From the Guidelines

Women with Polycystic Ovary Syndrome (PCOS) have a lower fertility rate, but approximately 50% of those who ovulate with treatment can conceive.

The American College of Obstetricians and Gynecologists (ACOG) recommends treatment with clomiphene citrate as the first line of treatment for ovulation induction in women with PCOS, as it is effective in inducing ovulation in about 80% of women, with half of these patients conceiving 1.
If clomiphene treatment fails, gonadotropins may be used to induce ovulation, with low-dose therapy preferred to minimize the risk of ovarian hyperstimulation 1.
Lifestyle modifications, such as weight loss and exercise, are also beneficial in improving ovulation rates in women with PCOS, particularly in those with insulin resistance 1.

Insulin resistance plays a key role in the pathophysiology of PCOS, contributing to hyperandrogenism and worsening symptoms, regardless of body mass index (BMI) 1.
Obesity exacerbates insulin resistance and worsens PCOS symptoms, making weight loss and lifestyle modification essential components of PCOS management 1.

From the Research

The fertility rate in women with PCOS is a topic of interest, with various studies investigating the relationship between PCOS and fertility outcomes.
A study published in 2019 2 found that the cumulative probability of childbirth is similar between women with and without PCOS, with 80.2% of women with PCOS and 78.2% of women without PCOS giving birth.
However, the same study found that women with PCOS have a lower fecundity ratio (FR) and give birth to fewer children per woman than women without PCOS.
Another study published in 2015 3 found that infertility is 15-fold higher in women reporting PCOS, independent of BMI, and that women with PCOS are more likely to use fertility hormone treatment.

A study published in 2022 4 found that the pregnancy outcomes of infertile women with PCOS undergoing intrauterine insemination (IUI) are not associated with the attempts of failed ovulation induction cycles previously.
The same study found that most pregnancies occurred in the first three cycles of IUI, and recommended three attempts of IUI for PCOS women before switching to IVF/ICSI.
A review article published in 2016 5 highlighted the importance of targeting metabolic abnormalities through lifestyle changes, medication, and potentially surgery to improve fertility outcomes in women with PCOS.
A study published in 2020 6 found that bariatric surgery can improve fertility outcomes in women with PCOS, with high pregnancy and live birth rates, and few maternal and neonatal complications.

The study published in 2020 6 found that pregnancy rates were 95.2% in women with PCOS and 76.9% in controls, and live birth rates were 81.0% and 69.2%, respectively.
The same study found that the time to achieve the first pregnancy after surgery was similar between women with PCOS and controls, and that maternal and neonatal complications were rare and similar between groups.
The study published in 2019 2 found that women with PCOS have a lower FR and give birth to fewer children per woman than women without PCOS, but that early diagnosis and information about PCOS may improve affected women's reproductive potential.