11 Tips for Getting Pregnant with PCOS (Treatments, Medications, Lifestyle Changes)
Polycystic ovarian syndrome (PCOS) is a hormonal disorder affecting more than 5 million women globally. It is also one of the most common causes of fertility issues. However, there are several ways you can get pregnant with PCOS, with or without treatment. Most women with PCOS can conceive with a combination of lifestyle changes and fertility treatment and a few rare cases may require in-vitro fertilization (IVF).
What is PCOS?
Polycystic ovarian syndrome, or PCOS for short, is a health condition affecting women’s endocrine system. It is caused by a particular kind of hormonal imbalance, which we will discuss in greater detail in the next section.
PCOS & Hormones
Women with PCOS have excessive levels of male sex hormones called androgens — especially testosterone — and the female sex hormone estrogen. This hormonal imbalance causes symptoms like polycystic ovaries (enlarged ovaries with multiple follicles forming small cysts), irregular or absent periods, problems with ovulation, and more.
Other symptoms of PCOS include:
- Heavy periods
- Insulin resistance
- Weight gain
- Excessive body hair
- Pelvic pain
PCOS & Ovulation
PCOS may cause irregular ovulation or a lack of ovulation altogether (called anovulation). Ovulation problems occur because the hormonal imbalance found in women with PCOS impedes the normal function of the ovaries. This can interfere with a woman’s ability to get pregnant when she is trying to conceive naturally.
Estrogen usually starts to rise about 4-5 days leading to ovulation. High levels of estrogen trigger the release of luteinizing hormone (LH). Within 12-24 hours of this LH surge, ovulation usually happens.
During ovulation, the ovary releases an egg, setting up the foundation for pregnancy. The egg travels down the fallopian tube to the uterus. If it meets a sperm along the way and becomes fertilized, it implants itself onto the inner lining of the uterus wall and starts to develop into an embryo.
The high level of androgens present in PCOS disrupts the rhythm of women’s cycle. Additionally, the unusually high level of estrogen interferes with egg development and egg release. If an egg can’t be released, fertilization can’t happen, meaning you can’t get pregnant.
Women with PCOS who experience problems with ovulation might be prescribed a medication called Clomid, which can help you ovulate more regularly. This medication is especially used during cycles of in-vitro fertilization (IVF) to prepare the body to release multiple eggs, which can also help women with PCOS get pregnant more easily.
How to Get Pregnant with PCOS
Understanding how PCOS affects your body is critical if you are trying to get pregnant with PCOS. PCOS affects ovulation by interfering with egg development and egg release (more on PCO vs PCOS here).
For this reason, PCOS usually comes with missed periods or irregular cycles and may result in infertility. However, it is still possible to get pregnant with PCOS by making small changes to your lifestyle or using certain medical treatments.
Here are some of the things you might try to help you conceive with PCOS:
Obesity affects as many as half of PCOS patients. If you are overweight, like many women diagnosed with PCOS, you may want to consider losing weight to restart ovulation.
The symptoms of PCOS include problems responding to insulin, which is called insulin resistance. Insulin is typically secreted to respond to increased levels of glucose when we eat, which is a small sugar molecule found in many carbohydrates. Insulin allows cells to uptake glucose so they can store it as energy for later use.
Insulin resistance doesn’t allow the body to respond to insulin well, which results in high blood sugar and low energy. Over time, it may cause weight gain and even obesity.
One major reason that women with PCOS have a hard time conceiving is that they don’t ovulate, or don’t ovulate regularly. Studies show that obese women are more likely to experience anovulatory infertility, or infertility due to a lack of ovulation. Without ovulating regularly, a woman cannot get pregnant.
Weight loss works for PCOS because it reduces the number of circulating androgens and increases insulin sensitivity. Research has found that losing a certain amount of weight may restart ovulation and make the pattern more regular. Studies showed that losing just 5-10% of your weight is enough to get ovulation back on track.
Weight loss alone may not be enough to help you get pregnant, but combined with fertility treatment, you may have a higher chance of a successful pregnancy. In general, doctors recommend you maintain a healthy weight while trying to conceive to avoid complications such as diabetes, preeclampsia, and hypertension.
Losing weight may not be a solution for you if you are not overweight. If you are underweight, you may even need to gain weight to maintain a healthy pregnancy. Consult with your OB/GYN to determine what course of action is best for you.
Healthy Diet and Exercise
A balanced lifestyle is always important for pregnancy, but especially if you struggle with PCOS.
