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PCOS and Fertility: Can I get pregnant with PCOS?

PCOS is one of the leading causes of fertility issues in women. If you’re trying to conceive with PCOS, you might wonder how long it takes to get pregnant, and how easy it is. 

Most women with PCOS will be able to conceive. However, due to the effect that PCOS can have on ovulation - which is required for pregnancy - a little help may be needed. 

On this page, you’ll find the most frequently asked questions around PCOS and getting pregnant. If you don’t find what you’re looking for, we recommend booking a free call with one of our fertility advisors, who will advise the best next steps for you.  

What is Polycystic Ovarian Syndrome (PCOS)?

How common is PCOS?

How is PCOS diagnosed?

What causes PCOS?

Is PCOS associated with any other conditions?

When should I see a doctor about PCOS?

How is PCOS treated?

What are the implications of PCOS on fertility? 

Can I get pregnant naturally with PCOS?

Which fertility treatments are advised for women with PCOS? 

Can I have polycystic ovaries (PCO) without having polycystic ovary syndrome (PCOS)?

I have PCOS and I’m struggling to conceive. What can I do?

 

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS (polycystic ovary syndrome) is the most common endocrinological* disorder in women. It is characterised by altered levels of hormones, especially high levels of androgens (hormones that are more prevalent in males, such as testosterone).

The symptoms range from individual to individual, but there are three main features associated with PCOS. To be diagnosed, you would normally have at least two of the following:

  • Irregular periods (oligomenorrhea or amenorrhea)
  • Excess androgens (hyperandrogenism) which may cause excess facial or body hair
  • Polycystic ovaries, where ovaries become enlarged from an increased number of follicles (fluid-filled sacs that surround the eggs)

*endocrinological disorders are issues with hormone production and / or function

How common is PCOS?

It’s hard to tell exactly how many women have PCOS, but it is the most common endocrinological disorder in women of reproductive age worldwide. The NHS estimates that around 1 in every 10 women in the UK have PCOS. Other estimates place PCOS prevalence around 2-20%. 

The variation noted in literature is attributed to the variation of the criteria used to diagnose it. (Royal College of Obstetricians, 2014)

How is PCOS diagnosed?

Diagnosing PCOS can sometimes be difficult due to the wide range of symptoms and signs that it includes. You’ll likely undergo blood tests and an ultrasound scan. Because PCOS is not the only disorder which causes its symptoms, a diagnosis may also involve ruling out other conditions or factors. 

If you think you have PCOS and you have amenorrhea,  a GP may start by ruling out pregnancy with a fast urine test. Next, a doctor may review your medications, as some can cause PCOS symptoms (such as dopamine antagonists or certain steroids).

A number of blood tests can check hormones for conditions like thyroid disease and hyperprolactinemia, which can both lead to irregular menstrual cycles. Normal blood tests can include TSH, FT3, FT4 (thyroid function), prolactin, FSH (follicle stimulating hormone), LH (luteinising hormone), oestrogen. Many of these are also within fertility diagnostic assessments. Additional tests may include androgens and progesterone. 

Finally, a transvaginal ultrasound would check for polycystic ovaries themselves.

What causes PCOS?

“The exact cause of polycystic ovary syndrome (PCOS) is unknown, but it's thought to be related to abnormal hormone levels.” NHS

We don’t know exactly what causes PCOS, but there is research that suggests that the following risk factors and associations are linked to a higher incidence of PCOS: 

  • Insulin resistance. (The high level of insulin causes the production of too much testosterone which interferes with the ovulation). 
  • Hormone imbalance (raised level of testosterone, LH, prolactin and low level of sex hormone-binding globulin (SHBG)
  • Genetics. PCOS can run in families

Is PCOS associated with other conditions?

Yes. Unfortunately, women with PCOS are more likely to have or develop a number of conditions, which can affect and influence each other. These include:

  • Infertility
  • Insulin resistance
  • Obesity & metabolic syndrome
  • Heart disease and high blood pressure (Cardiovascular disease)
  • Non-alcoholic fatty liver disease
  • Impaired glucose tolerance & type 2 diabetes
  • Endometrial cancer 
  • Obstructive sleep apnea 
  • Inflammation
  • Mood disorders 

The metabolic elements of the condition increase the risk of developing type 2 diabetes mellitus and cardiovascular disease later in life, especially if there are other predisposing factors, such as obesity, poor diet and lack of exercise. 

In women who have very irregular or no periods, there is a higher risk of developing endometrial cancer. These women should therefore receive treatment to induce menstruation at least once every three months.

If you have these conditions and/or believe that your PCOS may be a factor, seeing a doctor is advised. According to which symptoms and conditions you are experiencing, they can advise on the best next steps, whether that’s treatment or referral to another specialist.

When should I see a doctor about PCOS?

If you think you might have PCOS and have not had a formal diagnosis, it would help to speak to your GP. They may evaluate you and / or refer you to a Gynaecologist. 

You should also speak to your GP or health care provider if you are struggling with the symptoms of PCOS, such as weight gain, hair growth and acne, or the conditions listed above. They may be able to help with the symptoms that affect you the most.

How is PCOS treated? 

There is no treatment for PCOS itself, but specific symptoms and conditions may be treated. Depending on how PCOS is affecting you, you may be recommended different things.

Lifestyle interventions: depending on how PCOS affects you, lifestyle interventions could be a non-medical approach to improve symptoms. 

