Can You Get Pregnant With PCOS?

Can You Get Pregnant With PCOSCan You Get Pregnant With PCOS

Can You Get Pregnant With PCOS? – Introduction

References: (1, 2)

Polycystic ovary syndrome (PCOS) is a common chronic hormonal condition that affects women of reproductive age and usually produces dysfunction in the menstrual cycle. One of the concerns commonly related to PCOS is its impact on fertility. PCOS is the first cause of anovulatory infertility nowadays, and infertility is found in 70 to 80% of affected women (3).

PCOS is also associated with insulin resistance, obesity, endometrial cancer, type 2 diabetes mellitus, high blood pressure, and heart disease. (4)

In this article, we explore the definition of PCOS, why PCOS impacts fertility, and the available options for achieving pregnancy.

What Is PCOS?

References: (1, 2)

Polycystic ovary syndrome (PCOS) is a frequent hormonal condition that can affect your menstrual cycle and reduce fertility because of an ovary dysfunction (5). 

This dysfunction can produce:

  • Alterations in the oocyte quality (6).
  • Alteration of the endometrium (7).

Other characteristics of the body like: (4)

  • Acne and coarse facial hair
  • Increased risk of developing diabetes and high blood pressure.
  • Increased risk of developing insulin resistance (when the body cannot use insulin, the hormone that keeps your blood sugar steady, as it should).

PCOS affects women of childbearing age, and although there is no predisposition regarding ethnicity, the symptoms can vary depending on it. 

Only a third of women have the classic symptoms, so to be able to diagnose PCOS, there are three criteria (1):

  • Polycystic ovaries in ultrasound.
  • Chronic anovulation (prolonged lack of menses).
  • Hyperandrogenism (increased male hormones) manifested on the body or a lab test.

Can You Get Pregnant With PCOS?

References: (1, 2, 9)

One of the issues of PCOS is that androgens, the hormones that produce men’s traits (such as facial and body hair growth or voice changes), are elevated, producing fertility complications. This can occur due to:

  • Ovulation problems: High levels of androgens inhibit the production of the egg in the ovary. If there is no egg, the sperm cannot fertilize it, which impairs pregnancy.
  • Period problems: Due to the high levels of androgens, periods can be irregular, and there can be times when women lack periods for months. The irregular or absent ovulation experienced by women with PCOS can significantly affect fertility. Without regular ovulation, the release of a mature egg for fertilization becomes less predictable.
  • Cyst problems: Cysts in the ovaries can interfere with ovulation and cause fertility problems.

Furthermore, PCOS is often associated with insulin resistance, which can lead to metabolic abnormalities and hormonal imbalances that further impact fertility. Insulin resistance can disrupt the delicate hormonal balance necessary to conceive and implant a fertilized egg successfully.

However, it is important to note that while PCOS can present challenges, it does not mean that pregnancy is impossible. Many women with PCOS can achieve pregnancies with the right approach and appropriate medical interventions. (9)

How Can Fertility In PCOS Be Improved?

Lifestyle Modifications

Non-pharmacological measures, meaning lifestyle changes, are the first line of treatment doctors recommend when dealing with PCOS. These can include:

  • Smoking cessation.
  • Stress management.
  • Healthy dieting.
  • Regular exercise.

Managing Weight

Many studies have shown that losing only 5-10% of body weight in overweight women can be enough to restore a regular cycle. Also, reducing weight helps improve the effects of the medication used to induce ovulation. In conclusion, weight loss improves pregnancy odds and has metabolic benefits. (10)

Consuming a diet lower in calories and fats, watching the portion size, and keeping track of the diet in a journal or app can help losing weight. For this, women are encouraged to consult a nutritionist or dietitian. 

In some women, bariatric surgery can help decrease androgens levels and reduce many of the symptoms they produce, like the overproduction of hair and irregular menstrual cycles. (11)

Managing Blood Sugar

As previously mentioned, women with PCOS can develop insulin resistance. 

In some cases, a simple diet low in carbs, processed foods, and sugar is enough. When these measures fail, doctors can prescribe medication (like metformin), which can help manage insulin resistance. (12)

In either case, doctors offer guidance on approaching this issue.

Exercise

Exercise is a good way to reduce stress, burn calories and increase muscle mass. All these help reduce insulin resistance and androgens levels in women with PCOS. (10)

Medication

Medications are often used in women with trouble generating good eggs, acting in the fertility window of the menstrual cycle and helping stimulate the ovaries to grow a fertile egg. When considering a pharmacological treatment, you should always discuss the risks, adverse effects, and benefits of taking medication with your doctor. 

Factors such as blood glucose, weight, blood pressure, smoking, alcohol, diet, exercise, sleep, and mental, emotional, and sexual health should be considered when choosing infertility treatment.

Clomiphene citrate (Clomid, Serophene): This medication is frequently used to induce ovulation in women with PCOS that develop infertility. (13) 

It is an anti-estrogen that blocks estrogen receptors and stimulates egg development in the fertility window of the menstrual cycle (3). 

When taking this drug, women are monitored by ultrasound to know the ovulation day and prevent multiple pregnancies (13).

