Can I still get pregnant if I have PCOS?

PCOS is a hormonal disorder that is common amongst women of reproductive age. It can first be noticed during late teens or early 20s. Its main features include menstruation irregularities, an excess of androgens in the body and enlarged ovaries along with the formation of cysts on the outer edges in some women. 

The exact cause of PCOS is unknown but it can run in families and is the result of a hormonal imbalance in the body. It is associated with high levels of insulin (the hormone that manages blood sugar) and androgens (male sex hormones but the female body produces them in lesser quantity too) and low levels of progesterone (hormone essential for regular menstruation and maintaining a pregnancy). 

Not all women who have PCOS have visible symptoms but the ones who do have can include: 

• Excessive hair growth on the face, chest, back, abdomen and inner thighs
• Irregular and painful periods
• Pain in the pelvic region
• Sudden weight gain 
• Oily skin or acne 
• Excessive hair loss from the scalp

Here’s why getting pregnant can be difficult with PCOS: 

Hormonal imbalance: In conditions like PCOS, women have an elevated level of luteinizing hormone, decreased level of follicle-stimulating hormone along with increased levels of estrogen and insulin. All of this collectively inhibits the ovary’s ability to produce mature eggs (ovulation) which are required for a woman to conceive. Even if conception occurs, there is a high risk of miscarriage and other complications which puts the continuation of the pregnancy at risk.

Anovulation: High levels of circulating androgens in women who have PCOS makes the ovaries swell. Androgens are male sex hormones but reduced amounts are also produced in females. An increase in the level of androgen in the female body inhibits female reproductive function by seizing the growth and production of eggs from the ovary. All the immature eggs remain in the follicles inside the ovary and may form multiple ovarian cysts. In the absence of an egg, fertilisation cannot take place. This significantly reduces the chance of getting pregnant

Menstrual irregularities: Not all women suffering from PCOS go into a phase of anovulation. A few of them still ovulate, just not as regularly which leads to menstrual irregularities. Menstrual irregularity makes it difficult for a woman to analyse her menstrual cycle and deduce which time of the month she would be the most fertile. It can take a longer time for the couple to conceive in such cases as the menstruation is infrequent and unpredictable.

While having PCOS does not mean that you can’t get pregnant, sometimes the conditions are made unfavourable for conception. In such cases, the first step towards getting pregnant is to be able to produce mature eggs (ovulation). In order to accomplish this, your doctor might suggest the following things:

Weight loss: If a female with PCOS is obese, the first requirement, for the ovary to be able to release healthy eggs regularly, is to lose weight. A study confirms that even if you lose 5 to 10% of your current weight, your reproductive health can improve multifold. To lose weight in a healthy way, you must eat a balanced diet and include physical activity into your daily routine. A BMI (measure of fat using weight and height) between 18.5 and 24.9 is considered ideal. Managing to bring your BMI within this range will not only increase the probability of getting pregnant but also prevent long-term complications related to PCOS.

Medications: Your doctor may prescribe you a few medications in order to increase your chances of getting pregnant like:

• Clomiphene: It is the most commonly prescribed drug for the management of PCOS-related infertility as per the recommendations of the American College of Obstetrics and Gynecology. Clomiphene functions to induce egg maturation and help in its release. The pregnancy-induced by clomiphene tends to have multiples or twins.
• Metformin: It may be taken, in addition to lifestyle changes, to induce ovulation in PCOS patients. It can be either used alone or in combination with clomiphene. However, the FDA does not recommend metformin to treat PCOS-related infertility.
• Hormones: Fertility hormones like gonadotropins are given to the woman to induce ovulation. Hormonal therapy can cause multiple pregnancies and the probability of developing them is more than in the use of clomiphene.
• Letrozole: This drug functions to reduce estrogen production so that follicle-stimulating hormone (FSH) is secreted. FSH is necessary for ovulation. A study performed by Eunice Kennedy Shriver National Institute of Child Health and Human Development shows that letrozole is more potent than clomiphene for ovulation. Animal studies put a question mark on this drug as it may cause birth defects in the child if taken during pregnancy, however, there is no evidence from a study of letrozole conducted on humans.