PCOS fertility treatment options including letrozole, clomifene and metformin

November 6, 2023

Metformin, Clomid and other medications: fertility treatment options for PCOS

by Femme Health in Our Blog

Metformin, clomifene, letrozole and fertility treatment for PCOS

Originally written by Zita West. Updated by femme to reflect current evidence-based PCOS fertility guidance.

PCOS can make conception more difficult when ovulation is infrequent or absent. The good news is that there are established fertility treatments, and the right option depends on whether ovulation is the main problem and on the rest of the fertility assessment.

Why can PCOS affect fertility?

PCOS is associated with ovulatory dysfunction and higher androgen levels. Some people with PCOS also have insulin resistance. These features can make ovulation less regular, but PCOS does not mean pregnancy is impossible.

Medicines used for ovulation induction

Letrozole

The 2023 International Evidence-based PCOS Guideline recommends letrozole as the preferred first-line medicine for anovulatory infertility in PCOS when there are no other infertility factors.

Clomifene

Clomifene can stimulate ovulation and remains an established fertility medicine. Depending on the situation, it may be used alone or with metformin.

Metformin

Metformin improves insulin sensitivity and is used for metabolic features of PCOS. It can also have a role in fertility treatment, although it is not simply an “egg quality” medicine and may be less effective for ovulation induction than letrozole.

Second- and third-line treatment

Gonadotrophins, ovarian surgery in selected cases and IVF can be considered when first-line ovulation treatment is unsuccessful or when another fertility factor makes assisted conception appropriate.

Lifestyle can support health, not replace fertility treatment

A balanced diet, regular activity, sleep and weight management where relevant can support metabolic and reproductive health. The PCOS guideline emphasises healthy lifestyle for everybody with PCOS, including people who are not overweight.

There is no single low-GI diet or exercise routine that guarantees ovulation or pregnancy, and fertility difficulties should not be blamed on somebody's lifestyle.

What about supplements?

Inositol is widely marketed for PCOS. Current international guidance says it may be considered, but clinical benefits are limited and specific types or doses cannot be confidently recommended from the available evidence.

Omega-3 and vitamin D have roles in general nutrition, but supplements should not be presented as proven fertility treatments for PCOS unless a deficiency or specific clinical indication has been identified.

Age and PCOS

PCOS does not remove the age-related decline in fertility. Treatment can help address ovulation problems, but no combination of medicines, supplements or lifestyle changes can reverse reproductive ageing.

If you are struggling to conceive, a fertility assessment can look at ovulation, sperm, tubal factors and other causes rather than assuming PCOS explains everything.

The bottom line

For PCOS-related anovulatory infertility, evidence-based treatment starts with identifying the cause and choosing the right ovulation-induction strategy. Letrozole is now the preferred first-line medicine in the international guideline, while clomifene and metformin still have important roles in selected patients.

Further information

2023 International Evidence-based PCOS Guideline
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PCOS Is Now PMOS: What It Means & How to Support It