Maintaining a healthy diet and exercising regularly can help women with PCOS maintain a normal weight and increase insulin sensitivity.
There is some debate about what type of diet is best for women with PCOS. Some believe a low-carb diet may help, while others disagree. However, what’s most important is that you eat an overall balanced diet rich in whole foods, with plenty of fruits and vegetables, fiber, and adequate protein. Though you should still treat yourself sometimes, of course, it’s also a good idea to avoid added sugar as much as possible.
Exercise has also been found to be helpful for PCOS patients. One study found that exercise therapy restored regular periods in 60% of PCOS patients.
Small changes can make a big difference. Over time, shifting towards a healthier lifestyle benefits ovulation regularity and the success rate of fertility treatment.
Birth Control Pills
Birth control pills contain synthetic forms of the female sex hormones estrogen and progesterone. These hormones can reduce androgens, regulate cycles, and help correct hormone imbalance in patients with PCOS.
Birth control pills are a common treatment option for women with PCOS, but because they prevent pregnancy, they are not appropriate for women who are trying to conceive.
Monitor Blood Sugar
PCOS causes insulin resistance, which results in high blood glucose levels — a.k.a. high blood sugar. Having insulin resistance and high blood sugar increases your risk of developing type II diabetes, especially if you are overweight or obese. In fact, one study found that 19% of women with PCOS developed type II diabetes, compared with just 1% of the control subjects.
Women with PCOS can benefit from monitoring their blood sugar, especially if they have type II diabetes or prediabetes. If you do not have diabetes, you will need to visit your doctor for a blood glucose test. Together, you can decide how often to repeat the test to keep an eye on your blood sugar levels and monitor your risk of developing type II diabetes. Women with type II diabetes need to monitor their blood sugar more regularly at home to ensure they are staying within a healthy range.
In between monitoring your blood sugar, you can also take steps to maintain regular blood sugar levels throughout the day. You can do this by limiting your intake of carbohydrates and starchy vegetables, getting enough protein, and drinking plenty of water. It may also help you to eat many small meals throughout the day, as opposed to three large ones at breakfast, lunch, and dinner.
Metformin is a drug that is usually prescribed for type II diabetes. However, it is often used “off-label” to manage PCOS.
The drug works by treating the insulin resistance associated with PCOS. It makes the body more sensitive to insulin and lowers blood glucose levels. In addition to improving insulin sensitivity, the drug may reduce circulating levels of androgens in women with PCOS.
Due to these effects, studies show that metformin is effective at inducing ovulation in women with PCOS. In fact, an Italian study even found that the drug was significantly more effective than Clomid, a common infertility drug, in restarting ovulation.
Letrozole is a cancer drug that is often used to treat PCOS. Don’t be scared of the fact that it was originally developed to treat cancer: its side effects are rather mild, and the drug has been widely used in infertility treatment for women.
Letrozole suppresses the production of estrogen, one of the hormones associated with ovulation. Lowered levels of estrogen induce the pituitary gland to produce more follicle-stimulating hormone (FSH), which promotes the growth of follicles within the ovary to induce ovulation. Mira can be useful for better understanding how your hormones relate to your PCOS.
Some studies show that letrozole may be more effective than Clomid in promoting pregnancy among infertile women with PCOS. Compared with those taking Clomid, the study found higher live birth rates in women using letrozole.
Clomid, or clomiphene, is a common drug that is used for the treatment of infertility. Currently, it is the first-line treatment for anovulatory infertility in women with PCOS. Like letrozole, clomiphene works by blocking the body’s natural response to estrogen to induce ovulation.
Unfortunately, some women with PCOS may develop resistance to clomiphene over time, meaning that Clomid no longer induces ovulation successfully. For this reason, some doctors use intermittent clomiphene treatment (ICT), which has been found to be successful in around 80% of women with clomiphene-resistance.
If ICT is still not successful, other options include letrozole and metformin. While Clomid is currently the first-line treatment for anovulation in PCOS patients, as we mentioned previously, some studies show that these other drugs are more effective at inducing ovulation.
Clomiphene is considered an oral gonadotropin — but when it stops working, women with PCOS may turn to other gonadotropins for help with anovulatory infertility. While clomiphene is an oral medication, other gonadotropins are injectable. These “injectables” include brands like Follistim, Repronex, and Menopur.