Letrozole (Femara): This medication helps stimulate egg development in women with PCOS. It has some advantages over clomiphene citrate, like less likelihood of multiple pregnancies and other menstrual cycle changes (15). Letrozole is considered a treatment of choice for infertility in women with PCOS. (16)

Metformin: Could be used in women with PCOS and ovulation problems alone or combined with clomiphene citrate to induce ovulation, although there are more effective ovulation induction agents. (16)

Assisted Reproductive Techniques

This treatment is considered when other treatments have failed. There are two options: in vitro fertilization (IVF) and in vitro maturation (IVM).

IVF: This procedure is available for people with fertility problems. In this technique, an egg is removed from the woman’s ovaries and joined with the sperm in the laboratory. Then after it is fertilized, it returns to the woman’s womb to grow and develop. It is often used combined with hormonal medication. Some complications of this technique are multiple pregnancies and ovary overstimulation. (17)

IVM: This procedure involves a short duration of hormonal stimulation, where the eggs are retrieved from the ovaries before they are mature (in an earlier stage than IVF), reducing the associated risks of IVF and minimizing the exposure to estrogen, and preventing its associated complications. (16)

Ovarian Drilling

Ovarian drilling is an alternative treatment performed via laparoscopy (a small camera inserted through the abdomen) or transvaginal (the procedure is performed through the vagina with a small camera), also called ovarian diathermy or electrocoagulation.

This procedure can be done if Clomiphene citrate doesn’t work and before hormonal treatment. (3)

The technique consists in puncturing the membrane around the ovaries. This can improve the action of ovulation induction medication and reduce the chances of having multiple pregnancies. (18)

Can You Get Pregnant With PCOS

Can You Get Pregnant With PCOS – Hormonal Treatment

Hormonal Treatment 

Gonadotropin therapy: This option is associated with timed intercourse. Doctors start with low doses, increasing it over time to prevent overstimulating the ovaries and multiple pregnancies. (19)

Frequently Asked Questions

What are the risks of pregnancies in women with PCOS?

The increased risks of women with PCOS are

  • Preterm birth.
  • Gestational diabetes.
  • Gestational high blood pressure.
  • Miscarriage in early pregnancy increases three times more than in women without the condition.

When should I take a pregnancy test if I have PCOS?

Although you can take the test as soon as you have missed your period, it is recommended that you wait for at least one week after you have missed your period to get accurate results. This is because tests improve reliability after a week from the missed period.

Can PCOS be cured with pregnancy?

No, PCOS is a chronic condition and can’t be cured. However, many women have experienced a cessation of their symptoms while pregnant and an improvement in their menstrual cycle after pregnancy.

Can I breastfeed if I have PCOS?

Yes, breastfeeding has many benefits for the mother and the baby and can be done. However, if you take metformin, a medication to control blood sugar levels, you should consult a health professional since it can have some contraindications when breastfeeding.

Conclusions

Despite the challenges posed by PCOS, it is important to note that pregnancy is still possible for women with this condition. Various approaches can be taken to increase fertility in women with PCOS, starting with lifestyle modifications such as weight management, adopting a healthy diet, regular exercise, and managing blood sugar levels. These lifestyle changes have been shown to improve pregnancy outcomes and increase the chances of conception.

In addition to lifestyle modifications, medical interventions can induce ovulation and improve fertility in women with PCOS. Medications like clomiphene citrate and letrozole are commonly prescribed to stimulate egg development and regulate ovulation. Assisted reproductive techniques, such as in vitro fertilization (IVF) and in vitro maturation (IVM), can be considered if other treatments have not been successful.

Ovarian drilling, a surgical procedure, can be an alternative option when medication and other interventions have not yielded the desired results. Hormonal treatments such as gonadotropin can enhance fertility, but careful monitoring is necessary to prevent complications.

Women with PCOS need to seek guidance from healthcare professionals to develop a personalized treatment plan based on their circumstances. Regular monitoring, medical support, and appropriate interventions can significantly improve the chances of successful conception and pregnancy.

See Also

Infertility Overview

Infertility Support Resources

Assisted Reproductive Techniques

References:

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  4. Azziz, R., Carmina, E., Dewailly, D., Diamanti-Kandarakis, E., Escobar-Morreale, H.F., Futterweit, W., Janssen, O.E., Legro, R.S., Norman, R.J., Taylor, A.E. and Witchel, S.F.; Androgen Excess Society (2006) Positions Statement: Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism, 91, 4237-4245. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline – PubMed (nih.gov)
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  8. Wu XK, Stener-Victorin E, Kuang HY, Ma HL, Gao JS, Xie LZ. Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial. JAMA (2017) 317:2502–14. doi: 10.1001/jama.2017.7217 Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial – PubMed (nih.gov)
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Virginia Rodriguez, BSc
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Virginia Rodriguez is a last-year medical student at the Catholic University of Cordoba, Argentina. Her undergraduate studies are complemented by a diploma in eating disorders and experience as a teaching assistant in a normal anatomy chair for 6 years at the same university. She is interested in developing her research skills and producing educational content.

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