Polycystic Ovarian Syndrome, commonly known as PCOS, is one of the leading causes of infertility. As many as five million women in the U.S. are affected by this condition, which may impact ovulation. The condition can make conceiving difficult, but treatments are available and are associated with high success rates. Women with PCOS who are interested in conceiving may respond to a combination of lifestyle changes and medical treatment, so it’s important to reach out to a specialist for evaluation. Today we’ll look at what PCOS is, how it affects fertility, and what you can do to increase your odds of getting pregnant if you have PCOS.
What is PCOS?
Polycystic Ovarian Syndrome is a hormonal problem that causes ovulation to be erratic, infrequent, or even entirely absent. Women who do not ovulate regularly will complain of irregular or absent menses.
The name of the condition tells us something about it. “Poly” = “many,” and “cystic” = “having to do with cysts.” PCOS is a condition where there are many small follicles that are arrested in development. Usually, one follicle will develop a mature egg each cycle. In PCOS, the ovarian environment is dominated by androgens like testosterone and insulin resistance. This impairs the development of the follicle and prevents an egg from maturing.
How Does PCOS Affect Fertility?
For conception to take place, your body must produce and release a mature egg. If you don’t ovulate, you cannot get pregnant. Most people ovulate monthly, and the less frequently you ovulate, the fewer opportunities there are to get pregnant. While exact numbers are difficult to pin down due to the variability of severity and symptoms in PCOS, the 2015 Australian Longitudinal Study on Women’s Health found that 72% of participants with PCOS reported fertility problems, compared to 16% in those who did not have PCOS.
Getting Pregnant with PCOS
If you have PCOS, the most important step toward getting pregnant is to induce ovulation. Since ovulation may be irregular in women with PCOS, it can be difficult to identify your fertility window. In women who do not have menses, there is no opportunity to conceive due to a lack of ovulation. Many women with PCOS are prescribed hormonal contraception to help improve their bleeding; therefore, they may be unsure of their cycle regularity once they stop taking hormonal medication. If normal menses does not occur one month after stopping the hormonal medication, this may indicate an ovulation disorder.
In addition, the weight gain often associated with PCOS can make ovulation even less likely. For women with an increased body mass index (BMI), lifestyle approaches such as dietary changes and exercise may result in ovulatory cycles.
Lifestyle Changes that Can Increase Your Chances of Pregnancy
If you have PCOS and you’re overweight, one of the simplest things you can do to increase your chances of getting pregnant is to lose weight. Losing only five to ten percent of your current weight is often enough to restart ovulation. If you’re not overweight, weight loss is unnecessary. However, other non-drug options may be beneficial regardless of your weight.
Here are a few lifestyle changes that could help:
Watch What You Eat
There is no one-size-fits-all option for women with PCOS who are trying to lose weight, but caloric restriction is generally ideal.
- Decreasing the intake of carbohydrates and foods with high glycemic load is beneficial for women with PCOS because many women with PCOS have insulin resistance.
- Avoid intake of sugary beverages like soda, and try to buy less packaged food.
- Include high-fiber foods and lean protein in your daily diet, and pass on red meat.
These dietary changes may help decrease the risk of developing diabetes, which is common among women with PCOS, and promote weight loss — both of which will help to restore ovulation and decrease the risk of complications in pregnancy.
For roughly half of those diagnosed with PCOS, exercise can help regularize menstrual cycles and improve ovulation. And, of course, exercise can support weight loss. This doesn’t mean you have to take out a gym membership or invest in expensive equipment; walking and yoga are easy, enjoyable ways to include exercise in your daily routine. There are other benefits of exercise as well, and women with PCOS who exercise regularly report a higher quality of life.
Medications That Can Assist Ovulation
Along with lifestyle modifications, several drugs can help PCOS patients restart or regularize ovulation and get pregnant.
Metformin is commonly prescribed to help decrease the development of diabetes in women with PCOS but does induce ovulation. Metformin is commonly used in conjunction with letrozole to help induce ovulation in women with PCOS. It may be started in women with abnormal glucose testing or for women who failed to respond to letrozole or Clomid.
Letrozole and Clomid
These drugs are standard fertility drugs used to increase the regularity of ovulation and stimulate ovulation in people who do not ovulate. While both improve the likelihood of getting pregnant, letrozole appears to be more effective in achieving ovulation for women diagnosed with PCOS.
When to Seek Fertility Treatment
For patients with a diagnosis of PCOS, a pre-conception visit with either an OBGYN or a fertility specialist is important. Women should start incorporating lifestyle modifications (and start a prenatal vitamin) prior to conception.
For women who are not having regular periods, it’s important to seek help immediately so that a proper evaluation can be completed. Male partners should also be evaluated, as many couples have male and female problems.
If pregnancy is not achieved after three to six cycles, it may be time to consider other approaches to fertility treatment, such as IVF. Our fertility specialists can help you explore your options with your unique needs and goals.
Yes, You Can Get Pregnant with PCOS
While PCOS is one of the most common causes of infertility, it’s also one of the most treatable. If you’re ready to take the next step on your fertility journey, contact us today for a consultation.