Polycystic Ovary Syndrome (PCOS) is a hormonal condition affecting many aspects of a person’s life, including fertility and the ability to conceive.
Given the difficulty in diagnosing PCOS and the distress associated with its symptoms, fertility issues are understandably daunting. The good news is once you know you have PCOS, you can put a plan in place with your provider to hopefully reach your fertility goals.
While seventy to 80% of people diagnosed with PCOS will experience fertility struggles, getting pregnant with PCOS is possible. And most who do conceive will go on to have healthy pregnancies. As a provider, it’s a challenging yet fulfilling journey to go on with my patients where we invest in your future together.
How PCOS affects fertility
Trying to conceive can be a long road for many people, but especially for those with PCOS.
Since PCOS is challenging to diagnose, a lot of people may not even know they have it until they spend months or even years trying to get pregnant. So if you experience irregular periods, weight gain and/or appearance changes like facial hair growth or acne, we hope to see you before you try to conceive, to help with both symptom relief and to offer the best chances at having the family you want.
PCOS fertility issues usually fall into two camps: ovulation and excess weight.
Ovulation with PCOS
PCOS can create enlarged ovaries and immature eggs. And with irregular menstrual cycles, it’s hard to predict ovulation. Since there is only about a 20% chance of conceiving even when you have sex at exactly the right time, the situation can feel even more bleak with PCOS complications stacked against you.
PCOS is also the leading cause of anovulation—when no egg is released during the menstrual cycle.
PCOS weight gain and fertility
Excess weight beyond what’s normal for your body type is the other primary cause of PCOS infertility. Because PCOS leads to a higher glucose state in the body, it is more difficult to lose weight and easier to gain it, even with regular movement and proper nutrition. This excess weight can exacerbate the hormonal imbalances already present with PCOS, making it harder to predict ovulation or to ovulate at all.
Additionally, insulin resistance caused by obesity can increase androgen (male hormones) production, which also impacts ovulation.
Fertility treatment options for PCOS
It’s possible to get pregnant with PCOS naturally if you’re ovulating. But your chances of conceiving are lower simply because that ovulation timing is more unpredictable.
There are a few different fertility treatment options if you have PCOS, and you and your provider can make a personalized plan based on your fertility goals.
1. Medication
Letrozole combined with the supplement myo-inositol is the first choice for treating infertility caused by PCOS. Letrozole works by indirectly lowering the amount of estrogen in the body, which causes the release of follicle-stimulating hormone (FSH) and ovulation. Myo-inositol helps regulate FSH and improves some of the metabolic symptoms of PCOS. The pregnancy rate with letrozole is about 40%.
Your provider may also prescribe metformin. Used along with letrozole, it helps regulate insulin levels in the body to increase or regulate ovulation.
2. Hormones
Gonadotropins are another hormone treatment option, given as an injection to cause ovulation. With this, there’s a higher risk of multiples, and its use requires more frequent lab work and ultrasound exams to keep an eye on your body’s reaction. The success rate of getting pregnant with gonadotropins varies and is something to discuss with your provider.
3. In vitro fertilization
With In vitro fertilization (IVF), your provider will retrieve eggs directly from your ovaries, fertilize them with sperm in a lab and then implant the embryo back into your uterus. This can be a time-intensive and cost-prohibitive option, but potentially a life-changing one. The success rate of IVF for those with PCOS is about 70%.
It’s important to note that with all of these treatment options, lifestyle always plays a part. Your provider may recommend certain changes based on how your PCOS symptoms present to both help your odds of conceiving and carrying a pregnancy to full term.
Pregnancy complications with PCOS
When people with PCOS get pregnant, a whole new set of worries understandably arises, like if PCOS is considered a high-risk pregnancy and if you can have a safe pregnancy with PCOS.
In short, yes–you can absolutely have a safe pregnancy. And, there can also be some added complications due to the hormonal balances, insulin resistance and inflammation associated with PCOS. Generally, getting weight under control before pregnancy can have a dramatically positive impact on everything, especially on getting through the first trimester.
- Gestational diabetes. People with PCOS are more likely to develop gestational diabetes than those without PCOS. This isn’t a barrier to having a healthy pregnancy! But it is something we want to be aware of and test for early.
- Preeclampsia. There is an increased risk of preeclampsia—a pregnancy-related condition where extremely high blood pressure can affect both the birthing parent and baby.
- Preterm birth. Hormonal issues can affect the typical pregnancy progression. Additionally, preterm birth is a risk associated with gestational diabetes.
- Miscarriage. The risk of miscarriage is higher in those with PCOS because inflammation can impact embryo viability, higher androgen levels can affect the uterine lining and embryo implantation and insulin can interfere with embryo development.
A healthy pregnancy with PCOS
The effects of PCOS can often feel insurmountable. Not only are symptoms painful and disruptive, but they also need to be managed life-long. So if you decide you want to become pregnant, it may seem impossible.
But it’s not.
By working with a competent and compassionate provider early, you have a very good chance of getting to where you want to be in terms of fertility. So if getting pregnant is something you want now or in the future, be sure to make an appointment to discuss your options.
