Getting pregnant with PCOS

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female infertility treatment for women with pcos thinking about trying to conceive

Introduction
Symptoms
Risks
Causes
Biology
Diagnosis
Interpreting test results
Treatments
– Lifestyle
– Environment
– Dietary
– Medication
– Surgery

Revised: 20/06/2021

Introduction

Getting pregnant with PCOS is a step-by-step process. The first step towards effective treatment is understanding and diagnosing your unique type of PCOS.

Polycystic ovarian syndrome (PCOS) is a common endocrine condition that affects how a woman’s ovaries work. Described as a low-grade chronic inflammatory state, it is responsible for approximately 85% of cases of irregular periods in women.

The exact prevalence is unknown due to lack of awareness amongst the community, however it is estimated to affect between 5 to 15% of women. A higher prevalence of PCOS is common in population studies where higher incidence of obesity and diabetes exist.
Source: Dubey P, et al. (2021); Johnson, M H, (2018)

The 3 main features of PCOS are

Irregular periodsThis means the ovaries are not regularly releasing eggs
Excess androgenMale dominant hormones which may cause excess acne, facial or body hair and male pattern baldness (serum total testosterone > 2 nmol/L)
Polycystic ovariesAn increased number of antral follicles causing enlarged ovaries (specifically 12 or more antral follicles 2 to 9μm in diameter or ovarian volume > 10mL)

If you have at least 2 of these features, your Doctor may diagnose you with PCOS in absence of other possible causes. Such as an adrenal disorder, hyperthyroidism, prolactinoma and in rare cases, androgen secreting tumours.

There are 4 unique types of PCOS;

PeriodAndrogenOvaries
Type AIrregularElevatedPolycystic
Type BIrregularElevatedNormal
Type CRegularElevatedPolycystic
Type DIrregularNormalPolycystic

The effect of PCOS on a woman’s fertility varies greatly depending on the phenotype.

In fact women with polycystic ovaries but no symptoms (irregular cycles, obesity, acne, facial or body hair) observed no significant impact on their ‘time to pregnancy’ compared to similar women without polycystic ovaries.
Source: Hassam M A and Killick S R, (2003)

On the other hand women with elevated androgen levels are at higher risk of having children with neuropsychiatric disorders, particularly attention deficit hyperactivity disorder, autism spectrum disorder, Tourette’s disorder and chronic tic disorder.
Source: Cesta A E, et al. (2019)

Although hyperandrogenism and menstrual dysfunction is common in women with PCOS they are not associated. A recent study demonstrated the severity of menstrual dysfunction, in women with PCOS, is closely linked to the degree of insulin resistance (dynamic state) rather than androgen levels.
Source: Ezeh U, et al. (2021)

Despite the name polycystic ovarian syndrome, your ovaries do not have any cysts.

To understand PCOS, we need to go back to the very beginning. Approximately 3 months prior to ovulation, tiny sacs each containing an egg, known as follicles begin to grow. This growth and release is predominantly regulated by the female hormones estrogen and progesterone. However women with elevated levels of testosterone experience two to three times the normal number of follicle arrest during the early stages of this growth. This is what gives the appearance of small cysts in the ovaries under ultrasound and hence the name polycystic ovaries.

Interestingly normal puberty displays many of the features of PCOS, such as irregular periods, elevated androgen levels, increased luteinizing hormone (LH), insulin resistance and polycystic ovaries. This is one of the reasons why a Doctor might not send a young woman for ultrasound diagnosis, particularly if it has been less than 8 years since the woman began menstruating.
Source: Legro R S, et al. (2013)

However the sooner anti-androgenic treatment is started in women with PCOS, the higher the probability of childbirth following spontaneous ovulation and conception. In fact women who start treatment during adolescence see a mean reduction in time to first childbirth of 0.6 years (5.40 vs 6.00), and even greater in women with only mild hyperandrogenemia.
Source: Elenis E, et al. (2021)

In short, women with PCOS normally have problems with fertility because ovulation occurs intermittently or stops entirely. In addition, women with PCOS also commonly exhibit high levels of insulin, with 65-80% being resistant to insulin, causing difficulty and confusion when trying to lose weight.
Source: Lionett S, et al. (2021); DeUgarte C M, et al. (2005)

Interestingly the prevalence of polycystic ovaries decreases with age causing a return of normal menstrual cycles in some women over 30, however embryo quality also decreases with age, such that immediate treatment is always recommended over a wait and see approach.
Source: Jacewicz-Swiecka M, et al. (2021); Carmina E, et al. (2012); Elting M W, et al. (2000)

CAN I GET PREGNANT WITH PCOS NATURALLY?

Women with PCOS can fall pregnant naturally because ovulation still occurs intermittently. As long as intercourse occurs during this ovulation period, the likelihood of becoming pregnant is naturally the same as non-PCOS women.

However women with PCOS can quickly restore ovulation and increase their chances of falling pregnant using ovulation inducing medication. Normally 60% of women with PCOS fall pregnant within 6 months of starting ovulation induction medication. This success rate increases to over 90% by the end of 12 months standard treatment.

CAN I treat PCOS naturally AND fall pregnant?

PCOS can be treated naturally in women who are deficient in vitamin D and trying to fall pregnant. Restoring natural levels of vitamin D, reduces the level of abnormal androgens and reinstates normal menstrual cycles in 90% of women with PCOS, simultaneously treating PCOS and pregnancy naturally.

Although natural treatment of PCOS is preferred, a thorough investigation by your GP or Specialist is crucial to identify deficiencies and rule out other conditions that can inadvertently contribute to an initial diagnosis of PCOS.

Lifestyle change is commonly recommended, in obese women with PCOS, however the woman’s age will significantly influence such a recommendation by the Doctor. In cases of advance age, the Doctor may in fact not recommend lifestyle changes, but rather to begin ovulation induction medication immediately, simply due to the rapid decline in embryo quality beyond 35 years of age.

Symptoms of polycystic ovarian syndrome

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