Injectables work by stimulating the growth of follicles, which release eggs during ovulation. However, in women with PCOS, this presents a potential problem, as it is difficult to get just one or two follicles to develop. Many follicles usually develop in women with PCOS, as opposed to other women with anovulatory infertility. As a result, injectables are being used less often in women with PCOS due to the high risk of multiple pregnancies — including triplets, quadruplets, and higher.
In-Vitro Fertilization (IVF)
If none of the above interventions work, the next step is IVF. During IVF, doctors inject ovulation induction drugs to stimulate the ovaries to develop a few mature eggs, which are retrieved from the ovary and placed together with sperm in a culture dish. After some of the eggs are fertilized by the sperm, one or two divided and grown ones will be transplanted back into the uterus. Your fertility specialist will check for pregnancy two weeks after to see if the cycle was successful.
In-Vitro Maturation (IVM)
Some women may have more success with a type of IVF known as in-vitro maturation, or IVM. IVM works largely the same way as IVF, except that doctors do not usually use injectables to induce ovulation. Instead, they collect immature eggs from the ovaries and “ripen” them in a lab. In the past, immature eggs could not be used, but modern technology has enabled IVM to become possible. Once the egg has matured in the lab, it can be frozen or transferred into the woman’s uterus to promote pregnancy. As in IVF, your fertility specialist will check for pregnancy a few weeks later to see if the IVM cycle was successful.
When everything else fails to work, some women may need to use donor eggs if they want to become pregnant. These are eggs collected from another woman that are fertilized with your partner’s sperm and transferred into your uterus for pregnancy. Usually, only one or two embryos are transferred at once to reduce the risk of multiple births. Other embryos from the donation process can be frozen for use at a later time. Sometimes, the donor may carry the pregnancy herself in a process known as surrogacy.
Chances of Getting Pregnant with PCOS
About 70 to 80% of women with PCOS struggle with infertility. Knowing this, the idea of conceiving with PCOS may seem overwhelming and you may worry that you will never be able to have a baby.
The good news is that with the help of assisted reproductive technology, your odds of pregnancy are fairly good. About 60 to 70% of PCOS patients treated with Clomid get pregnant within six cycles, and approximately 70% of women who undergo IVF successfully get pregnant. Tracking your cycles with Mira’s digital fertility tracker may also increase your likelihood of conceiving with PCOS.
Where to Start
Knowing where to start can make the process of conceiving with PCOS feel less nerve-wracking. Here are the initial steps to take if you are ready to take the plunge toward getting pregnant with PCOS:
- Make an appointment with your OB/GYN to discuss your pregnancy
- Create a treatment plan with your doctor that includes medications and lifestyle changes
- If it’s safe for you to do so, lose 5-10% of your body weight
- Every week, make a meal plan and schedule your workouts
- Time sex with ovulation if you are trying to conceive naturally
- Start tracking your hormone concentrations with Mira to better understand your cycle
Stories of PCOS Pregnancy Success
If your goal is to get pregnant with PCOS, it can be inspiring to hear stories of other women with PCOS who went on to conceive successfully. Check out these pregnancy success stories if you want to be amazed!
✔️ Medically Reviewed by Dr Roohi Jeelani, MD, FACOG and Lauren Grimm, MA
Dr Roohi Jeelani is Director of Research and Education at Vios Fertility Institute in Chicago, Illinois. Dr Jeelani earned her medical degree from Ross University School of Medicine in Portsmouth, Dominica. She then completed a residency in Obstetrics and Gynecology and a fellowship in Reproductive Endocrinology and Infertility at Wayne State University, Detroit Medical Center, where she was awarded a Women’s Reproductive Health NIH K12 Research Grant. She is board certified in Obstetrics and Gynecology. Dr Jeelani has authored numerous articles and abstracts in peer-reviewed journals, and presented her research at national and international scientific meetings. A Fellow of the American College of Obstetrics and Gynecology, Dr Jeelani is a member of the American Medical Association, the American Society of Reproductive Medicine, and the American Association of Gynecologic Laparoscopists.
Lauren Grimm is Research Coordinator at Vios Fertility Institute in Chicago, Illinois. Lauren earned her bachelor’s degree from Loyola University Chicago, where she also completed her masters in Medical Sciences. Lauren has worked alongside Dr. Jeelani for the last 3 years, authoring a number of abstracts and articles in peer-reviewed journals, and presented her research at national and international scientific conferences. Lauren will be continuing her education this fall at Rush University Medical College in Chicago, IL as an MD candidate.
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