One of the most common reasons a woman has trouble getting pregnant is a condition called polycystic ovary syndrome (PCOS).
It’s a hormone problem that interferes with the reproductive system.
When you have PCOS, your ovaries are larger than normal. These bigger ovaries can have many tiny cysts that contain immature eggs.
What causes PCOS?
While doctors are not sure about the precise causes of PCOS, the following factors have been linked to the condition:
- Genetics. PCOS appears to run in families, so if your mom or close female relative has PCOS, your chances of also having it are higher.
- Excess insulin. Researchers have found that women with PCOS tend to have high levels of insulin (the hormone that regulates how your body breaks down sugar) because their bodies have a hard time using it properly. Insulin also controls ovarian function, and too much insulin in the body can cause irregular or absent ovulation.
- Being overweight or obese. While overweight women are at greater risk for PCOS and women with PCOS are at greater risk of becoming overweight, the jury is out on whether excess weight causes PCOS or vice versa. Even so, if you’re trying to conceive, it’s a good idea to start eating healthy foods and exercising.
What are the symptoms of PCOS?
An irregular period isn’t the only sign of PCOS (and an unpredictable cycle isn’t necessarily a sign that you have PCOS, either). You might also notice acne, excessive hair growth on the face or other parts of the body, weight gain, and occasionally prolonged vaginal bleeding. More than 1 in 2 women with PCOS also develops Type 2 diabetes (insulin resistance) or pre-diabetes (impaired glucose tolerance) before the age of 40.
Because many women who don’t have PCOS may also have these symptoms, you’ll want consult your doctor if you have irregular periods or suddenly develop any of the symptoms above. Your practitioner will consider whether you’ve had them in the past and look carefully at your family history. She’ll also examine areas of increased hair growth, conduct blood tests, and perform a pelvic exam or ultrasound to check for ovarian cysts (though it’s totally possible to have PCOS but no cysts).
Getting pregnant with PCOS
Effect of PCOS on Fertility
If you have PCOS, you have an excess of male hormones, called androgens. While the ovaries of all women produce androgens, an overabundance of androgens disturbs the balance of other reproductive hormones, such as estrogen and luteinizing hormone. These hormones are necessary for the development and maturation of an egg each month. You cannot get pregnant if you do not produce and release a mature egg from the ovary. Anovulation, one of the hallmarks of PCOS, is the single most common cause of infertility, according to the textbook “Effectiveness of Assisted Reproductive Technology.” Women who do not ovulate have irregular or absent menstrual cycles.
PCOS causes a woman’s body to produce higher-than-normal levels of androgens. These are hormones that are usually thought of as male hormones, because men have much higher levels of androgens than women.
Androgens are important in the development of male sex organs and other male traits.
In women, androgens are usually converted into the hormone estrogen.
High levels of androgens interfere with the development of your eggs and the regular release of your eggs. This process is called ovulation.
If a healthy egg isn’t released, it can’t be fertilized by sperm, meaning you can’t get pregnant. PCOS can cause you to miss your menstrual period or have irregular periods. This can be one of the first signs that you may have a problem such as PCOS.
Regulating Your Period
Fortunately, there are some treatments that can help women with PCOS have healthy pregnancies.
Your doctor may prescribe birth control pills that contain man-made versions of the hormones estrogen and progestin. These pills can help regulate your menstrual cycle by reducing androgen production.
If you cannot tolerate a combination birth control pill, your doctor might recommend a progestin-only pill.
You take this pill for about 2 weeks a month, for about 1-2 months. It’s also designed to help regulate your period.
Medicines to help you ovulate
You won’t be able to get pregnant while you’re taking birth control pills for PCOS. But if you need help ovulating so that you can become pregnant, certain medicines may help:
- Clomiphene is an anti-estrogen drug that you take at the beginning of your cycle.
- If clomiphene doesn’t help with ovulation, you may be prescribed the diabetes drug metformin.
- If clomiphene and metformin don’t work, your doctor may prescribe a medication containing a follicle-stimulating hormone (FSH) and a luteinizing hormone (LH). You get this medicine in a shot.
- One other drug that helps with ovulation is letrozole. It’s sometimes used when other medications aren’t effective.
