PCOS and Getting Pregnant: Tips to Improve Your Chances
September 2019 signals the start of Autumn, back-to-school – and PCOS awareness month. To mark the occasion, WH is sharing a deep dive into the reality of conceiving, if you have been diagnosed with the condition.
If that's you, you're far from alone. It's thought that 20-30% of women are affected, with 10-15% showing symptoms of polycystic ovary syndrome (PCOS.)
Here's the expert view.
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Getting pregnant with PCOS: the expert view
'PCOS is the most common hormonal disturbance to affect women,' says Adam Balen, Professor of Reproductive Medicine and Surgery at Leeds Fertility and a leading expert on all things baby-making.
'Of women who aren't ovulating and have not yet hit the menopause, 90% have the condition.'
'The main problems that women with PCOS experience are menstrual cycle disturbances like irregular or absent periods, [more on this, shortly] difficulty in controlling body weight and skin problems, such as acne and unwanted hair growth on the face or body.'
So, what actually is PCOS?
As you know, your ovaries contain thousands of eggs, the stocks of which deplete over time.
Each of said eggs is surrounded by cells, which develop into a fluid-filled cyst. If your periods are regular, for ovulation, one of these cysts will grow to around 20mm in diameter and then release the egg it's housing into the fallopian tubes (if it meets a sperm here, then that's conception and the fertilised egg will sail on down to the lining of the uterus. All being well, it'll chill here and grow into a baby.)
Polycystic ovaries, similarly, have these cysts which contain an egg. Difference is, the eggs don't reach a mature size and, instead, stay teeny – about 2-9 mm in diameter.
In the polycystic ovary, there's usually a minimum of 20 of these cysts. Because these eggs never reach the appropriate size, ovulation doesn't occur, or occurs much less frequently than once every month.
Your ovaries also produce hormones. Namely, oestrogens, androgens – this includes testosterone – and progestogens.
If you have PCOS, your ovaries may produce higher levels of testosterone, which cause the skin and hair issues.
Plus, if you’re overweight, then you have higher levels of insulin in your circulation (this comes from the pancreas to help you deal with sugars in your diet).
Insulin may also stimulate the ovary to over-produce testosterone, which can then prevent the follicles from growing as they should, to release eggs.
Can you get pregnant with PCOS without treatment?
Of course, the menstrual cycle element is likely one of the biggest causes for concern, if you have PCOS.
Whilst not as smooth sailing as it might be for your non PCOS-having sisters, Professor Balen says 'you have a good chance of having children if you are the right age, [twenties to early thirties] weight [you have a 'normal BMI'] and are generally healthy. It might take you a little while longer, though.'
Getting pregnant with PCOS: your lifestyle
First thing: your weight. Being medically overweight can exacerbate the symptoms of PCOS and dampen chances of conceiving, says Professor Balen. This is a tricky one, because people with PCOS may find it easy to gain weight, as the condition can interfere with your metabolism causing it to deal with food inefficiently.
'Regular physical exercise (at least 20-30 minutes of hard exercise 5-7 days per week) will increase the body’s metabolism and significantly improve the ability to lose weight and improve long term health,' Professor Balen explains. And when it comes to food?
There's no magic bullet that works for everyone. 'The right diet for an individual is one that is practical, sustainable and compatible with your lifestyle,' he elaborates. 'It is sensible to keep carbohydrate content down and to avoid fatty foods.' It could also be an idea to seek out a dietician, if this is an area you're finding tricky.
The classic baby-making advice still applies here. 'Keep your alcohol intake minimal, make sure your BMI is in the 'normal' range, eat lots of fresh fruit and vegetables – maintain an overall healthy lifestyle.'
Getting pregnant with PCOS: your age
If you've not yet hit your mid 30s, then you should be all good from that point of view. From that stage onwards, you may find it does take you longer to get pregnant, thanks to the decline in fertility that happens around 35, before a more dramatic slide at 38.
What medical treatment is available for women with PCOS?
If you do ovulate but have irregular periods, then Professor Balen advises trying naturally, but seeking professional help much sooner (after about six months) than the year that people are generally advised to wait before getting checked out.
If you don't ovulate – i.e. you don't have periods, full stop – then you'll need treatment to get pregnant. Remember: it is your right to be referred by the NHS to a specialist clinic for this issue.
If you seek treatment, first off, a fertility expert will check that your fallopian tubes are open and that your partner’s sperm count (if applicable to your situation) is normal. This is to ensure that the following procedures are actually appropriate for what's going on in your/ your significant other's body.
Assuming the above are all good, then here's your options.
1/ Stimulating ovulation
If you're not ovulating, then there's some science to get it going.
'We can stimulate ovulation with a tablet called Letrozole. We used to use one called Clomid, but this is generally thought of as better as you have a lower chance of a multiple pregnancy,' says Professor Balen.
This works for around 75% of women with PCOS who take it, meaning that they then have a 20-25% chance of getting pregnant if they have sex whilst they're ovulating on each cycle. This is the same chance that a woman who doesn't have PCOS has.
'So, 50-60% of women can expect to get pregnant after six months’ therapy – but this does depend on your age and weight, as well,' says Professor Balen.
2/ Hormone injections
If that doesn't work for you, another solution is daily hormone injections. This requires close monitoring by healthcare pros, and so is more time consuming and invasive than the tablets. This kick-starts ovulation in around 80% of women, at which point your chances of getting pregs are the same as above, again, assuming you're under 35ish age and are at a healthy weight.
3/ Ovarian drilling
You may also be referred for keyhole surgery, known as an ovarian diathermy or ovarian drilling, which, no, doesn't sound too nice, but destroys the testosterone-producing tissue of the ovary and induces ovulation in 80% of women. 'This tends to be rarer in the UK and needs to be done at a specialist clinic,' says Professor Balen.
4/ IVF
If this does not work, then IVF would be the final port of call in the getting pregnant. 'At a good clinic, your chances per cycle are roughly 40%, if you're under 35,' says Professor Balen. One thing to remember: the NHS will not fund your IVF if your BMI is over 30, so make sure that's in check before exploring this road.
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