If you've spent any time in PCOS corners of the internet lately, you've probably seen it: PCOS has a new name. As of May 2026, it's officially Polyendocrine Metabolic Ovarian Syndrome, or PMOS for short. And no, your diagnosis hasn't changed, your treatment plan hasn't changed, and you haven't missed some huge medical U-turn. But the name change is a bigger deal than it might first look, and since September is PMOS Awareness Month, it felt like the right time to actually explain it properly, rather than just dropping an acronym on you and moving on. So let's get into it: what PMOS is, why the name changed, and what you can actually do about it, whether you're trying to conceive, trying to figure out why your cycle has a mind of its own, or just trying to feel like yourself again. Jump to what you need Wait, PCOS Is Now Called PMOS? Okay, So What Is PMOS, Exactly? Your PMOS Support Toolkit 15% Off PMOS Support Wait, PCOS Is Now Called PMOS? Yes, really. In May 2026, the American Society for Reproductive Medicine and the Endocrine Society, backed by a global consensus process involving patient groups and clinicians and published in The Lancet, formally renamed Polycystic Ovary Syndrome to Polyendocrine Metabolic Ovarian Syndrome. The short version of why: "Polycystic Ovary Syndrome" was never a great description. A lot of people with the condition don't actually have cysts on their ovaries at all, what shows up on a scan is usually a higher number of small follicles, not cysts in the traditional sense. And naming the condition after the ovaries made it sound like an ovary problem, when really it's a whole-body hormonal and metabolic condition that happens to show up in the ovaries as one of its symptoms, not the cause. The new name isn't just a rebrand for the sake of it. According to the Endocrine Society, the goal is better awareness, earlier diagnosis, and less confusion for the estimated 170 million women living with it worldwide, including around 1 in 8 women in the UK, per coverage from ITV News and the UK charity Verity. If you already have a PCOS diagnosis, nothing changes for you clinically. Same condition, same you, just a name that finally makes a bit more sense. 1 in 8women in the UK 170Mwomen worldwide 70%still undiagnosed Okay, So What Is PMOS, Exactly? "Polyendocrine metabolic ovarian syndrome (PMOS) is a hormone condition that can affect hair growth, periods, fertility and mood. There is no cure, but treatments and lifestyle changes can help." - NHS UK Here's the plain-English version. PMOS is a common hormonal and metabolic condition, and it's usually driven by insulin resistance, which is when your body doesn't respond to insulin as efficiently as it should. To compensate, your body produces more insulin, and higher insulin levels are closely linked to higher androgen levels (the hormones often labelled "male hormones," though everyone has them). That knock-on effect is where a lot of the classic symptoms come from: irregular or unpredictable periods, acne, extra hair growth, changes in weight, and fertility difficulties. Diagnosis usually comes down to three main things: irregular or absent ovulation, higher androgen levels, and polycystic-appearing ovaries on a scan. You don't need all three, and you don't need to have "classic" symptoms to have PMOS. It shows up differently for everyone, which is part of why it takes people so long to get diagnosed in the first place. And that's a genuinely big problem: PMOS is thought to be one of the most under-diagnosed hormonal conditions out there, with some estimates suggesting up to 70% of cases go undiagnosed. If you've been told your symptoms are "just stress" or "normal," you're honestly not alone. Your PMOS Support Toolkit Managing PMOS isn't about strict rules or restriction, it's about giving your body practical, targeted support in the areas where it needs it most. Here's how we think about it, broken into four areas. Four ways to support your journey, however it looks: Track your cycle with confidence Support your body while trying to conceive Balance everyday hormonal symptoms Relieve the discomfort that can come with it SHOP PMOS COLLECTION Track: Wearable BBT Sensor Know What Your Cycle Is Actually Doing Ovulation with PMOS can be hard to predict. Cycles can run long, irregular, or for some, not include ovulation at all. Tempdrop reads your basal body temperature automatically overnight, helping you understand your pattern, including whether and when ovulation happens, without daily guesswork. Support: Myo-Inositol If you're trying to conceive