- If you have PCOS and you want to get pregnant, you should work with a doctor who is a specialist in reproductive medicine. This type of doctor is also known as a fertility specialist.
A specialist will help make sure you get the right dose of medicines, help with any problems you have, and schedule regular checkups and ultrasounds to see how you’re doing. (An ultrasound is a machine that uses sound waves to create images of the inside of your body. It’s a painless procedure that can track the growth and development of your baby).
Polycystic ovary syndrome is a common hormonal imbalance that can cause many different symptoms including the following:
- Ovarian cysts
- High levels of insulin
- Excessive amounts of male hormones
- Ovulation and menstrual problems
- Fertility problems
- Weight gain
- Excess body and facial hair or male pattern baldness
- Anxiety and depression
Due to abnormal hormone levels with PCOS, your eggs may not develop properly and may not fully ripen. This can lead to ovulation disorders and infertility. If you have irregular menstrual cycles or are having trouble getting pregnant, ask your doctor about PCOS infertility testing and treatment.
PCOS infertility treatment
If you have PCOS and are trying to get pregnant, the following fertility drug treatments may be helpful.
Metformin (Glucophage). To reduce high insulin levels and stabilize your hormones, your doctor may prescribe a medication called metformin. After taking metformin, your ovulation cycles may become more regular.
Clomid (clomiphene citrate). Your doctor may also prescribe the fertility drug clomid to help you conceive, with or without metformin. The combination of clomid with metformin often helps women with PCOS get pregnant more quickly than by just using metformin alone. Some women with PCOS may require a very high dose of Clomid to restore fertility, which can sometimes cause uncomfortable side effects.
Gonadotropins. Gonadotropins are naturally occurring hormones that stimulate your ovaries to release one or more eggs. This medication may help you ovulate if you are not ovulating regularly. Women with PCOS that do not respond to Clomid treatment may benefit from fertility drug treatment with gonadotropins.
If you have PCOS and do not respond to low doses of Clomid, your doctor may also recommend in vitro fertilization (IVF).
For some women, gaining a lot of weight can affect their hormones. In turn, losing weight, if you’re obese or overweight, may help get your hormones back to normal levels. Losing 10% of your body weight may help your menstrual cycle become more predictable. This should help you get pregnant.
In general, living a healthier lifestyle with a better diet, regular exercise, no smoking, less stress, and control of diabetes and other medical conditions should improve your fertility odds.
Remember, if your period isn’t happening when it should, or you’ve already been diagnosed with PCOS, work closely with your doctor to help get it under control. And if you want to get pregnant, talk with a fertility specialist.
Exercising regularly is another positive step that a woman with PCOS can take to increase her chances of getting pregnant. Exercise plays a role, because it helps a woman lose weight and keep it off, which helps regulate her hormones and minimize the symptoms that lead to infertility, such as anovulation. The American College of Obstetricians and Gynecologists’ practice guidelines recommend starting with exercise and weight loss as therapies for inducing ovulation. Take any physical limitations or health problems such as cardiovascular disease into account before starting an exercise program. Always talk to your doctor before starting a new exercise program.
What you need to know about PCOS during pregnancy
If you’ve been suffering from PCOS, getting pregnant was likely a hurdle. Once you conceive (congratulations!), it will hopefully be smoother sailing ahead — though you should be aware that moms-to-be with PCOS are more likely to experience certain pregnancy complications. Women with PCOS are three times more likely to miscarry and are more at risk for gestational diabetes, inflammation, prenatal depression, heart disease, high blood pressure, and preeclampsia. Moms-to-be are also more likely to require a C-section, while their babies are more likely to be born preterm and spend time in a neonatal intensive care unit (NICU).
Your best bet if you’re expecting with PCOS? Work with your doctor to outline a plan of attack. Gaining the right amount of weight based on your preconception BMI by eating well and staying active is always a good way to reduce your risk of pregnancy complications. Researchers also think the diabetes drug metformin may reduce the chances of having problems while pregnant, since it lowers male hormone levels and can limit weight gain if you’re overweight or obese. More research needs to be done to confirm its safety, but so far the studies that have been done show promising results. Talk to your practitioner about whether it’s an appropriate option for you.
PCOS can have an impact on your fertility and your pregnancy, but with the right care and treatment, conception and a healthy pregnancy are completely possible — and probable!