Polycystic ovary syndrome (PCOS) is a very common health condition for women caused by a hormonal imbalance. PCOS causes your body to produce more androgens or testosterone than usual. This hormonal imbalance can affect your ovaries and lead to problems with menstruation and fertility. PCOS can cause your eggs to develop incorrectly or to not get released during ovulation. It is also one of the most common causes of infertility in reproductive age women. If eggs don’t get released (ovulation), you can’t get pregnant.
Becoming Pregnant With PCOS
Thankfully, PCOS is treatable, and people with PCOS can ovulate and get pregnant; you just might need a little extra help. It is important to remember that PCOS manifests differently depending on the person and that there's no one size fits all solution. What helps one woman manage her PCOS symptoms and get pregnant may not work for everyone. There are several options to help you start ovulating and get pregnant, and finding the one that works for you can take some time. The first recommendation most physicians give is to lose weight. This can be difficult because weight gain is a common symptom of PCOS. But, if you are overweight or obese, losing weight can help make your menstrual cycle more regular and improve fertility.
There are also a variety of medications that you can take. Clomiphene (brand name Clomid) is used to induce egg production (ovulation). This is the medication recommended by the American College of Obstetricians and Gynecologists (ACOG) to treat infertility caused by PCOS. Metformin is an insulin-sensitizing drug used to treat diabetes. Physicians also prescribe it in combination with clomiphene to treat infertility in women with PCOS, but it is not FDA approved for that purpose specifically. Letrozole is another hormone that can also be used to get your body to make more follicle-stimulating hormone (FSH), a hormone needed for ovulation. Lastly, gonadotropins are hormones that cause ovulation. They are delivered as shots and are a very expensive option.
If medications don’t work for you, your physician can recommend ovarian drilling. A surgeon will use a small laser or needle to make holes in part of an ovary which can lower androgen levels and help restore ovulation. This surgery is usually only a last resort if medications don’t work.
Another option is in vitro fertilization (IVF), which involves fertilizing your egg with sperm in a laboratory and then placing the fertilized egg into your uterus to develop. This is the last option most providers recommend. It can be costly and may not be covered by your health insurance.
How PCOS Impacts Pregnancy
While PCOS can make it difficult to get pregnant, it can also affect you during your pregnancy. Pregnant women with PCOS are three times more likely to miscarry in the first few months of pregnancy than women who don’t have PCOS. They are also at a higher risk for other pregnancy complications such as gestational diabetes, preeclampsia, preterm birth, and delivering via cesarean section (C-section).
Fortunately, there are ways to reduce your risk of these pregnancy-related complications due to PCOS. Taking folic acid and reaching a healthy weight and blood sugar level before pregnancy through healthy eating habits, regular exercise, and potentially medication such as metformin, are all options to discuss with your health care provider when deciding to try to get pregnant.
Each person may experience PCOS differently and finding ways to manage your symptoms can feel like a never ending battle. Connecting with women who are going through it with you can help. Try exploring different social media groups to find a community that meets your needs and can help you navigate PCOS.
For more information on PCOS visit our Polycystic Ovary Syndrome Fact Sheet.
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 Insulin resistance often goes hand-in-hand with PCOS and can make it difficult to maintain or lose weight. Insulin-sensitizing drugs (often used to treat diabetes) can help the body respond to insulin and treat symptoms of PCOS.