How to Get Pregnant With PCOS
Polycystic ovarian syndrome (PCOS) is a hormone disorder that most commonly occurs for women, 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 could get pregnant with PCOS, with or without treatment. Most women get over this by a combination of lifestyle change and fertility treatment. Some cases may require In-Vitro Fertilization (IVF) treatment.
What are the hormone problems?
PCOS causes hormone imbalances for women. Women with polycystic ovary have elevated levels of androgens, which are often considered as male hormones, as they help with the development of male sex organs and other sex traits. Males have much higher androgen levels than women. Androgens in women are usually converted to Estrogen, a hormone that controls ovulation. Hormone imbalance often leads to irregular periods.
There are many women with PCOS who use Mira to track their cycles. Mira is different from all other OPKs because Mira gives your actual hormone concentrations. With PCOS, elevated LH is usually common, and OPK will give you positive all the time. With Mira you can see your actual hormone levels and curve even your baseline LH is high.
How does PCOS affect ovulation?
PCOS affects ovulation by interfering with egg development and egg release (more on PCO vs PCOS here).
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 LH surge, ovulation usually happens.
During ovulation, the ovary releases an egg, setting up the foundation of 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.
A high level of androgens disrupts the rhythm of women’s cycle. The unusual level of Estrogen interferes with egg development and egg release. If an egg couldn’t be released, fertilization can’t happen, meaning you can’t get pregnant. PCOS usually comes with missed periods or irregular cycles.
How to Get Pregnant With PCOS
If you are overweight like many women diagnosed with PCOS, you may want to consider losing weight to restart ovulation.
Symptoms of PCOS include problems responding to insulin, which is called insulin resistance. Insulin is typically secreted to respond to the increased level of glucose, which is a small sugar molecule and comes from carbs we eat. Insulin lets cells to uptake glucose and stores them as energy for later use.
Insulin resistance doesn’t allow the body to respond to insulin well, which leaves a high level of glucose molecules in the blood and low energy. Over time, it causes weight gain.
One major reason that women with PCOS have a hard time to conceive is that they don’t ovulate, or don’t ovulate regularly. Studies show that overweight women with PCOS are more likely to have anovulation. If there is no egg to be fertilized, the woman can’t get pregnant. If she ovulates irregularly, she has a smaller chance of conceiving.
The research found that losing a certain amount of weight may bring ovulation back and make the pattern more regular. Weight loss by itself might be enough to restart ovulation. And the good news is you don’t have to lose all the weight! Studies showed that losing 5-10% of your weight is enough to get the ovulation back again. But there is no evidence showing that losing weight will help you to conceive by yourself.
Combined with fertility treatment, the chances of a successful pregnancy are higher than having fertility treatment alone. In general, it is recommended to 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. Plus, losing weight is not easy, especially for women with PCOS. Increased exercise and limited calorie intake are often recommended. Consult with your OB-GYN for a plan that works for you.
Healthy diet and exercise
A healthy diet is important because you want to avoid being overweight while trying to conceive. This is especially true for women with PCOS whose body might struggle with insulin regulation. However, there is a debate about if a low-carb diet is the best choice for PCOS. What’s important is to make sure you eat balanced and natural foods, containing adequate-protein, a good amount of fiber, with plenty of vegetables and fruits, and avoid foods with high sugar or high fat.
Exercise is found helpful to PCOS treatment. Studies showed that a combination of regular exercise and a healthy diet improved menstrual cycle consistency by 50%. A small change can make a big difference. Shifting towards healthier lifestyle benefits ovulation regularity and the success rate of fertility treatment.
Birth control pills
Birth control pills contain hormones that can lower the male hormones, regulate cycles, and correct PCOS hormone imbalance. It is a commonly used form of treatment for PCOS.
As a drug known to treat type 2 diabetes, using metformin for PCOS is considered off-label use as a fertility drug. It is often used to treat insulin resistance. It lets the body use insulin better, so there won’t be that much insulin in the bloodstream.
According to research, Metformin could help you to lose weight, restart ovulation, and improve the outcome of certain fertility treatments. It is also found that Metformin increases the chance that a woman ovulates by herself but didn’t show that Metformin increased the chance of pregnancy.
Letrozole is a cancer drug but often used to treat PCOS. Don’t be scared of the fact that it was originally developed to treat cancer. It is rather mild and has been widely used in infertility treatment for women.
Letrozole suppresses the production of Estrogen, a hormone associated with ovulation. A low level of Estrogen induces the pituitary gland to produce more follicle-stimulating hormone (FSH), which promotes the growth of follicles within the ovary to induce ovulation. Letrozole was found to be more effective than Clomid to trigger ovulation, specifically for women with PCOS who have developed Clomid resistance. Mira can be useful for tracking and understanding how your hormones relate to your PCOS.
Clomid is a common drug that is used for the treatment of fertility. It works by blocking the body’s response to Estrogen to induce ovulation. Unfortunately, some women with PCOS may develop Clomid resistance over the long term, meaning that Clomid doesn’t induce ovulation successfully. With the help of Metformin, you may be able to beat Clomid resistance.
In Vitro Fertilization (IVF)
If none of the above works, 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 to the uterus. Your fertility specialist will check for pregnancy two weeks after to see if the cycle was successful.
✔️ Medically Reviewed by Banafsheh Kashani, MD, FACOG
Banafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treating couples and individuals with infertility since 2014. Prior to joining Eden Centers for Advanced Fertility, she was practicing as a top fertility specialist at Kaiser Permanente in Orange County and Reproductive Fertility Center. Dr. Kashani has received numerous awards throughout her years of study and medical training.
Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation. Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.
Dr. Kashani is a fellow of the American Congress of Obstetricians and Gynecologists. In addition, she is a diplomat of the American Board of Obstetrics and Gynecology and an active member of the American Society of Reproductive Medicine (ASRM) and Pacific Coast Reproductive Society (PCRS). She is also a member of the Society of Reproductive Endocrinology and Infertility (SREI).