Polycystic ovary syndrome (PCOS) is a hormonal disorder causing irregular menstrual periods and problems with ovulation. It is a common disorder affecting at least 8-10% of women of reproductive age, although this number may be conservative since many individuals with PCOS go undiagnosed.
How does PCOS impact fertility?
Many women with PCOS have more follicles (the small sacs inside which eggs grow) than age-based averages for women without PCOS. However, they often fail to respond to the brain’s signal to grow and ovulate an egg, resulting in periods that are irregular or do not come on their own. Since the ovaries are not releasing an egg every month, individuals with PCOS often struggle with infertility as a result.
In addition to issues with ovulation, PCOS can also impact many other aspects of health, including acne and excessive hair growth, mental health and metabolic issues, such as weight and levels of blood sugar or cholesterol. Every person with PCOS experiences the diagnosis differently, with a unique combination of these symptoms.
How can a person with PCOS achieve pregnancy?
The good news is, there are things you can do to prepare your body for the best chances of pregnancy success. Some people with PCOS can and do conceive on their own by adopting simple lifestyle changes, such as changing up what foods they’re putting in their bodies and regular exercise. For others, hormone medications might be needed for ovulation, and in some cases, additional fertility treatments could be necessary.
PCOS and diet
Focusing on the types of food you eat can be critical in improving your fertility when you have PCOS. An important place to start is by reducing the amount of refined and processed carbohydrates in your diet, such as sweet snacks and beverages, and white flour, breads and pastas. These foods aren’t well metabolized when you have PCOS, often due to developing resistance to insulin, the hormone that processes dietary sugar.
Studies have shown a Mediterranean-style diet can be beneficial when you’re trying to get pregnant. Here, the focus is on fresh fruits and vegetables, lower amounts of packaged foods, lean poultry and fish, healthy fats, and whole grains. High-fiber foods, such as seeds and legumes, and berries, as well as foods high in antioxidants are also recommended. With a healthy diet, along with regular exercise, individuals can achieve weight loss, which in turn reduces insulin levels and regulates hormones.
Fertility medications for PCOS
If diet alone isn’t enough, certain oral medications might be used to help increase your chances of pregnancy such as clomiphene or Letrozole. Both medications work in slightly different ways to help you ovulate.
In some cases, oral pills aren’t as effective, and you may be prescribed injectable medications including Follistim, Menopur, and Gonal-F. It’s important to be aware that fertility medications can produce more than one egg and therefore increase the chances of having multiples.
Though not as effective as other available medications for treating infertility, Metformin is sometimes used for people with PCOS help with ovulation. It’s used primarily to treat diabetes, but can work to balancing insulin levels in their body. It’s best used along with healthy lifestyle changes. Certain supplements, such as inositol, can also be part of a comprehensive management plan.
Additional assisted reproductive techniques
Some people with PCOS might not achieve pregnancy with medications alone and therefore may need intrauterine insemination (IUI) or in vitro fertilization (IVF). These treatments can be particularly helpful for cases involving abnormal sperm testing or age-based fertility decline.
IUI, typically combined with oral or injectable medications, involves preparing sperm outside the body and then using a thin catheter to deposit a concentrated sperm specimen directly into the uterus.
With IVF, after taking medication to grow multiple follicles, mature eggs are retrieved from the ovaries and combined with sperm in the laboratory. After fertilization occurs, the resulting embryo(s) are then transferred into the uterus.
If you have PCOS and are struggling to get pregnant, now is a great time to work with a CCRM Fertility specialist to make a personalized plan for your fertility. Schedule your appointment today.
Written by: Dr. Rashmi Kudesia, a board certified reproductive endocrinology and infertility specialist at CCRM Houston