Polycystic Ovary Syndrome and Pregnancy

Polycystic ovary syndrome is linked to infertility and pregnancy problems. Medical and self-help measures can boost fertility and lower pregnancy risks.

Around five million women in the U.S. have the hormonal disorder known as polycystic ovary syndrome (PCOS). It’s caused by a slight excess of sex hormones associated with male traits (testosterone and other androgens), often resulting in irregular or missed menstrual periods, weight gain, and excessive body hair. Ovaries may fail to regularly release eggs, causing difficulty in achieving pregnancy.

In fact, when it comes to polycystic ovary syndrome and pregnancy, PCOS is the most common cause of female infertility in the U.S., the Endocrine Society points out. And if a woman with the condition becomes pregnant, she faces an increased risk of pregnancy complications, including miscarriages.

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But there’s good news about polycystic ovary syndrome and pregnancy. PCOS symptoms vary in individual women, and having the condition does not necessarily mean you are infertile. Some woman can get pregnant naturally. For others, fertility treatments are available and, with proper medical care, along with healthy life-style strategies, women with PCOS can often have safe pregnancies, according to the PCOS Awareness Association.

Medications to help women with PCOS ovulate

Several prescription medications can help women with polycystic ovary syndrome ovulate. Clomiphene (Clomid) is an oral anti-estrogen drug taken at the beginning of the menstrual cycle. Another medication, letrozole (Femara), can stimulate the ovaries to release eggs.

Polycystic ovary syndrome is linked to an increased risk of obesity and abnormal glucose levels (even in women with the condition who aren’t overweight). And these factors are known to negatively impact ovarian function, contributing to infertility, according to research published in Diabetes Care, the journal of the American Diabetes Association.

That’s why metformin, an oral drug prescribed to treat type 2 diabetes, can be beneficial as part of infertility treatment for women with polycystic ovary syndrome.

What’s more, by helping control high blood sugar and insulin resistance during pregnancy, treatment with metformin may lower the risk of miscarriage, gestational diabetes and preterm birth, the researchers concluded.

Lifestyle changes can help polycystic ovary syndrome and pregnancy

If you have PCOS, getting prepared for pregnancy with weight loss, if needed, and exercise can improve the odds you will ovulate and soon be expecting, according to an Endocrine Society study.

“The findings confirm what we have long suspected — that exercise and a healthy diet can improve fertility in women who have PCOS,” noted researcher Richard S. Legro, MD, professor of obstetrics and gynecology and public health sciences at Penn State College of Medicine. “Making preconception lifestyle changes is beneficial, either alone or in combination with other pretreatment options.”

Women with PCOS often take birth control pills to help regulate hormone levels and reduce symptoms. Previous research found that a short course of birth control pills improved the odds that women with PCOS would ovulate and become pregnant.

However, the research from Legro and colleagues found women who not only took a short course of birth control pills but also participated in lifestyle changes to lose weight and exercise regularly were more likely to ovulate and become pregnant than women who took only birth control pills.

There was another advantage for the women who made the lifestyle changes: Their insulin sensitivity (a marker of type 2 diabetes risk) improved and so did their levels of triglycerides (a type of fat linked, at high levels, to heart disease).

“The research indicates preconception weight loss and exercise improve women’s reproductive and metabolic health,” Legro concluded.

Polycystic ovary syndrome and pregnancy complications

If you have PCOS and get pregnant, it’s important to be aware of extra risks you and your baby can face. For example, women with polycystic ovary syndrome are three times as likely to miscarry in the early months of pregnancy as women who don’t have the hormonal disorder, the National Institute of Child Health and Human Development points out.

Pregnant women with PCOS are also more likely to need C-sections due to complications associated with polycystic ovary syndrome and pregnancy, such as pregnancy-induced high blood pressure.

Other polycystic ovary syndrome and pregnancy risks and complications include:

• Gestational diabetes. This kind of diabetes, which only pregnant women get, is common in women with PCOS who are expecting. Fortunately, treating the condition and keeping blood glucose under control can help you and your baby avoid complications.
• Preeclampsia. Women with PCOS have a higher risk of this sudden, serious increase in blood pressure after the 20th week of pregnancy. Preeclampsia can affect the mother's kidneys, liver, and brain. The main treatment for preeclampsia is to deliver the baby, even if it is not full term, usually by C-section.
• Pre-term birth. Newborns whose mothers have PCOS are at higher risk of being born preterm, spending time in the neonatal intensive care unit, or dying before, during, or soon after birth.

Despite these extra risks, women with PCOS can have healthy pregnancies and deliveries. However, it’s crucial to work with your doctor to stay as healthy as possible by eating a nutritious diet, watching your blood sugar levels, and keeping all prenatal appointments.

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