If you have PCOS or suspect you have PCOS then you probably have heard about the link between PCOS and pregnancy. One of the symptoms of PCOS can be difficulty getting pregnant but can you still get pregnant with PCOS? And what are the risks of conceiving with PCOS and how can you increase your chances of conception?
Keep reading to learn more about PCOS and pregnancy in our ultimate guide.
What is PCOS?
PCOS is an endocrine condition that affects 1 in 10 people with ovaries in the UK. Common symptoms associated with PCOS include acne, oily skin, irregular periods, lack of ovulation, excessive hair growth, increased testosterone levels, insulin resistance and trouble getting pregnant.
How does PCOS affect fertility?
One symptom of PCOS is difficulty getting pregnant and the cause of this is likely to be linked to irregular ovulation and/or insulin resistance.
Irregular ovulation
The most common reason people with PCOS may have trouble getting pregnant is irregular or lack of ovulation.
Within the ovary, an egg (ovum) develops in a follicle. Ovulation normally occurs monthly when the egg is released into a Fallopian tube. The tube takes the egg into the uterus. Every month several follicles develop but only one follicle and therefore egg usually fully develops and is released.
In people with PCOS, ovulation does not occur or happens irregularly or infrequently.
Insulin resistance and fertility
The majority of people with PCOS have insulin resistance (IR), with some research suggesting up to 80% of people with PCOS have IR.
Insulin resistance may cause delayed maturation of eggs and lead to smaller eggs being released during ovulation. Insulin resistance is also linked to raised testosterone levels. Managing insulin resistance may improve PCOS symptoms and help improve the chances of conception.
Can you get pregnant with PCOS?
Yes, you can get pregnant if you have PCOS. In fact, evidence suggests that about one-third of people with PCOS have no problems conceiving. The remaining two-thirds may need more support to become pregnant or it may take longer, but it is important to note that people with PCOS tend to give birth to the same number of children as people without PCOS.
6 ways to increase the chance of conception with PCOS
There are various steps you can take to improve your chances of getting pregnant with PCOS, let’s dive into them now.
Fertility diet
Some foods can be beneficial for fertility, and some can hinder the chances of conception. Having a diet rich in whole grains, omega-3 fatty acids, monounsaturated fats, fibre, vitamins and minerals can all help with pregnancy chances.
You may want to remove or limit alcohol and caffeine intake to improve the chances of conception.
Regular movement
Generally, regular exercise is good for us – whatever you choose to do! Movement can help reduce the incidence of insulin resistance and improve the chances of regular ovulation.
There is no “best” movement for conception but you may want to engage in a variety of exercises that you enjoy. Remember, the movement you enjoy will be the one you stick to regularly!
Reduce stress
Stress is linked to PCOS in a variety of ways. People with PCOS tend to have higher cortisol levels and people with PCOS tend to be more sensitive to the effects of stress too. Stress alone doesn’t cause infertility but stress can impact the chances of conceiving.
It may seem easier said than done but try to be conscious of actively lowering your stress levels through proactive and reactive stress management techniques.
If you are struggling with infertility and the stress, anxiety and depression linked to this then speak to a mental health provider or your doctor for tailored support.
Read more | Top tips for PCOS stress management
Take supplements
There are a variety of supplements with differing levels of evidence that may support the chances of conception. Everyone trying to conceive should take folic acid to prevent neural tube defects.
People with PCOS may also find supplementing with vitamin D, inositol, omega-3 fish oil and other supplements can improve symptoms. Always talk to your healthcare provider before trying a new supplement.
Read more | Best fertility supplements for PCOS
Start taking medication
If you are not pregnant after trying for 12 months (or six months if you are aged over 35 years), go and see your doctor for bespoke advice. They can discuss medical treatments that can help, or refer you to a fertility specialist.
There are a few medicines considered for individuals with PCOS who are trying to get pregnant.
Firstly, a medicine called ‘clomifene’ known as ‘Clomid’ may be recommended as it encourages the release of an egg from the ovaries (aka induces ovulation).
If clomifene is unable to encourage ovulation, metformin may also be suggested. Whilst more commonly known for its treatment of type 2 diabetes, it can help lower insulin and blood sugar levels and stimulate ovulation and regular monthly periods.
Letrozole may also be used to stimulate ovulation as in replacement of clomifene. While both metformin and letrozole are considered ‘off-label’, meaning they haven’t been licenced to treat PCOS, your healthcare professional may still consider them if they believe they may be effective for you.
As with all medicine they may have side effects and it’s essential to work with your healthcare professionals to make sure you’re comfortable with any recommendations and attend regular check-ups.
Engage in fertility treatments
If lifestyle changes don’t result in conception, your doctor or healthcare team may recommend fertility treatments such as laparoscopic ovarian surgery or IVF.
