How To Get Pregnant With Pcos: The Takeaway
Remember: In many cases, having PCOS doesnt mean you cant start a family. Living with PCOS essentially means there are some factors that can make it harder to get pregnant. But, like with any health concern, its important to speak to your health care provider because everyones experience is different, and there are plenty of treatment options.
In some ways, PCOS is a label that acts as an alert to say, Hey, be vigilant, Pal notes. If infertility is your concern, use the information to maximize your well-being. Dont be concerned about it. Just go and seek help because its easily, easily surmountable.
One person who knows that to be true is mom-of-one Stephanie. Her key piece of advice? Dont give up hope, she says. Seek help and guidance from wherever possible, and dont ignore it. I am so thankful and grateful for my little boy. It can happen for you just dont give up.
References
Balen, Adam H., et al. Should Obese Women with Polycystic Ovary Syndrome Receive Treatment for Infertility? BMJ, vol. 332, no. 7539, Feb. 2006, pp. 43435.
Boomsma, Carolien M., et al. Pregnancy Complications in Women with Polycystic Ovary Syndrome. Seminars in Reproductive Medicine, vol. 26, no. 1, Jan. 2008, pp. 7284.
Brady, Christine, et al. Polycystic Ovary Syndrome and Its Impact on Womens Quality of Life: More than Just an Endocrine Disorder. Drug, Healthcare and Patient Safety, vol. 1, Feb. 2009, pp. 915.
Understanding Your Odds Of Pregnancy By Age
Haley Fritz
Banafsheh Kashani
MD, FACOG
From your doctor asking if youre thinking about getting pregnant soon to nosy relatives asking when youre going to settle down, you may have felt your biological clock counting down already. With all the pressure placed on women to have a baby by a certain age, it can be easy to feel like your fertility is a ticking time bomb.
Thankfully, age does not necessarily limit your fertility as much as you may think. More and more women are choosing to wait until their 30s and 40s to have a child for reasons like pursuing career goals, traveling the world, or finding the right partner.
Still, that does not mean that your fertility is an unlimited reserve. While its becoming more common and, thanks to modern medical technology, safer to have children at an older age, your fertility still changes significantly as you get older. Heres what you need to know to understand your odds of pregnancy by age.
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Pcos And Pregnancy Odds
People with PCOS âcanâ get pregnant, but the odds are typically lower because they tend to ovulate less. Here’s a closer look at the numbers:
- Infertility drugs can help those with PCOS get pregnant. Clomiphene citrate , a medication used as first-line treatment to induce ovulation, assists about 75 to 80 percent of those with PCOS to ovulate, with a reported conception rate of 22 percent per cycle, according to a December 2019 article in âClinical Medicine Insights: Reproductive Healthâ.
- The clinical pregnancy rate of letrozole, another first-line treatment to induce ovulation, was found to be higher than CC in one February 2014 review of 26 randomized controlled trials in the Cochrane Database of Systematic Reviews.
- Weight loss â specifically, shedding 5 to 10 percent of body weight â might help with re-establishing ovulation and thus getting pregnant, according to a 2015 chapter in âA Case-Based Guide to Clinical Endocrinologyâ.
- While it may take people with PCOS longer to get pregnant, family size isn’t necessarily reduced compared to thosewho don’t have the condition, according to a July 2012 study in âHuman Reproduction Updateâ.
- PCOS presents a moderate risk of ovarianhyperstimulation syndrome, a potential complication of fertility medications that stimulate egg production, in up to 7.5 percent of people with PCOS who conceiveafter in vitro fertilization , according to the September 2017 paper in âWomen’s Healthâ.
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How Pcos Can Affect Your Fertility
Polycystic ovary syndrome can develop at any age. In fact, you may develop the signs and symptoms of PCOS when you first begin menstruating. But most women dont get diagnosed with PCOS until their 20s and 30s when theyre having difficulty getting pregnant and turn to their OB/GYN for answers.
The good news is, PCOS is treatable, and womens health experts like Dr. Kelly Morales here in San Antonio, Texas, can help you figure out the best treatment to improve your fertility. Knowing how PCOS affects your fertility may help you understand the specific treatments that are prescribed to improve your chances of pregnancy.
Treating Pcos And Improving Fertility
Having PCOS doesnt mean you cant get pregnant. In fact, PCOS is one of the most treatable causes of infertility in women. Initially, hormonal birth control pills may be recommended to help regulate ovulation and control some of your symptoms. However, you cant get pregnant when taking birth control pills.
If youre overweight, following a healthy diet and exercise program may help improve your hormone balance by decreasing both insulin and androgen levels to help regulate ovulation and improve your chances of pregnancy. Losing weight before you get pregnant may also make for an easier pregnancy and delivery.
You may also need medications that increase your ovulation to help for improve your fertility, such as clomiphene or gonadotropins.
PCOS can affect fertility, but that doesnt mean you cant get pregnant. Dr. Morales specializes in the diagnosis and management of PCOS and can provide treatment to reduce your symptoms and improve your fertility. Call our office today or request an appointment online.
