Getting pregnant with PCOS

Polycystic Ovarian Syndrome, commonly known as PCOS, is a chronic hormonal condition, which affects a woman’s reproductive cycles. It can impact a woman’s fertility, her menstruation, weight maintenance, appearance and even her body’s insulin production. 

PCOS also contributes to the production of high levels of male sex hormones. A common outcome of this can be irregular menstrual cycles, excessive amounts of facial and body hair, oily and coarse skin with the development of acne, excess weight gain and irregular ovulation patterns. Another common result of PCOS is that the body produces too much insulin for its requirements. This has an impact on digestion and the normal metabolism of food. 

How common is PCOS?

It is currently estimated that PCOS affects between 15-20% of women who are still within their reproductive years. Of these women, it is thought that around half of them are not correctly diagnosed with PCOS. Women will commonly pass off their symptoms as being vague and not connected to each other.

What causes PCOS?

The exact cause is unclear and though there have been a lot of theories put forward, a definitive set of causes has not been identified:

• There is probably a genetic influence on whether a woman is more at risk of developing PCOS.
• Because so many women with PCOS are overweight, there is thought to be a relationship between insulin production and this condition. Some women only experience PCOS when they are overweight. As their weight returns to a healthy range, their symptoms disappear.
• Hormonal imbalance. Raised levels of testosterone, luteinising hormone (LH) and low levels of sex hormone binding globulin all could contribute to developing PCOS. 

What are the symptoms of PCOS?

• Abnormal or irregular menstrual cycles, or none at all.
• Infrequent or absent ovulation.
• Difficulty getting pregnant (because of infrequent ovulation).
• Excess weight with a higher BMI. This is not always in relation to eating behaviours. Commonly, women with PCOS report having a normal appetite and diet though seem to gain weight more easily.
• Abnormal amounts of facial and body hair, acne, oily skin with a rough texture.
• Hair on the head can become thin.
• Enlarged ovaries with numerous small cysts that can be detected with an ultrasound.
• Later on in life, PCOS can increase the risk of type-2 diabetes and high cholesterol. 

Treatment for PCOS

There is no cure for PCOS so treatment focuses on alleviating the symptoms. Some women are able to tolerate having PCOS better than others. The impact on fertility is a major reason for seeking treatment, and often it is not until a woman and her partner experience problems conceiving that a diagnosis of PCOS is made. Improve your diet and general lifestyle behaviours. Keep an eye on your weight, have a regular exercise pattern and improve your sleeping behaviours. This all supports a reduction in symptoms. 

Your doctor may prescribe some medications to treat your various symptoms (all depending on their severity):

• Medication to regulate your menstrual cycle, like a birth control pill containing synthetic oestrogen and progesterone. This will help to regulate your periods and has the additional benefit of improving your skin and reducing excess hair growth.
• Occasionally, it is necessary to take diabetic medication, which helps to control the excess production of insulin and stabilise the blood sugar. A diabetic diet can also be useful because of its focus on reducing the intake of sugars.
• If excess hair growth is distressing and having an impact on your self-esteem, then laser or electrolysis hair removal can be low risk and very effective.
• In women who are keen to conceive, medication can be prescribed, which prompts ovulation. The risk of taking this is that the chances of having a multiple pregnancy are increased.
• Ovarian surgery is sometimes recommended if you struggle to become pregnant. This procedure is known as “laparoscopic ovarian drilling” and its aim is to induce ovulation. It involves using a laser to destroy tissue in the ovaries that is producing androgens such as testosterone.
• If the effect of PCOS is so significant that it is affecting conception, then fertility assistance may become necessary. 

How is PCOS Diagnosed?

• Usually PCOS only becomes apparent in your late teens or early twenties.
• Through careful history taking, PCOS can often be suspected. Often there is a pattern of symptoms, which include menstrual problems, weight gain and problems conceiving.
• Charting the menstrual cycles, patterns of ovulation and bleeding history can all provide valuable information regarding fertility.
• Blood tests measure the levels of insulin, sugar, hormones and thyroid function. They can also provide valuable information on how the endocrine glands are functioning.
• An ultrasound of the uterus and ovaries is commonly ordered. It is possible to see the fluid-filled cysts on the ovaries, which are characteristic of this condition.
• A laparoscopy is a surgical procedure, which involves a doctor inserting a small camera, via an abdominal cut and looking at the reproductive organs. Many fluid filled cysts on the ovaries as well as tissue samples can confirm the diagnosis of PCOS. Laparoscopy can help to free up adhesions, open the fallopian tubes and remove endometrial cells. 

What happens if I do conceive?

Apart from having an impact on the chances of conceiving, PCOS increases the risks of miscarrying. This is because of the influence of hormones, which are produced by the ovaries and help to sustain early pregnancy. 

There is also an increased risk of the following:

• Pregnancy induced hypertension (PIH)
• Developing Gestational Diabetes
• Premature delivery of the baby and the associated risks of this occurring 

What’s the point of doing anything about PCOS?

Even if you’ve been able to conceive without any problems and your PCOS is not adversely affecting you, there are still benefits to having it treated. Women who have PCOS appear to have an increased incidence of developing on-going health complications. 

Diabetes, hypertension, heart disease as well as an increased incidence of endometrial cancer are all reason enough to seek professional advice. It is thought that PCOS is connected to insulin resistance and is a precursor to developing Type-2 Diabetes. 

Other tips to help increase the chances of conceiving with PCOS

• Get as much support as possible to establish a healthy lifestyle. Losing weight, regular exercise, sound mental health and realistic goal setting all helps.
• Establish a good network of medical support. There are gynaecologists who specialise in treating women with PCOS. Capturing the “window of time” when maternal age impacts so strongly on fertility is important.

• Quit smoking. If you are having problems with this then check out My Health's website: How to quit smoking and why
• Stop using recreational drugs and limit your alcohol intake.
• Limit your caffeine intake – a high intake of caffeine has been proven to increase the risk of miscarriage in early pregnancy.
• Taking and recording the basal body temperature can give an indication of when ovulation is close. It’s worth remembering that women with PCOS can have very erratic ovulation patterns, so there may not be a rise in temperature at all.
• It is important not to assume problems with conception are solely related to the woman. Sperm analysis can provide important information about sperm quality, numbers, motility and health. All of these factors contribute to the overall likelihood of successful conception.
• Keeping a healthy mental attitude is always useful. Some couples benefit from supportive counselling and group sessions.