmed.ncbi.nlm.nih.gov/27664216/2.https://www.mja.com.au/journal/2012/196/1/prevalence-polycystic-ovary-syndrome-sample-indigenous-women-darwin-australia3.https://www.racgp.org.au/afp/2012/october/polycystic-ovary-syndrome/4.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984569/5.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456969/6.https://www.monash.edu/__data/assets/pdf_file/0003/3371133/PCOS-Guideline-Summary-2023.pdf