with PCOS, ovulation is usually the biggest hurdle. One common reason it gets disrupted is insulin resistance: when your body becomes less responsive to insulin, it produces more of it, and higher insulin levels can interfere with ovarian hormone signalling, delaying or suppressing ovulation. This is where myo-inositol comes in. It's a naturally occurring compound that plays a role in insulin signalling and ovarian function, and it's one of the most frequently mentioned supplements in PMOS communities, even though half of people haven't heard of it before trying to conceive. It's not a cure and not a guarantee, but it can be a helpful piece of a broader fertility plan. Proceive's Pure Myo-Inositol is highly bioavailable, free from fillers and binders, and can be taken alongside a multivitamin like Proceive Max Women for broader nutritional support. Balance: Supplements Daily Hormone Support Not everyone managing PMOS is trying to conceive, and honestly, a lot of PMOS content forgets that. If you're dealing with the day-to-day side, skin changes, energy dips, mood swings, an unpredictable cycle, daily hormone balance supplements are designed specifically for that: ongoing, everyday support for hormonal and metabolic balance, rather than something tied to a fertility goal. KIKI Health PMS supplement provides vitamin B6 to support normal hormonal activity, zinc for normal fertility and carbohydrate metabolism, plus magnesium and vitamin B5 to support energy, psychological function and normal steroid hormone metabolism. Gigi's PMS & Hormone Balance Blend is built for everyday support. It combines four nutrients backed by research, zinc, inositol, magnesium and vitamin D, each targeting a different part of the picture. Zinc helps support lower testosterone levels and more regular ovulation, inositol supports steadier blood sugar and more regular cycles, magnesium helps ease inflammation and supports better sleep, and vitamin D, often low in women with PMOS, supports mood and hormonal balance. Together, they're designed to help with the everyday side of PMOS, skin, energy, cycles and mood, not just fertility. The Phase System offers nutritional support that many women find helpful, including those managing PMOS. The standout is myo-inositol, involved in insulin signalling and ovarian function, and one of the most researched ingredients for PMOS specifically. Alongside it, Phase contains vitamin B6, zinc, magnesium, vitamin D3, folate and B12, nutrients that contribute to normal hormonal activity, fertility, energy metabolism and psychological wellbeing. Together they offer nutritional support that fits naturally into a PMOS conscious routine. Relieve: Period Harmony Soothing Patches Cramping and pelvic pain can be part of the picture too, and sometimes you just need something that helps in the moment. That's where something like Period Harmony patches come in, offering targeted, on-the-go relief for the physical side of things, alongside everything else you're doing to support your body long-term. SHOP PMOS COLLECTION A Few Doable Things You Can Start Today Supplements and tracking help, but they work best alongside a few small, sustainable habits, not a total lifestyle overhaul: Aim for regular meals with a mix of protein, fibre and slow-release carbs, it helps keep insulin levels steadier through the day. Move your body in ways you actually enjoy. Consistency beats intensity here. Prioritise sleep where you can. Poor sleep is linked to worse insulin sensitivity, which can make symptoms harder to manage. Be patient with yourself. PMOS is a long-term, whole-body condition, and small, consistent changes tend to matter more than dramatic short-term ones. Support That's Easy to Find That's the whole point of PMOS Awareness Month, as far as we're concerned: making the information and the support easier to access, whatever stage of your journey you're on. All September, you can get 15% off products in the PMOS collection with code SUPPORT15. PMOS Awareness Month · September 15% off Save 15% on products in our PMOS collection throughout September. One use per customer. Use code SUPPORT15 Shop now This article is for general information only and isn't a substitute for medical advice. Products mentioned are suggested only as general support and aren't guaranteed to relieve or treat PMOS symptoms. If you think you might have PMOS, or you're managing symptoms and unsure what's right for you, speak to your GP or a specialist. Food supplements should not be used as a substitute for a varied and balanced diet. SHOP PMOS COLLECTION

