PCOS and pregnancy: what’s the connection? PCOS can affect your fertility, but it doesn’t have to stop you from getting pregnant. If you're trying to conceive with PCOS, here's what you need to know.
Does PCOS affect your fertility? Short answer: yes. But that doesn’t mean you can’t get pregnant if you have PCOS.
Polycystic ovary syndrome (PCOS) is a condition that refers to your ovaries being filled with many cysts, or small sacs filled with fluid. This endocrine condition, which can be genetically inherited, affects at least 7% of adult women. Not everyone with PCOS develops cysts, but everyone with PCOS does struggle with menstruation. PCOS causes hormonal imbalances that throw off regular ovulation.
Because PCOS messes with ovulation, it also has an impact on fertility. If you have PCOS, you ovulate less frequently, which means that if you’re
trying to conceive (TTC) it becomes harder to get lucky and happen upon a pregnancy. So, how much harder is it for someone with PCOS to get pregnant? What are some ways to boost your chances of PCOS and pregnancy? How common is pregnancy with PCOS?
Unfortunately, many people with polycystic ovary syndrome experience
infertility. Infertility isn’t a forever diagnosis; it just means that after six months of unprotected sex, you haven’t conceived yet. Infertility happens often for people with PCOS, but luckily, it is still entirely possible to conceive with this condition. Depending on what type of infertility treatment you pursue, conception rates for PCOS treatments can range anywhere from 20-60%.
A PCOS diagnosis means that you have a hormone imbalance. Usually, you have too many androgens, hormones that are more typically present in bodies assigned male at birth. The overflow of hormones can cause all sorts of side effects, like acne, excess hair growth, and trouble with regulating weight, which is related to the way your body processes insulin. It also affects ovulation—with too many androgens in your system, your body is prompted to menstruate less often.
Preparing for PCOS and pregnancy
While people with PCOS struggle more often with infertility, there’s still hope for healthy pregnancy. The first step in preparing for pregnancy with PCOS is getting a PCOS diagnosis. Many people struggle with the symptoms of PCOS for many years without getting a diagnosis, which can delay any efforts toward fertility optimization. To get diagnosed, healthcare professionals need proof of two of three things: a history of
irregular cycles, cyst-like growths within your uterus, and a hormone imbalance in your blood. >>MORE: How Is Polycystic Ovary Syndrome (PCOS) Diagnosed?
After you’ve been diagnosed, you can start crafting your preconception plan. It’s important to work with professionals who specialize in PCOS and fertility. All of their suggestions should be geared towards correcting anovulation, or making sure an egg actually leaves the ovaries when you’re in the ovulation period.
Medical interventions and treatments
infertility treatment options for people with PCOS are medications that are designed to induce ovulation. Clomiphene
Clomiphene is a non-steroidal drug. With clomiphene, doctors usually start you out on a low dose for the five days after your period. If you do not ovulate after taking the smallest dose of clomiphene, you might be moved up to a larger dose.
It is usually recommended to try this for three menstrual cycles before looking at other fertility treatment options. According to a 2013 paper, clomiphene results in pregnancy 30% of the time. Drawbacks include side effects like ovarian enlargement or ovarian hyperstimulation syndrome (OHSS), and the fact that
20% of those pregnancies end with “spontaneous abortions or stillbirths.” Antidiabetic drugs
Another option to increase fertility in people with PCOS is the use of antidiabetic drugs. Antidiabetic drugs can be used in conjunction with clomiphene or on their own, but they are more effective when used with clomiphene. Examples of these drugs include:
Metformin: this drug is most often used on people with PCOS trying to conceive; it is designed to manage high blood sugar levels. Letrozole: a medication originally designed to help with cancer, is also sometimes used to induce ovulation. (Don’t be scared by its original use — it’s been heavily tested!) Gonadotropins: usually the final medical intervention, doctors prescribe this only after trying out less intense fertility drugs like clomiphene. These fertility drugs are more effective in inducing ovulation. In one 2012 study, gonadotropins had a 58% pregnancy success rate, while clomiphene resulted in a 44% pregnancy success rate. However, gonadotropins are also more expensive to administer, so they’re not usually suggested right off the bat. (Learn how to save money when trying to conceive.) Assisted reproductive technologies
After attempting first with medication, assisted reproductive technologies (ARTs) like
intrauterine insemination (IUI) and in-vitro fertilization (IVF) can also be used to help people with PCOS conceive.
Success rates for assisted reproductive technologies vary by type of technology; factors like maternal age and genetics can also affect conception rates.
Eighty-eight percent of people who used IUI become pregnant within their first three cycles, while 95.5% become pregnant after the first four. Nearly 40% of IVF egg retrievals result in live births for women under 35, with percentages declining to under 5% for women older than 42. Can I get pregnant with PCOS naturally?
Doctors might also ask you to consider making lifestyle modifications in order to optimize your fertility. These suggestions may include changes like following a more nutrient-rich diet, or folding more regular exercise into your day-to-day life.
>>MORE: 5 Tips for a PCOS Diet, According to a Registered Dietitian Nutritionist
According to the
American College of Obstetricians and Gynecologists, weight loss in people who are overweight can lower androgen, luteinizing hormone (LH), and insulin levels. These changes help regulate your menstrual cycle. With a more regular cycle, ovulation is more predictable, and conceiving can become easier.
Of course, losing weight is not a one-size-fits-all plan for conceiving.
Stress reduction is also highly important when it comes to conceiving with PCOS. Some techniques for stress reduction can include talk therapy, meditation, or exercise. There are also online support groups for people with PCOS; consider checking out the resources offered by My PCOS Team, a social network designed specifically to connect people dealing with PCOS diagnoses. PCOS and pregnancy FAQs
What else do you need to know about PCOS and pregnancy when trying to conceive? Here's what else you might need to know when trying to conceive with PCOS.
Is pregnancy with PCOS high risk?
Pregnancy with PCOS is higher risk than in people who don’t have PCOS. Pregnancy complications for people with PCOS include miscarriage or early loss of pregnancy, gestational diabetes, preeclampsia, and preterm birth. However,
some doctors have found that drugs like metformin can improve pregnancy and live-birth rates for people with PCOS. How common is pregnancy with PCOS?
PCOS is associated with higher rates of infertility and high-risk pregnancy. While research is limited on exact rates of infertility and early pregnancy loss, one study
suggests people with PCOS have 15 times greater rates of infertility and three times greater risk of EPL. Can you have a healthy pregnancy with PCOS?
Although people with PCOS have higher risk of pregnancy complications, you can definitely have a healthy pregnancy with PCOS. Be in close communication with your doctor to ensure the best prenatal plan for you.
How fast did you get pregnant with PCOS?
People with PCOS can still expect to get pregnant within a year if there are no other infertility risk factors from either partner. This is especially true if someone with PCOS has regular cycles and normal ovulation. If there are other infertility risk factors or problems with ovulation, getting pregnant with PCOS may take longer, or you may need to seek the help of a fertility specialist.
At the end of the day, a PCOS diagnosis is not the end of the world for you and your fertility journey. Actually, it’s an important step toward getting the help your body needs in order to have a successful pregnancy. Stay hopeful, stay focused, and you’ll find a way to have a child — PCOS may be a roadblock, but it’s not blocking the whole road.