PCOS & Infertility
Polycystic ovary syndrome is found in around 70% of women who have ovulation difficulties leading to infertility. This is more common in women who are overweight, and as a first-line treatment, weight reduction can be very successful in restarting spontaneous ovulation. The amount that needs to be lost is less than most might expect – around 5% of the current weight is associated with an increased number of ovulation cycles.
However, in women who continue to have problems with ovulation and menstruation but wish to get pregnant, treatment is available. Ranging from fertility drugs for PCOS to surgery, a variety of options may need to be tried before your pregnancy hopes are realised. Find out more about the facts about conception with PCOS and help to relieve your pregnancy concerns. It is not impossible to get pregnant if you have PCOS; find out more now!
Despite the many symptoms associated with PCOS, not all women will display the obvious signs of PCOS. In fact, some women may not learn that they have PCOS until they undergo a fertility workup. Other women, though, may already be aware that they have polycystic ovary syndrome and see no reason to undergo fertility testing; they already know why they can’t get pregnant.
Fertility testing may still be a good idea, even if you have previously been diagnosed with PCOS, not only for yourself but also your partner. Undergoing an assessment for fertility issues in both partners can bring to light any other factors that may cause problems, such as male infertility, which may also require treatment.
Clomifene citrate, more commonly known as Clomid, is the most commonly used drug to stimulate ovulation. It is taken in the early days of the cycle (usually days 2 to 6) and results in ovulation in around 80% of women overall, and a six month successful pregnancy rate of 45% to 50%.
There are a number of side effects associated with the use of clomid, including an increased chance of having a multiple pregnancy, therefore regular professional monitoring while taking this drug is important. Additionally, prolonged use of clomid has not found to be beneficial. In general, it is recommended that clomid be prescribed for three to six cycles. If ovulation does not occur in this time, it is advised to move on to another type of treatment.
When clomiphene is unsuccessful, the next step is to use injectable hormones to stimulate the ovary to produce eggs. This is known as ovarian stimulation and, where there is an additional sperm problem, can be combined with intrauterine insemination (IUI) around the time of ovulation. Live birth rates after ovarian stimulation following failed clomiphene treatment reach 54% after six months and 62% after 12 cycles. Find out more about IUI treatments and PCOS.
Like clomid, the hormone treatment must be monitored by blood tests and ultrasound scans to avoid over-stimulation. Multiple pregnancy is always a risk with this type of treatment, but especially so for women with PCOS, whose ovaries are particularly sensitive to the hormones.
Also find out more about some new ovarian simulation therapies like TTC and Femara and about how PCOS ovulation kits can help you.
Another option for couples dealing with PCOS is to undergo in vitro fertilisation, or IVF. Just how successful IVF will be, though, can depend very much upon individual characteristics such as age, length of infertility and weight. Additionally, neither IVF nor ovarian stimulation is likely to be successful if a woman is severely overweight (body mass index is greater than 30). This is why most hospitals and fertility clinics restrict these treatments until a woman’s weight is within the normal range. Find out more about IVF and PCOS.
The alternative to ovarian stimulation is an operation called laparoscopic ovarian diathermy (LOD), also known as "ovarian drilling". Similar to laparoscopy, this involves a day case operation, a short general anaesthetic, and a telescope look into the abdomen. The ovaries are identified and several small holes made in each ovary, either with a fine hot diathermy probe or via laser. It is not actually known how this works, but it can restore regular ovulation, or make the ovary more sensitive to clomifene.
By 12 months after LOD the average pregnancy rate is around 60% to 80%, the greatest success rates being in women with a shorter length of infertility (less than 3 years) and a higher level of the hormone LH (>10 iu/l). Advantages of LOD include the fact that it may improve other symptoms of PCOS, such as menstrual disturbance, as well as avoiding the need for stimulatory drugs and their increased risk of over-stimulation and a multiple pregnancy.
Unfortunately, women with PCOS tend to have a higher risk of miscarriage than women without PCOS. Some studies have suggested that as many as 50% of women with PCOS experience a miscarriage compared to the average rate of 15% among the general population. While the exact reason for the increased miscarriage risk with PCOS is unknown, experts do have a few theories.
Insulin resistance is thought to be a contributing factor, as women with PCOS and insulin resistance seem to be at a greater risk of miscarriage than women with PCOS but no insulin resistance issues. However, it is also thought that the increased LH (lutenizing hormone) levels present in some women or the high androgen levels in women with PCOS could also be a factor.
While there is no treatment for miscarriage and no sure way to prevent, there are a few things that may possible reduce your risk of having a miscarriage. This includes regulating your hormones levels; following a healthy diet and exercising regularly to keep insulin levels down; receiving pre-treatment prior to pregnancy with GnRH-agonist or using baby aspirin, folate supplementation or low dose heparin to help with possible clotting issues. Currently, there is not enough data on the use of metformin prior to and during pregnancy to give any conclusive answer as to how it impacts your risk of miscarriage.
Despite the problems that can present themselves to PCOS sufferers looking to get pregnant, a successful pregnancy is entirely possible and has been experienced by numerous women with PCOS. In fact, for many women, getting pregnant the second time around is much easier. Furthermore, it is not unusual for PCOS sufferers to notice that their menstrual cycles begin to regulate themselves after a pregnancy.
When you successfully become pregnant, check out our article on breastfeeding with PCOS.