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Getting Pregnant With PCOS; Ovulation, Medications & More

How To Increase Your Chances Of Getting Pregnant With PCOS

One of the most common disorders related to fertility hormones is Polycystic Ovarian Syndrome (PCOS). The disorder affects as many as 5 million women all across the globe. Women suffering from PCOS stand a high chance of infertility and other problems about reproductive health. That said, there is no reason to believe that PCOS is not treatable and women with the condition can’t get pregnant. A combination of positive lifestyle changes and fertility therapies can give excellent results. In-vitro fertilization (IVF) is required only in rare cases.

Getting Pregnant With PCOS

What is PCOS?

PCOS is an endocrine disorder affecting women. It results from an imbalance of infertility hormones in women. In this article, we will be discussing various aspects of PCOS and ways to manage and mitigate the condition.

PCOS, Hormones & trying to get pregnant 

One of the hallmarks of PCOS is the presence of male sex hormones or androgens, specifically Testosterone and female sex hormone estrogen, in their blood. This imbalance results in the development of enlarged ovaries with multiple follicles that forms cysts. Other problems associated with the condition include irregular periods, amenorrhoea (absence of periods), problems with ovulation, and a host of others. Here is a list of problems associated with PCOS:

    • Infertility
    • Unusually heavy periods
    • Development of insulin resistance
    • Unexpected and abrupt weight gain
    • Excessive hair growth on the body and face
    • Pain in the pelvic region
    • Adult acne

PCOS and Ovulation

Women suffering from PCOS have problems during ovulation. Many women with PCOS experience irregular ovulation or absence of ovulation (anovulation). The hormonal imbalance causes the ovaries to malfunction. As a result, they are not able to produce mature follicles and release eggs regularly. As you can imagine, problems with ovulation may lead to issues conceiving. The level of estrogen increases in the body as the menstrual cycle progresses. At its peak, the elevated estrogen triggers the pituitary gland to release Luteinizing hormone (LH). Ovulation occurs within 24-36 hours of this peak LH surge. An egg is released during ovulation that initiates the process of fertilization. The egg travels down the Fallopian tube, where it fuses with the sperm by a process called fertilization. The fertilized egg then travels down the Fallopian tube, embeds itself in the uterine lining, and develops into an embryo. As an increased level of androgens accompanies PCOS, the rhythm of the menstrual cycle is completely disrupted. Furthermore, abnormally high levels of estrogen cause problems with normal egg development and release. It goes without saying that there is no question of fertilization and conception if there is no egg released. One of the most common ways to manage PCOS is with a drug called Clomid. This medicine can help women with PCOS to ovulate and can help them in getting pregnant. This is the same medicine that is used during the IVF procedure to make the body release multiple eggs.

How to Know If You Are Ovulating Regularly With PCOS

Ovulating Regularly With PCOS
Image courtesy of The Bright Girl Guide by Demi Spaccavento.
  1. Ovulation tests: Pinpoint the surge of LH in your system right before ovulation. Because women with PCOS typically have a higher LH level throughout their whole cycle, an ovulation predictor kits (OPK) may not be as reliable for them as they are for women without PCOS.
  2. Basal Body Temperature: Using an ovulation thermometer is another way to determine you’re ovulating. It involves you taking your temperature early in the morning upon waking up is best. The BBT will detect a woman’s temperature will spike before ovulation and detect the dip in temperature after a woman has ovulated.
  3. Cervical Mucus & Cervical Position: Cervical mucus (CM) changes throughout the course of her monthly menstrual cycle. Looking for wet Cervical mucus and raw egg consistency is a sign that you are in your fertile window and ovulation is approaching.  Checking your cervix position can give insights into your cycle. When you are ovulating, your cervix tends to be higher.

 

How to get pregnant with PCOS

You must understand what exactly happens to your body during PCOS if you are trying to get pregnant. As PCOS interferes with ovulation, it can cause irregular menstrual cycles and can even result in infertility. That said, the situation is not as bleak as it might seem. It is still possible for women suffering from PCOS to get pregnant. Using certain medicines prescribed by your doctor and making positive changes in your lifestyle can make conception possible. Following is a list of things you can do to improve your conception of conception if you are suffering from PCOS.