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Getting Pregnant Despite Pcos
Courtney discusses going through fertility treatments.
Having lived with polycystic ovary syndrome for most of her adult life, Courtney knew it would affect her chances of getting pregnant. But that fact didnt become real until her mid-30s, when she married and wanted to start a family.
PCOS is one of the most common causes of infertility. Courtney and her husband quickly became immersed in the world of fertility treatments. It took its toll but just when they were ready to take a break, the treatments worked. The couple welcomed daughter Caroline in summer 2019.
In this edited interview, Courtney shares her journey and a message for other women facing similar struggles.
ACOG: How were you diagnosed with PCOS?
Courtney: From when I was a teenager, my period never followed any real pattern it would show up whenever it wanted to. I once went more than 2 years between periods.
I was finally diagnosed when I moved to Chicago in my mid-20s. My new ob-gyn suspected PCOS based on my history and other symptoms, including excessive hair growth, fatigue, pelvic pain, and vaginal dryness. They confirmed it with an ultrasound. My ovaries were covered in cysts.
We tried hormonal birth control to get my body on a schedule. It did help regulate my periods, but it came with extreme side effects for me, like anxiety and weight fluctuations. I finally quit taking the pills, thinking I dont need to put up with this.
ACOG: How did PCOS affect your plans to get pregnant?
Add In Iui Or Ivf If Needed
Intrauterine insemination is a type of artificial insemination thats used to treat infertility. Sperm is first washed and concentrated. Its then placed into the uterus with the hope that itll swim up into the fallopian tube to fertilize a waiting egg. This can be done with a normal cycle, or after ovulation induction.
IUI is a limited procedure that still relies on the sperm and egg to do a lot of the work. By comparison, during in-vitro fertilization , every step of the process is controlled and monitored.
IVF starts with ovulation induction. But unlike natural conception or IUI, IVF uses a lot more gonadotropins. The goal is to mature and collect 12 20 eggs for fertilization in the lab.
Fertilization can occur by introducing the sperm into the same petri dish as the egg. Alternatively, one lucky sperm and be injected into the egg. This process is known as intracytoplasmic sperm injection . ICSI is an optional technology. It increases fertilization rates and helps overcome male infertility.
Once the eggs are fertilized, theyre then grown for a few days under controlled lab conditions. After theyve matured, these fertilized embryos can be placed back into the uterus as a fresh embryo transfer. They can also be cryogenically preserved for later use.
Just when you thought that it was all bad news!
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Pcos And In Vitro Fertilization
In vitro fertilization is the most effective fertility treatment available for PCOS patients. IVF treatment offers the highest success rates and quickest time to pregnancy of any Assisted Reproductive Technology . Research has shown that clinical pregnancy and live birth rates are similar for PCOS patients and women who ovulate normally without PCOS . Fertility specialists recommend IVF treatment to patients who have tubal blockages or severe male factors during their initial assessment, are of advanced age, or have failed other lesser treatments. IVF can also be used for patients who have undergone tubal ligation surgery.
IVF involves a multi-week/month process in which eggs are removed from a females ovaries, fertilized with sperm in a petri dish, grown inside a lab for several days , then transferred into the females uterus to develop for the remainder of gestation. IVF is used in conjunction with a multitude of medication protocols for PCOS patients to induce ovulation and produce more and higher quality eggs, embryos, and a receptive uterine lining.
Getting Pregnant With Pcos Twice 12 Years Apart
When youre told at 19 years old that youre probably never going to have a baby, and then you meet the love of your lifethats so hard, Heather says of learning about her slim chance of getting pregnant. Luckily, I met a man who was okay with however it played out.
It began with bad luck, when Heather was diagnosed with a serious case of polycystic ovary syndrome while she was still a teenager. PCOS is a hormonal disorder that affects up to 10 percent of women of reproductive age. Getting pregnant with PCOS can be difficult, and it is a common cause of infertility in women because it interferes with ovulation.
Young, in love and unwilling to give up, Heather and her husband, Michael, decided to see if infertility treatment would give them a chance at starting a family. In 2003 Heather scheduled an appointment with Dr. Carol Wheeler.
Dr. Wheeler did an ultrasound to see what my follicles looked like to confirm that I had PCOS, Heather explains. Not only did they check me, but they checked my husband as well.
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Can I Pass Pcos To My Daughter
PCOS often runs in families. Up to 70 percent of daughters of women with PCOS also develop it, but genetic variation doesnt fully explain the high incidence within familiessome genome-wide association studies of PCOS susceptibility reckon genetics explains less than 10 percent of the conditions heritability.
Track Your Menstrual Cycle
Whether you have regular periods every month or more unpredictable, irregular bleeds, its always worth monitoring your cycle to better understand the way your body works better. A period-tracking app like Flo can help here, improving your chances of getting pregnant by predicting when youre likely to be ovulating even if you have an irregular cycle. .