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Know Your Eggs: A Guide to Egg Health, Egg Freezing and What's Next

Eggs. We all know they’re part of the fertility equation, but how much do we really know about egg health? We talk a lot about timing ovulation, tracking hormones, and optimising sperm, but egg health deserves a headline of its own. Whether you’re trying to conceive now or just thinking ahead, understanding what affects your eggs, and what you can actually do to support them, can make fertility feel a little less mysterious and a lot more empowering. Here’s what you need to know. Welcome to The Ultimate Egg Health Guide Learn what egg count (ovarian reserve) really means Understand how egg quality affects fertility Discover what AMH testing can tell you Explore what affects egg health over time Find out when egg freezing might be worth considering No overwhelm. No jargon. Just facts, clarity, and your next best step. DOWNLOAD NOW Egg Health 101: Count vs. Quality First things first: egg count and egg quality are not the same thing. Egg count, your ovarian reserve, is about how many eggs you have left. You’re born with all the eggs you’ll ever have, around 1–2 million, and that number steadily declines over time. Egg quality is about how healthy those eggs are, especially their DNA and ability to develop into a healthy embryo. Quality naturally declines with age, particularly after 35, but it’s also influenced by your overall health, lifestyle, environment, and hormones. So yes, age matters. But it’s not the whole story. And there are things you can do to support egg quality, even if you can’t increase the number of eggs you have. Your Egg Health is a combination of egg reserve and egg quality. What Is Ovarian Reserve? Ovarian reserve refers to the number of eggs left in your ovaries. While there’s no way to count them directly, doctors use hormone tests and ultrasound to estimate your reserve. A lower ovarian reserve doesn’t automatically mean you can’t get pregnant, and a higher reserve doesn’t guarantee it. It’s one piece of the fertility puzzle. AMH Testing, Explained Simply AMH (Anti-Müllerian Hormone) is produced by the small follicles in your ovaries. A simple blood test can check your AMH level and give you a rough estimate of your ovarian reserve. A higher AMH usually means more follicles. A lower AMH may suggest fewer eggs remaining. But AMH doesn’t measure egg quality, and it doesn’t predict your chances of natural conception. It’s best used as a guide, not a verdict. A few numbers worth knowing: AMH typically peaks in your late teens to early 20s. It declines slowly through your 20s and more rapidly after 35. By 37, many women have around 25,000 eggs left, compared to the 1–2 million they started with. It’s a useful clue, but not the full picture. A few numbers worth knowing: AMH typically peaks in your late teens to early 20s. It declines slowly through your 20s and more rapidly after 35. By 37, many women have around 25,000 eggs left, compared to the 1–2 million they started with. What Affects Egg Quality? Egg quality naturally declines with age, but that’s not the only factor. Your eggs are sensitive to what’s happening in your body and your environment. Things like stress, smoking, excess alcohol, poor nutrition, lack of sleep, and chronic inflammation can all affect how well your eggs function. The good news? While you can’t stop time, you can support the health of your eggs by focusing on the key 90-day window before ovulation, the time when an egg is maturing and getting ready for release. Nutrition for Egg Quality A balanced diet is one of the most effective ways to support egg health. That means whole foods, plenty of colourful fruit and veg, and nutrients linked to antioxidant protection, hormone function, and cell health. Some key nutrients include: CoQ10 – Supports cellular energy and mitochondrial function. Omega-3s – Help reduce inflammation and support hormone production. Folate – Essential for DNA synthesis and early embryo development. Zinc and Selenium – Support antioxidant defence and reproductive health. Vitamin D – Plays a role in hormone regulation and ovulation. This is where a well-formulated fertility supplement can help to fill any nutritional gaps. OVUM - Time to Conceive, for example, is designed with this 90-day window in mind, combining antioxidants and key nutrients to support egg health, ovulation, and fertility. 👉 Shop the Ovum Time to Conceive supplement here Because knowing your eggs deserves more than a blog post. Join us in raising awareness and celebrating Egg Health Week with this exclusive offer: 🥚 10% off all products in our Egg Health collection Just use the code: KNOWYOUREGGS at checkout. When Should You Think About Egg Freezing? Egg freezing isn’t just for “later”. It’s about giving yourself options, especially if you’re not ready for a baby now, or if medical treatments or conditions could affect your fertility in the future. It’s worth considering if: You’re in your late 20s or early 30s and don’t plan to try for a baby for a few years You have a lower AMH or a family history of early menopause You’re about to undergo chemotherapy or surgery that could impact your ovaries You have conditions like endometriosis that can affect egg quality or quantity The earlier you freeze, generally the better the outcomes, but it’s a very personal decision. Speaking with a fertility specialist can help you understand whether it’s the right choice for you. Life Beyond Fertility Planning Egg health isn’t only about trying to get pregnant, it’s also a reflection of your wider wellbeing. Hormones, sleep, stress, blood sugar, and nutrition all connect back to how your body functions, and supporting them now can benefit you well into the future. 👉 Want to understand your cycle better, too? Try a Tempdrop Cycle Tracker Tempdrop is a wearable sensor that tracks your basal body temperature (BBT) while you sleep, giving you valuable insight into ovulation and your cycle without the daily 6am thermometer routine. It pairs with a smart app that learns your body over time, helping you see when and if you’re ovulating, spot cycle changes, and feel more in tune with what’s going on hormonally. Whether you're trying to conceive or simply want to understand your cycle better, Tempdrop can be a helpful tool for fertility tracking, hormone awareness, and peace of mind. SHOP TEMPDROP Final Thoughts You may not be able to change your egg count, but there’s a lot you can do to support your egg quality and overall fertility. Eat well. Rest. Move. Get curious about your hormones. And don’t wait until you’re “ready” to start learning what your body’s been trying to tell you all along. Because egg health is about more than fertility. It’s about understanding, supporting, and investing in your future. Want to learn more? Download our free Egg Health Guide here.