Laparoscopic ovarian surgery
Laparoscopic ovarian surgery is considered a second-line treatment for infertility associated with PCOS. Because of its invasive nature, high costs and need for anaesthesia, it is usually only done in people who require a laparoscopy for another reason (such as investigating pelvic pain).
Laparoscopic ovarian surgery is the action of ovarian drilling and this technique can be performed using monopolar electrocautery or laser techniques.
In terms of efficacy, this treatment was observed to contribute to an ovulation rate between 54 and 76% in the 6 months after the procedure and 33 and 88% in the 12 months after the procedure in one observational study.
In-vitro fertilisation
In-vitro fertilisation (IVF) is a third-line treatment for infertility associated with PCOS unless other factors are present. It is a common treatment route for people with PCOS with a good success rate.
IVF involves the injection of fertility drugs to stimulate the ovaries to produce mature eggs. These eggs are retrieved from the ovaries in an egg retrieval.
These eggs are then added with sperm into Petri dishes in the hope of fertilisation. After the eggs have had between 3-5 days to divide and mature, they are placed into the uterus in an embryo transfer.
PCOS pregnancy complications: what are the risks?
Unfortunately living with PCOS increases the risk of certain health conditions during pregnancy for both parent and baby. Ensure you inform your healthcare provider that you have PCOS so you can be supported during your pregnancy.
High blood pressure
High blood pressure (hypertension) is common during pregnancy, specifically during the mid to later stages. The incidence of high blood pressure in pregnant people with PCOS is much higher than that of those without PCOS.
This is likely to be related to hormonal irregularities and insulin resistance in people with PCOS.
Gestational diabetes
People with PCOS have a higher risk of developing gestational diabetes during pregnancy. This is because of the higher incidence of insulin resistance seen in people with PCOS.
Before or early in the pregnancy your medical team will invite you for an oral glucose tolerance test (OGTT). You will do another OGTT at 24-28 weeks of pregnancy too.
People usually recover from gestational diabetes post-pregnancy. Monitoring by your doctor and medical team is essential.
Preeclampsia
It does appear that people with PCOS are at an increased risk of developing preeclampsia. Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. This can impact the parent’s kidneys, brain, and liver.
It is not yet understood why people pregnant with PCOS have an increased risk of preeclampsia and an independent correlation between the two has not been found.
Cesarean or C-section delivery
Because of the risk of early birth and high blood pressure in pregnant people with PCOS, delivering via cesarean or C-section is much more likely. This can take more time to recover from and may carry more risks for the parent and baby.
Early birth
Babies delivered before 37 weeks are considered early births or preterm deliveries. People with PCOS are at risk of early births and this is likely linked to a variety of factors. These include preeclampsia, insulin resistance, hypertension or fertility treatments.
Miscarriage
Unfortunately, people with PCOS are 3 times more likely to suffer from early miscarriage than those without PCOS. This may be because of a variety of factors including the use of fertility treatments or the higher age of conception commonly seen in people with PCOS.
Hormonal balance may influence the likelihood of miscarriage too. Raised insulin resistance, higher LH levels and elevated testosterone levels plus low progesterone levels are linked to PCOS and miscarriage.
FAQ: PCOS and pregnancy
It is possible to become pregnant if you have PCOS and endometriosis. Natural conception is possible with PCOS and endometriosis but you may require support from your doctor to improve your chances of conceiving. Speak with a healthcare professional about your options.
It is possible to become pregnant with PCOS after 40 but the chance of conception does decrease and unfortunately, the risk of miscarriage also increases. If you haven’t become pregnant within 6 months of trying and you’re over 35, speak to your doctor or healthcare provider for support and advice.
Although two-thirds of people with PCOS take longer or require more interventions to become pregnant, evidence suggests that people with PCOS have the same number of children as those without PCOS.
Pregnancy can be safe for people with PCOS but there are increased risks of certain health conditions such as gestational diabetes, preeclampsia, hypertension and even early birth. Ensure you inform your doctor and healthcare team that you have PCOS so you can be monitored and treated if required, to reduce the risk of adverse health outcomes.
Although there are no guarantees, anecdotal evidence suggests that symptoms of PCOS may reduce during pregnancy and even after pregnancy in some people with PCOS.
Key takeaway: PCOS and pregnancy
People with PCOS can get pregnant. About one-third of people with PCOS get pregnant with no issues. Otherwise, it may just take longer and/or require more interventions.
To improve the chances of conceiving with PCOS, you can focus on adding certain foods to your diet, engaging in regular movement, reducing stress, increasing sleep quality, starting supplementing or taking medication and engaging in fertility treatments if necessary.