If your BMI is over 30, you may be advised to lose weight with a combination of a healthy diet and exercise. Sustainable diet regimes with modifications in both quantity (calorie content) and composition of food are advised, while crash diets, which are unhealthy, should be avoided. 

 A low GI diet is also advised, alongside general healthy eating habits. Avoiding fatty and sugary foods and drinks is recommended, and input from a dietician may be beneficial. (Dr Yvonne Deanes and The Association of UK Dieticians, 2019)

Losing weight can be difficult, especially for women with PCOS. However, studies have shown favourable outcomes with noticeable improvement of irregular cycles and better response to medical treatment, with even small reductions in body weight in the range of 5%. (Rao and Carp, 2009).

Surgical management: ‘ovarian drilling’ (also known as LOD, for laparoscopic ovarian drilling) has also been used to reverse the effects of PCOS, and specifically targets the tissue on the ovaries that produces testosterone. However, LOD is not the first port of call, or advised for everyone, because it involves the risks of laparoscopic surgery and of decreased ovarian reserve (the ovaries’ potential in terms of numbers of eggs contained) .

If trying to conceive, there are a number of options available to increase chances of conception.

What are the implications of PCOS on fertility? 

Ovulation is necessary when trying to conceive. Because PCOS and anovulation are closely linked, having PCOS may mean that a little help is needed to get pregnant. There are a number of options available. In infertility patients, the management of PCOS usually has a favourable outcome.

Women with PCOS are also unfortunately at a higher risk of a number of pregnancy complications, such as miscarriage and gestational diabetes. 

Can I get pregnant naturally with PCOS?

You can get pregnant naturally with PCOS, but it can be difficult. If you don’t ovulate regularly, a little help may be needed.

Which fertility treatments are advised for women with PCOS? 

 

Ovulation induction

Depending on how PCOS affects you, the first port of call could be ovulation induction with the help of medication. Drugs like clomifene (brand names include Clomid) or aromatase inhibitors (Letrozole) come as a short course of tablets at the beginning of each cycle, and encourage ovulation in order to make pregnancy more likely. Metformin may also help women with PCOS ovulate by treating insulin resistance. 

Gonadotrophins (brand names Menopur, Meriofer, Gonal F and Bemfola) are another type of medication to help stimulate ovulation. Gonadotrophins come as injections. If the idea of injections worries you, the Apricity app has a number of videos showing you how to self-inject. An Apricity advisor or nurse can also be available to do your first injections together.

With the help of ovulation induction, many women successfully conceive. 

 

IVF

In vitro fertilisation is offered to PCOS women when ovulation induction has failed or other indications for IVF warrant this.

 

What are the success rates for fertility treatment with PCOS? 

It is difficult to estimate success rates, as there are so many variables. Most women with PCOS will be able to conceive and have a baby with the help of fertility treatment. As with all fertility treatment, chances are highest when under 35.

If you would like to explore your chances of success, our Fertility Treatment Predictor allows you to plug in PCOS as one of the factors influencing fertility treatment. Plugging in other factors such as age, other fertility conditions and length of time trying to conceive, you will be able to visualise the average success rate for women with a similar profile.

Try the Apricity Fertility Predictor

 

Can I have polycystic ovaries (PCO) without having polycystic ovary syndrome (PCOS)?

In short, while both polycystic ovaries (PCO) and polycystic ovary syndrome (PCOS) can involve multiple cysts on the ovaries, in PCOS these are caused by a hormonal imbalance that causes a range of other symptoms. 

Polycystic ovaries (PCO) are a variant of a woman’s ovaries, where ovaries are slightly larger than usual and contain many antral follicles. Sometimes, these influence ovulation, and sometimes they do not. In PCO, these can be caused by a range of conditions. PCO often remains undiagnosed.

Polycystic ovary syndrome (PCOS) is a metabolic condition in which hormone levels are unbalanced, and polycystic ovaries can be one of several symptoms. In PCOS, the polycystic ovaries are linked to a hormonal imbalance.

This means you can have polycystic ovaries (PCO) without having polycystic ovarian syndrome (PCOS).

 

I have PCOS and I’m struggling to conceive. What can I do?

Experiencing fertility issues can be really tough, and difficult feelings are not rare. It helps to remember that there are medical options to help you conceive, and many women with PCOS successfully have a child, or children.

If you know you have PCOS and are struggling to conceive, you can start by booking a free call with one of our fertility advisors. They will explore your fertility questions, ask and answer questions and advise on the best next steps for you.

A common first step is our fertility diagnostic assessments. This allows us to assess the impact of PCOS on different hormone levels and advise the best course of treatment. Lifestyle interventions may be advised, and / or ovulation induction. If neither are successful, or something in your results suggests that ovulation induction is not a good option, another treatment, such as IVF, may be recommended.

All of our treatment packages come with unlimited supportive counselling, which can help if you are struggling. This is very normal within fertility struggles. It may also help to connect with others in similar situations. Verity is the UK’s PCOS charity, with a number of resources and support on their website. Daisy PCOS is also a great source of information, and hosts a page with PCOS support resources on their website.

The Fertility Network and Tommy’s also offer community and support for those struggling with infertility. 

 

References

Dr Yvonne Deanes and The Association of UK Dieticians (2019) Polycystic Ovary Syndrome (PCOS) Food Fact Sheet.

Rao, K. and Carp, H. (eds) (2009) The Infertility Manual. Third. Jaypee.

Royal College of Obstetricians (2014) Long-term Consequences of Polycystic Ovary Syndrome.

Teede, H. et al. (2018) International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. Melbourne, Australia.

 

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