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IVF Timeline: Every Journey, Every Hope, Every Step Forward

Every year, World IVF Day gives us a chance to pause and talk openly about a journey that millions of women and families go through, often in silence. Behind every fertility appointment, blood test, and medication schedule is something deeply personal: hope. Hope for good news. Hope for the future. Hope for a family. At Femme, that journey is represented by Faye. Faye isn't just a character. She's someone many women will recognise a little of themselves in. She dreams of having her own family one day, and like so many women navigating fertility challenges, she knows that the road to parenthood isn't always straightforward. There are moments when she feels excited and optimistic. There are moments when she feels frustrated, overwhelmed, and tired of waiting. Yet through it all, she continues to show up for herself, her loved ones, and the life she's building in the present while still holding onto her dreams for the future. Faye represents the resilience, patience, and strength that so many women carry every day, especially when their fertility journey isn't going to plan. For some women, that journey may eventually include IVF. What is IVF? IVF (In Vitro Fertilisation) is a fertility treatment where eggs are collected from the ovaries, fertilised with sperm in a laboratory, and then transferred back into the uterus as an embryo. People pursue IVF for many different reasons, including ovulation disorders, blocked fallopian tubes, male-factor infertility, unexplained infertility, age-related fertility challenges, and family building for LGBTQ+ couples and single parents by choice. Even though IVF has become increasingly common, it can still feel overwhelming when you're experiencing it for the first time. Between appointments, medication schedules, and unfamiliar terminology, there can be a lot to process emotionally and physically. If you're considering IVF or are already preparing to start treatment, here's what a typical IVF timeline might look like. The IVF Timeline: What to Expect Week by Week Weeks 1–2: Initial Consultation and Testing The IVF timeline usually begins with a series of tests and consultations. Your clinic may arrange: Blood tests and hormone panels Ultrasound scans Ovarian reserve testing Semen analysis (where applicable) This stage is all about understanding your individual fertility picture and creating a treatment plan tailored to you. Weeks 2–6: Priming Phase (If Required) Some treatment protocols include a priming phase using birth control or other medications. Although it might feel like a delay, this step helps prepare your body and encourages follicles to develop more evenly once stimulation begins. Days 1–12: Ovarian Stimulation This is often the stage people most associate with IVF. Daily hormone injections encourage the ovaries to produce multiple eggs rather than the single egg typically released during a natural cycle. During this time, you'll attend regular monitoring appointments where your clinic tracks follicle growth through blood tests and ultrasound scans. For many women, this can be one of the busiest stages of treatment. Between medication timings, dosage adjustments, and appointments, there's a lot to keep track of. Trigger Shot Once the follicles have reached the ideal size, you'll take a trigger injection to help mature the eggs before collection. Timing is incredibly important at this stage and is usually scheduled 34–36 hours before egg retrieval. Egg Retrieval Egg retrieval is a short procedure typically performed under light sedation. Using ultrasound guidance, eggs are collected directly from the ovaries. Most women return home the same day and spend the next day or two resting and recovering. Days 1–6: Fertilisation and Embryo Development Once collected, the eggs are fertilised in a laboratory. Over the next few days, embryologists carefully monitor embryo development. By days five or six, healthy embryos may reach what's known as the blastocyst stage, when many