PCOS is a common hormonal disorder that affects reproductive-aged women. Having PCOS does not mean natural conception is impossible. PCOS is common and treatable for women with fertility issues.
PCOS is a common hormonal disorder that affects reproductive-aged women. Having PCOS does not mean natural conception is impossible. PCOS is common and treatable for women with fertility issues.

PCOS is a common hormonal disorder that affects reproductive-aged women. About 5%–10% of women from ages of 15–44 have PCOS.  It is a condition in which the ovaries can have many small follicles (cysts) of fluid and will not release eggs regularly. If eggs are not released monthly, getting pregnant with PCOS may be difficult. However, there are ways to increase the probability of conceiving naturally.

What causes polycystic ovary syndrome?

The exact cause of PCOS is not known. However, it is believed that genetics play a role.

Androgens are many times called “male hormones.” However, women do make small amounts of androgens. Androgens control male traits such as pattern baldness. Androgen levels are higher in females with PCOS. These high androgen levels can prevent the release of an egg from the ovaries during ovulation each menstrual cycle. It can also cause other signs of PCOS, such as acne and facial hair growth. 

Higher than normal insulin levels are also believed to cause PCOS.  Insulin is a hormone that helps to convert food to energy after a meal.  When insulin and the body do not work together correctly, it is called insulin resistance. Overweight women with PCOS and women with diabetes and PCOS often have insulin resistance. 

How does polycystic ovary syndrome affect fertility and pregnancy?

Having PCOS does not mean natural conception is impossible. PCOS is common and treatable for women with fertility issues. When someone has PCOS, the imbalance of the androgen hormones interferes with egg release during ovulation so pregnancy can not happen. In addition to decreased ovulation, egg quality can also make getting pregnant harder. 

Usually, those with PCOS take much longer to get pregnant than those without. In addition to causing irregular menstrual cycles, being overweight decreases fertility. That, in addition to PCOS, adds to the conception issue. 

But though there are obstacles, people with PCOS have gone on to conceive children naturally. During pregnancy, patients must take caution and watch their health. PCOS can cause complications during pregnancy. PCOS can cause higher rates of:

PCOS moms also have a risk of having a large baby. Also, these babies risk more days in the NICU.

What are the signs of polycystic ovarian syndrome?

Those who have difficulty getting pregnant may want to be evaluated for PCOS. Some of the signs of PCOS include:

  • Overgrowth of hair: Otherwise known as Hirsutism, excess hair may grow on the chin, face, or areas where males usually grow hair. This may affect up to 70% of those with PCOS.
  • Weight gain: Being overweight or having difficulty losing weight is a sign of PCOS.
  • Irregular periods: With PCOS, some may experience periods less than eight times a year; or stop having menstrual cycles at all. 
  • Thin hair: This is also known as male-pattern baldness. 
  • Acne: Bumps from acne may appear on the chest, face, and back.
  • Skin darkening: This may be common in the groin, beneath the breast, and in the neck creases. 
  • Skin tags: Small areas of extra skin in the neck area and armpits. 

How can chances of natural conception with polycystic ovary syndrome conception be increased?

For those with PCOS, weight loss and reduction of calorie intake are recommended. It is more effective than weight loss alone. A fitness routine that results in weight loss can reduce PCOS symptoms. Nutritional balance is vital.

An overall lifestyle improvement is better than a short-term weight loss goal. A healthy lifestyle includes:

Your doctor may address your PCOS fertility issues through the regulation of your menstrual The proper formulation of birth control pills can decrease androgen production and increase the female hormone estrogen.  In addition to improving your ovulation, it also improves other symptoms of PCOS.

Progestin therapy every two months also regulates the menstrual cycle. It does not, however, improve androgen levels. To specifically improve ovulation, your doctor may begin treatments with the medications clomiphene, Femara, or gonadotrophins.  Metformin, a pill given to treat type 2 diabetes, improves insulin resistance. Insulin resistance is a problem with PCOS.

QUESTION

Men and women are equally likely to have fertility problems. See Answer

What are other fertility treatment options for polycystic ovarian syndrome?

Laparoscopic ovarian surgery: 

Ovarian drilling via laparoscopy can improve the functioning of ovaries. An incision is made in the abdomen under general anesthesia. Holes are drilled on the surface of the ovaries to remove the tissues that produce androgens. This procedure often restores ovarian function for 6 -12 months. 

Bariatric surgery: 

Since being overweight reduces fertility, bariatric surgery is an option to improve fertility and reduce pregnancy complications. There are several versions, but ultimately a part of the stomach is cut and stitched, making it harder to overeat. It is usually a final option after other weight loss solutions have failed. It is not a quick option for fertility improvement because weight needs to be stabilized for longer than a year before pregnancy is considered. 

 In vitro fertilization:

If natural conception, medications, and weight loss have all been unsuccessful, assisted reproductive technology is another fertility choice. This includes in vitro fertilization. In vitro fertilization is the implantation of an embryonic baby conceived artificially in a lab. This is best considered after minimally invasive treatments have failed. It is costly and requires much discipline to be successful. The procedure is not as effective in those that are overweight, unhealthy, or older. It works best in healthy people who have made lifestyle improvement changes, even if those changes alone did not improve fertility. 

If all else fails, surrogacy or adoption are always options. Your doctor can discuss PCOS causes, recommend treatments, and provide guidance in what fertility and pregnancy options are best. 

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Medically Reviewed on 3/28/2022
References
SOURCES:

Jean Hailes for Women's Health: "PCOS Healthy Living," "Fertility - management & treatment."

Mayo Clinic: "Polycystic ovary syndrome (PCOS)."

Office of the Assistant Secretary for Health. Office on Women's Health: "Polycystic ovary syndrome." Your Fertility Coalition: "Polycystic Ovary Syndrome (PCOS)."