Losing the excess weight

As many as 50%, of women suffering from PCOS are obese or overweight. Losing that extra weight can help your body to start ovulating again. One of the reasons for weight gain in women with PCOS is the development of resistance to yet another hormone called Insulin. Insulin is released by a gland called the pancreas and is released in the body after you eat something. This hormone is responsible for making sure that the glucose produced after the digestion of food can be absorbed by the cells that need glucose. These cells need glucose to release energy for their sustainability and growth. Insulin resistance causes the body to get resistant to this hormone. In other words, when you have insulin resistance, the insulin released normally won’t be sufficient for your cells to absorb glucose from the blood. The result of this condition is the accumulation of a high concentration of glucose in the blood. The elevation of blood sugar level over some time causes obesity and accumulation of fat. Many studies show that women who are obese or overweight have more anovulatory cycles and therefore have problems conceiving.

Women with PCOS have irregular periods and are more prone to anovulatory cycles if they are obese. Losing weight can greatly help to manage PCOS. It has been shown that losing weight can reduce the level of androgens in the blood and even improve insulin resistance. Many studies have found that women who lose even 5-10% of their body weight can restart ovulating regularly. All said and done; weight loss does help in PCOS, especially combined with other fertility treatments.

Maintaining a healthy weight is important if you are trying to get pregnant irrespective of whether you have PCOS or not.

Being overweight during pregnancy can significantly increase your chances of developing gestational diabetes, preeclampsia, and even gestational hypertension. That said, not all women who suffer from PCOS are overweight. If you are underweight, you might even need to gain some weight. Your fertility specialist will guide you through the best approach regarding your weight.

A healthy diet and regular exercise

Whether you have PCOS or not, maintaining a healthy diet and exercising regularly helps you get pregnant. If you have a healthy diet and exercise regularly, you might not struggle with insulin resistance or weight gain and give yourself a better chance of getting pregnant. Regarding the diet of women with PCOS, there is still quite a lot of debate in the scientific community. There are as many in favour of a low-carb diet as there are against it. What matters the most is to have a balanced diet, more than anything else, including plenty of whole foods, green leafy veggies, fibre, and protein work the best. Avoiding added sugar is something that most nutritionists recommend. That said, you can occasionally indulge your sweet tooth. Exercising regularly also helps patients suffering from PCOS. One study concluded that as many as 60% of PCOS patients could restore their regular periods by just exercising a few times a week. Take small steps to change your lifestyle. Remember, a slower and more gradual change is easier to implement than an abrupt one.

Monitor blood sugar levels

As we discussed earlier, PCOS might cause insulin resistance and an elevation of blood sugar level. A high blood sugar level can predispose you to develop type II diabetes. In one of the many clinical studies on the subject, as many as 19% of women with PCOS were diagnosed with diabetes compared to just 1% of control subjects. It is advised that if you have PCOS, you should monitor your blood sugar levels closely. If you don’t have diabetes currently, your doctor might still prescribe you a blood sugar test to be sure. If you have type II diabetes, your doctor will have you monitor your sugar level regularly. Apart from just measuring your blood sugar levels, you can also take active steps to control your blood sugar levels. Limiting the intake of starch-rich foods can help you with this. Ensure that you include plenty of protein in your diet and drink lots of water throughout the day. Eating small meals multiple times a day also helps a great deal to cut down on insulin surges.

 

Medications used to assist with getting pregnant

Metformin

It is a medication that is commonly prescribed to patients who have type II diabetes. It is also used to manage PCOS is the off-label use of the drug. The drug works as it decreases insulin resistance, making your body more sensitive to insulin and decreasing blood glucose levels. The drug is also thought to reduce the levels of circulating androgens in women suffering from PCOS. Some studies even suggest that the inclusion of Metformin in the treatment of PCOS can regulate ovulation. A few studies also compared Metformin with other commonly prescribed drugs Clomid and found it to be more effective in inducing ovulation in women with PCOS.

