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PCOS AND PREGNANCY – IS IT POSSIBLE?

- 7 min read
written by Shield Connect

Are you planning to get pregnant and do you have PCOS? Are you worrying that PCOS may hamper your plans of being a mother? Then worry not and read on to understand how it is possible to get pregnant even if you are combating PCOS. Polycystic ovarian syndrome, or PCOS, is a common hormonal condition … Continue reading “PCOS AND PREGNANCY – IS IT POSSIBLE?”

Are you planning to get pregnant and do you have PCOS?

Are you worrying that PCOS may hamper your plans of being a mother?

Then worry not and read on to understand how it is possible to get pregnant even if you are combating PCOS.

Polycystic ovarian syndrome, or PCOS, is a common hormonal condition in women. Women with PCOS can struggle to become pregnant and if they get pregnant, are at higher risk of developing complications.1

Around 70% to 80% of women with PCOS experience difficulties in becoming pregnant.2 A range of PCOS related factors such as increased hormone levels, increased weight (BMI higher than 31) and negative lifestyle influences might cause fertility issues. However, medical and positive lifestyle management can increase the chances of a successful pregnancy.3

The Very First Step In Trying To Get Pregnant
About 40% to 60% of women PCOS are either overweight or obese, and obesity causes hormonal imbalance causing infertility. Hence it is important to treat the obesity first. Weight loss not only improves hormonal imbalance, but also your cholesterol levels. The very first step towards getting pregnant is to lose your weight by modifying your lifestyle.2

    • Start an exercise plan. A regular exercise would not only help you lose weight but would also improve your other symptoms including irregular menstrual cycle and ovulation rate. It is recommended that a minimum of 150 minutes of moderate intensity exercise/week or 75 minutes of vigorous intensity and muscle strengthening exercise on 2 nonconsecutive days/week would help you to lose weight effectively.2 Talk to you doctor before starting on any exercise routine.
    • Inculcate a healthy diet plan. A low-calorie diet with adequate nutritional intake and healthy food choices significantly improves fertility outcome in PCOS. The diet should be high in fibre and protein; moderate in carbohydrate and low in fat.2 Consult with your doctor and nutritionist to decide on an appropriate diet plan for you.
    • Understand your mental status. There is a possibility that having PCOS or not able to get pregnant may affect the your mental state causing you to become sad or depressed. Adequate treatment and consultation would help you to improve your PCOS symptoms as well as your chance to get pregnant.2 If you are feeling sad or depressed, talk to your doctor today.

Apart from changing your lifestyle, there are other interventions that would help you in getting pregnant.

Ovulation Induction
Lifestyle changes and weight loss management has to be followed throughout the life but if it did not help improve your fertility after 12 months, then your doctor may recommend referral to a fertility specialist for treatment. If you are aged 35 years or more, your doctor may refer you after six months.3

Ovulation induction is a medical treatment that uses oral tablets or injections to stimulate the ovary to increase egg production. Ultrasounds and blood tests are performed to determine the best time to trigger ovulation. For women with PCOS who have a BMI more than 35, prior to ovulation induction it is recommended to reduce the weigh and BMI.3

Once ovulation has been triggered, semen (sperm) is introduced either by natural means or by inter-uterine insemination (IUI), where in the collected semen is placed directly into the uterus through the cervix.3 Oral medications that may help you get pregnant with PCOS include2:

    • Clomiphene citrate – It is antiestrogenic, stimulates a gonadotropin‐releasing hormone and promotes ovulation
    • Letrozole – It is considered as a first-line agent and it is antiestrogenic, which causes the release of follicle stimulating hormone (FSH) and follicular growth for ovulation induction.

Second line agents for ovulation induction

    • Gonadotropins – They are used as second-line agents for ovulation induction following unsuccessful treatment with first-line oral ovulation induction agents. Gonadotropins include highly purified FSH and recombinant FSH that directly stimulate ovaries.2
    • Oral insulin-sensitising agent such as metformin – It plays a role in improving ovulation induction in women with PCOS by reducing insulin levels and altering the effect of insulin on ovarian androgen synthesis.2
    • Myoinositols – It shows insulin-sensitizing activity, regulates glucose uptake, FSH signalling and reduces insulin-induced androgen synthesis.2

Laparoscopic Ovarian Drilling
Laparoscopic ovarian drilling is a surgical procedure, and is the second-line treatment for ovulation induction.2

It is a simple procedure performed using a laparoscope (a small telescope-like instrument). It is a minimally invasive procedure where an incision is made in the stomach under a general anesthesia. Small holes are created on the surface of the ovary. This procedure helps in lower the amountof ‘testosterone made by ovaries. Following the procedure, ovulation is often restored for up to 6–12 months.3

This surgery might be considered after other lifestyle or medical treatments have been proven to be ineffective. Discuss with your doctor if it is a good option for you.3

Assisted Reproductive Technology (ART)
Assisted reproductive technology includes intrauterine insemination (IUI) and In vitro fertilisation (IVF) considered as a third-line treatment option. It is for women who have not had success in conceiving naturally or by using lifestyle modifications or medications to improve their fertility. Referral to a fertility specialist is necessary for these treatments.3

IUI – It is also known as intra uterine insemination. In this procedure, sperm is deliberately introduced into a female’s cervix or uterine cavity for the purpose of achieving a pregnancy without involving sexual intercourse.2

IVF – It is a process of fertilization where an egg is combined with sperm outside the body, in vitro (in a test tube). The process involves monitoring and stimulating woman’s ovaries, removing eggs from the ovaries and letting sperms fertilize them in a laboratory.2

The first step, for all women, in ART treatment is to eat a balanced diet and get plenty of exercise done to reach a healthy weight. Women with PCOS who are at a healthy weight are twice as likely to get pregnant with ART than women with PCOS who are not.4

Assisted reproductive technology is best tried after other less intensive treatments have proven unsuccessful. These procedures are costly and demanding, and are less effective in women who are with advanced age or of an unhealthy weight. The technology is more successful in women who have made lifestyle changes first.3

Don’t get disheartened, as it is possible to get pregnant even if you have PCOS. All you need is to have a moderate weight, balance your blood sugar levels, and treat other PCOS symptoms with healthy lifestyle changes and medications. In some cases, fertility medications alone will help you get pregnant.

If that doesn’t work, there is always the option of assisted reproductive technology. But regardless of what treatment you explore, don’t lose hope. Success rates are optimistic. In time you may be smiling with a positive pregnancy test in hand.4

References:
1.
PCOS and pregnancy [Internet]. Available at: https://www.pregnancybirthbaby.org.au/pcos-and-pregnancy. Accessed on Sep 13, 2020.

2. Sawant S, Bhide P. Fertility treatment options for women with polycystic ovary syndrome. Clin Med Insights Reprod Health. 2019;13:1179558119890867.

3. Fertility-management and treatment [Internet]. Available at: https://www.jeanhailes.org.au/health-a-z/pcos/fertility-management-treatment. Accessed on Sep 13, 2020.

4. How to get pregnant with polycystic ovary syndrome (PCOS) [Internet]. Available at: https://www.healthline.com/health/pregnancy/how-to-get-pregnant-with-pcos. Accessed on Sep 13, 2020.

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