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Follow My Babys Growth
Scientists still arent exactly sure what causes PCOS, but they believe youre more likely to develop it if it runs in your family or if you have insulin resistance.
While its named polycystic ovary syndrome, confusingly, you dont always develop polycystic ovaries if you have PCOS. Instead, you may be diagnosed with PCOS if you have two of the following three symptoms:
- Irregular or missed periods
- A high level of male hormones, called androgens
- Polycystic ovaries, which occur when small egg sacs on the ovaries become filled with fluid, known as cysts
But back to how all this can affect your chances of getting pregnant. Lubna Pal, professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, explains that in order for pregnancy to happen, you need to have an egg that is released from your ovaries .
After ovulation, an unfertilized egg stays in the uterine tubes for 12 to 24 hours before it dissolves and is shed as part of a period. If its fertilized by sperm before then, however, it can lead to a successful pregnancy. But if youre not having regular periods, it means youre probably not ovulating regularly either. As a result, Pal explains, the probability of conception goes down.
Thats not the only way PCOS may impact getting pregnant, however. One theory thats been researched suggests that PCOS can cause hormonal imbalances that change the quality of your cervical fluid, making it harder for sperm to survive.
Pregnancy Complications And Pcos
If you have PCOS and get pregnant, you’re at an increased risk of the following, according to that same September 2017 study:
- âEarly pregnancy loss:â It’s estimated to be three times greater inthose with PCOS.
- âMiscarriage:â After IVF, miscarriage was reported in about 36 percent ofthose with PCOS .
- âGestational diabetes :â One study found a two- to threefoldincrease in GDM in those with PCOS.
- âPregnancy-induced hypertension and preeclampsia :â Research has found these conditions to occur three to four times more often in people with PCOS.
- âPremature delivery:â These rates are increased as well, especiallyin those with hyperandrogemia. One study found the rate of premature delivery inthose with PCOS to be 21 percent compared to 12.5 percent in a control group.
- âCesarean sections :â Elective and non-elective CS were doubled in a PCOSpopulation compared to a non-PCOS population.
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You Are At The Right Place
After twice getting pregnant with PCOS as a result of treatment with Dr. Carol Wheeler, Heather hopes her story raises awareness of the syndrome and the available treatments.
A lot of people dont even know what PCOS is, Heather says with a laugh. A lot of people assume that fertility treatment means IVF, but thats not always the case.
You dont realize how many people are facing infertility until you are going through it yourself and you see how many people there are in the clinic. And everybody is there for the same thing. When you find out you are expecting, you just want to hug everybody in there and say, You are at the right place!
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Communicate With Your Healthcare Provider
If you know you have PCOS, the best type of doctor to see is a board-certified reproductive endocrinologist, as they have specialized training in diagnosing and treating hormonal disorders.
Once youve found a doctor you like and trust, let them know about your family-building plans so they can help you achieve those goals in the best way possible.
Heres what you should chat about with your doctor:
- Any medications or supplements you may be on
- How to manage any PCOS-related symptoms
- Any mental health concerns
- What your ideal timeline looks like
- If you need any fertility testing to confirm your PCOS diagnosis or rule out any other anatomical or hormonal issues
- What the best pathway to parenthood is for you and your goals
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Medications To Help You Ovulate
If lifestyle changes alone are not sufficient, you may require some medication that stimulates your body to produce and release eggs. This is known as ovulation induction therapy.
In most cases, the first choice of medication is a tablet called clomiphene . This has a good success rate it can achieve 30%-50% pregnancy rates after 6 treatment cycles.
The next option for ovulation induction therapy, if Clomid is unsuccessful, is usually an injection of hormones known as follicle-stimulating hormone and luteinising hormone . These hormones, which are normally produced by your body, mimic the normal hormonal cycle to stimulate the growth and release of eggs from the ovaries.
Medications And Treatments For Pcos
After other reasons for infertilityâsuch as blocked fallopian tubes, fibroids, or low sperm countâhave been ruled out, a healthcare provider may prescribe medications to induce ovulation in someone with PCOS who is trying to conceive.
Insulin resistance is common in people with PCOS. Insulin is a hormone that is released from the body to regulate the amount of glucose in the bloodstream. Insulin resistance occurs when the bodyâs cells donât respond normally to insulin, resulting in too much of it in the body . The excess insulin disrupts the hormones produced by the ovaries and pituitary gland, and this interferes with ovulation .
Metformin is a medication that makes it easier for the body to use the insulin it makes, decreasing the amount of insulin in the bloodstream. Metformin is used for people with PCOS to stimulate ovulation . Metformin has the added benefit of sometimes helping people lose weight, but can also cause abdominal pain and diarrhea .
Clomiphene and letrozole are medications that induce ovulation . Clomiphene blocks the bodyâs response to estrogen and letrozole suppresses the production of estrogen. The low levels of estrogen or lack of response to it cause the pituitary gland to produce more follicle stimulating hormone , which promotes the growth of the follicles containing eggs within the ovary. Both medications can cause hot flushes as a side effect, and generally they should not be used for more than six cycles .
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