Letrozole

It is an anticancer drug that is used to manage PCOS in some cases. Although it was originally developed to treat cancer, it is effective in managing PCOS over the years. There are mild side effects of the drug, and as a result, it is used quite widely to treat infertility associated with PCOS. Letrozole decreases the production of estrogen. Lowering estrogen levels stimulates the pituitary gland to secrete more FSH that promotes the growth and maturation of the ovarian follicles and induces ovulation. In some comparison studies with Clomid, Letrozole was found to be more effective in inducing ovulation in women with PCOS.

Clomid

The active component in the medication is called Clomiphene and is very commonly prescribes in infertility associated with PCOS. Clomid also works by decreasing the secretion of estrogen in the body, a mechanism that it shares with Letrozole. That said, one issue with Clomid is the development of resistance over time. If used for a longer time, Clomid can become less effective. As a result, it is often prescribed as an intermittent therapy and has been shown to reverse Clomid resistance in as many as 80% of subjects. Clomid is still the first-line therapy for PCOS. If it fails due to the development of resistance, your doctor can try other options mentioned above.

Gonadotropins

Many gonadotropins are available in injectable form. While Clomid or Clomiphene is orally active gonadotropin, it can cause resistance. That’s when injectable gonadotropins, including Repronex and Menopur, can be prescribed. These gonadotropins work by stimulating the ovarian follicles and release an egg. There is, however, a problem associated with the use of injectable gonadotropins. In women with PCOS, these injectables can potentially stimulate multiple follicles, causing the release of multiple eggs during one cycle. This might result in multiple pregnancies-triplets, quintuplets, or even higher. As a result, injectables are rarely used in women suffering from PCOS.

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Treatments

In-vitro fertilisation

If nothing works, the next logical step to take is in-vitro fertilization (IVF). During this procedure, Ovulation inducing drugs are directly injected into the body, causing the release of multiple eggs from the ovaries. The mature eggs are harvested and allowed to fertilize with sperm outside the body in a Petri dish (hence the term in-vitro, which means outside the body). Once there is successful fertilization of a few eggs with the sperms, they are injected back into the uterus and allowed to implant. The cycle can be repeated multiple times if it is not successful in the first go.

In-Vitro Maturation (IVM)

It is a similar process to IVF with a major difference. Unlike IVF, the doctors don’t induce ovulation by injecting synthetic gonadotropins, and rather they harvest immature eggs directly from the ovaries themselves. The immature eggs are ‘ripened’ or developed in a lab environment. Once the eggs are matured in-vitro, they can even be frozen for use at a later date.

Egg donor

If everything else fails, there is always an option of an egg donor. These donor eggs are from other women and are fertilized with the sperms of your partners. The developed eggs are then transferred into your womb. Usually, one or two such embryos are transferred to the womb to avoid multiple pregnancies. The remaining embryos can be frozen and used later as well. If the donor herself carries the pregnancy, the process is called surrogacy.

Chance of getting pregnant with PCOS

As many as 80% of women suffering from PCOS suffer from some degree of infertility. This statistic can understandably put you under a lot of stress if you are trying to conceive with PCOS. But the things are not as bad as they might seem. Assistive Reproductive Technology (ART) can significantly improve your odds of getting pregnant. According to some robust studies, as many as 70% of women treated with Clomid get pregnant within six cycles of the therapy. The success rate of IVF also stands at an impressive 70%. One of the best things you can do if you are trying to get pregnant is to track your fertility hormone levels. Fertility2family offers many ovulation strip tests and home pregnancy tests (HPT) that can help you track your fertility window and get pregnant.

Where to start with PCOS

Making a right start is half the battle won in the case of PCOS. It can be overwhelming to cope up with the diagnosis, especially if you don’t know when and how to start. The following are initial steps you can take to overcome PCOS and get pregnant despite the diagnosis:

    • Make sure that you talk to your doctor before trying anything
    • Sit with the doctor and try to understand the diagnosis and develop a plan that includes fertility treatments and lifestyle changes
    • If your doctor recommends, try and reduce your weight by 5-10%
    • Make sure that you include an exercise plan
    • Try timing intercourse with ovulation