Many diseases and conditions can affect fertility. Polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility, affecting an estimated 5 million women.
Every woman dreams of becoming a mother, but women with a chronic disease, such as PCOS is always in doubt whether they can conceive or not.
DON’T WORRY! Yes you can get pregnant with PCOS. There are a number of effective fertility treatments available.
What is PCOS?
Polycystic ovary syndrome (PCOS) is a hormonal disorder, which is common among women of reproductive age. PCOS may cause infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The women may experience numerous small collections of fluid (follicles) in ovaries and ovaries may fail to regularly release eggs.
The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2-diabetes and heart disease.
Symptoms of PCOS
- irregular or no periods
- taking longer to fall pregnant
- increased risk of some pregnancy complications
- weight gain
- increased risk of diabetes
- excess hair growth on the face, stomach and back
- loss of hair on the top of the scalp
- acne (pimples)
PCOS causes a woman’s body to produce exaggerated levels of androgens. These are hormones that are usually thought of as male hormones, because men have much higher levels of androgens than women.
Androgens are important in the development of male sex organs and other male traits.
In women, androgens are usually converted into the hormone estrogen.
Infertility in PCOS:
High levels of androgens interfere with the development of your eggs and the regular release of your eggs. This process is called Ovulation.
The main cause of infertility is irregularities in ovulation. Which occur due to the abnormal hormone levels in PCOS.
PCOS is also associated with a higher risk of early miscarriage. Research on PCOS has shown that the miscarriage rate may be as high as 20 to 40 percent, which is twice as high as in the general population. It’s not exactly clear why miscarriage is more common in women with PCOS, but some theories include the following:
- Poor egg quality, related to premature or late ovulation
- Insulin resistance
- Less-than-favorable environment for an embryo to implant in the uterine lining (due to abnormal hormone levels associated with PCOS)
Pregnancy complications with PCOS:
Women with PCOS do have an increased risk for some pregnancy complications. Women with PCOS are significantly more likely to develop gestational diabetes, pregnancy related high blood pressure, preeclampsia, and preterm labor. Babies born to women with PCOS have an increased risk of needing NICU care after birth.
The reason for these increased risks may come from PCOS-related obesity or insulin resistance. The best way to reduce these risks is to reach a healthy (or healthier) weight before pregnancy (if possible), be sure to get regular prenatal care, and eat a healthy diet. Of course, you can do all the right things and still experience complications.
Will losing weight help me to gain fertility?
Out of many reasons, the one main reason that women with PCOC have difficulty getting pregnant is obesity. They can’t conceive because they don’t ovulate regularly. Women with PCOS who are overweight are more likely to experience more severe anovulation, going months between periods.
Studies have found that losing some weight may bring back ovulation. According to the research, losing 5% to 10% of current weight may be enough to jump-start menstrual cycles.
Research has found that women who have lost weight have a great chance of having fertility treatment success. Although, there’s no such evidence that losing weight will help you conceive on your own. You may still need fertility drugs. But it will definitely boost up the treatment effects.
Losing weight with PCOS isn’t easy for anybody, and it may be even more difficult compared to the normal person. Also, not all women with PCOS are overweight. If that’s your situation, weight loss isn’t a solution to help with fertility.
Will changing diet help me to treat infertility?
Eating a healthy diet is important for women with PCOS. This is partially due to the higher risk of becoming overweight, and partially due to their bodies’ trouble with insulin regulation.
Some fertility-friendly diet options are;
- Get yourself a bigger breakfast and a smaller dinner.
- Include more protein and greens in your daily intake.
- When you eat carbohydrates, make them complex carbs (like whole grains and beans).
- If you eat sweets or a high carb food, combine it with healthy fats (avocado, olive oil, nuts) or protein to slow down the sugar spike
What are the treatment options to have healthy pregnancy?
Fortunately, there are some treatments that can help women with PCOS have healthy pregnancies.
Your doctor may prescribe birth control pills that contain man-made versions of the hormones estrogen and progesterone. These pills can help regulate your menstrual cycle by reducing androgen production.
Medicines to Help You Ovulate:
You won’t be able to get pregnant while you’re taking birth control pills for PCOS. But if you need help ovulating so that you can become pregnant, certain medicines may help:
Clomiphene is an anti-estrogen drug that you take at the beginning of your cycle to increase the chances of an egg being released by the ovary, enabling the egg to be fertilised naturally. It is the most common medication used for ovulation induction. It is often recommended for improving fertility in women with PCOS who are infertile because they do not ovulate.
If clomiphene doesn’t help with ovulation, you may be prescribed the diabetes drug metformin.
If clomiphene and metformin don’t work, your doctor may prescribe a medication containing a follicle-stimulating hormone and a luteinizing hormone. You get this medicine in a shot.
You may experience serious side effects of this tablet. It can be associated with a higher risk of multiple births (twins, triplets) as more than one egg often develops
There is a small but increased risk of ovarian cancer associated with its long-term use, so it should be used only in the short term (no longer than six to nine months)
There can be some physical and emotional side effects associated with use of clomiphene citrate, including headaches, blurred vision and mood swings
Not all women with PCOS are responsive to clomiphene citrate, and some might have to use combinations of clomiphene with other drugs (such as metformin) to gain the most benefit.
If pregnancy does not happen within six ovulatory cycles (six months) with clomiphene citrate, your doctor will discuss other options with you.
One other drug that helps with ovulation is letrozole, which is also known as aromatase inhibitor. It is sometimes used when other medications aren’t effective. Aromatase inhibitors are ovulation-inducing tablets. Letrozole is the most widely used. It is one of the options for improving fertility in women with PCOS.
Trials suggest that aromatase inhibitors are the most effective first-line medical treatment for these women. An advantage is that they are less likely to result in a multiple pregnancy (twins, triplets).
Letrozole is used early in the menstrual cycle to stimulate growth and release of eggs from the ovary. The eggs potentially can then be fertilised through natural means.
It can be used initially for treating infertility or, most commonly, after clomiphene citrate where women have not responded to therapy.
Side effects include;
Temporary gastrointestinal side effects:
- abdominal bloating
- loss of appetite
- hot flushes
- back pain
There were initial concerns that letrozole might increase abnormalities among babies. Current studies do not support this. However, we cannot be 100% sure of this as studies to date have not included many thousands of pregnancies, and most of these abnormalities are rare.
If you have PCOS and you want to get pregnant, you should work with a doctor who is a specialist in reproductive medicine. This type of doctor is also known as a fertility specialist.
A specialist will help make sure you get the right dose of medicines, help with any problems you have, and schedule regular checkups and ultrasounds to see how you’re doing.
What are my chances of conceiving with PCOS?
Although it is difficult to give statistics as cases vary so much and different treatments have different success rates, most women with PCOS will be able to have a baby with fertility treatment. For women who are under 35, this is even more the case.
Mental health and PCOS
It is common to feel shocked or guilty when you find out that you are having fertility issues. However, if you can, think of it as a medical problem that is treatable alongside most other conditions, and not a reflection on you as a woman. Many, many couples use fertility treatment to conceive and the inconvenient start is long forgotten in later years.
For some couples, working through different treatments works is a long, complicated and anxious process, especially if it is combined with having to take time off from an unsympathetic workplace. Try to support each other as much as you can through the consultations, treatments and appointments.