clinics choose to freeze or transfer them. Embryo Transfer The embryo is transferred back into the uterus either during the same cycle (fresh transfer) or during a later cycle (frozen embryo transfer). The procedure itself is usually quick and relatively painless. The hard part often isn't the transfer—it's the waiting that comes after. The Two-Week Wait If you've ever spoken to someone who has gone through IVF, you've probably heard about the infamous "two-week wait." For many women, this is the most emotionally challenging part of the entire process. Every sensation feels significant. Every day feels longer than normal. Every symptom gets analysed. Every phone notification can bring a wave of anticipation. It's a period where all you can really do is wait and hope. Beta hCG Test Usually around two weeks after embryo transfer, a blood test measures hCG levels to determine whether implantation has occurred. Sometimes additional tests are needed to confirm that hormone levels are rising appropriately. For many women, this is a moment they've been working towards for months or even years. Understanding Your Body Along the Way Fertility journeys often come with a crash course in cycle literacy—and knowing when you ovulate and how your hormones shift can be genuinely empowering, especially through the ups and downs of treatment. Basal body temperature (BBT) tracking confirms ovulation and reveals hormonal patterns by capturing the subtle temperature rise post-ovulation and dip before your period. The catch? Traditional BBT tracking demands rigid discipline—same wake time daily, temperature taken before you move, speak, or even think. One missed morning and your data suffers. During an already demanding IVF timeline, that kind of pressure is the last thing you need. A Smarter Way to Track Tempdrop takes that burden off your plate. This comfortable wearable works while you sleep, continuously monitoring temperature overnight and syncing automatically—no alarms, no perfect routines, no anxiety over a restless night or early appointment throwing off your chart. Built on proven BBT science, Tempdrop's smart algorithm filters out disturbances and adapts to irregular schedules, so you still get reliable data even when IVF's early mornings, medication side effects, and unpredictable days make consistency hard. When so much of the process already feels out of your hands, having a clearer, effortless window into your cycle can offer something invaluable: a little more confidence and control along the way. The Part People Don't Always Talk About While IVF timelines follow a medical timeline, fertility journeys rarely follow an emotional one. That's why Faye's story feels so important. Like many women, Faye is learning that fertility isn't something you can simply schedule or control. It's a journey that often requires patience, resilience, and self-compassion. Some days she feels hopeful. Some days she feels exhausted by the waiting. Some days she wonders if everyone around her seems to be moving forward while she remains stuck in place. And that's completely normal. The reality is that fertility journeys aren't defined by appointment dates, ovulation charts, or treatment milestones alone. They're defined by the courage it takes to keep believing in your future, even when the path isn't clear. Faye reminds us that it's possible to hold hope and uncertainty at the same time. To dream about tomorrow while still embracing today. To Every Woman Navigating Fertility Challenges This World IVF Day, we're thinking about every woman who is trying to conceive, undergoing treatment, waiting for answers, grieving setbacks, celebrating milestones, or simply taking things one day at a time. Whether your journey includes IVF or not, your experience is valid. Like Faye, you are allowed to dream about the future while still embracing the life you're living today. You are allowed to feel hopeful and vulnerable at the same time. You are allowed to have difficult days. And most importantly, you are not alone.

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