PCOS and pregnancy: a guide

PCOS woman taking pregnancy test

Polycystic ovary syndrome is a common condition that affects one in five women. PCOS can make it harder to get pregnant, but if you’ve been told you have it, then you’ll be pleased to know that you can still conceive with treatment.

What is PCOS?

It can be hard to diagnose in the first place, but it is one of the most common causes of female infertility. It's a condition where large fluid-filled sacs can develop in your ovaries, which makes it more difficult to release an egg. They are harmless but can result in a hormonal imbalance. Having said that, the Polycystic Ovarian Syndrome Awareness Association (PCOSAA) says that: “Despite the name, many women [with the syndrome] do not have cysts on their ovaries.”

If you have the condition, you'll produce more of the male hormone testosterone than normal, and you may not ovulate every month. You’ll be able to tell if you’re not ovulating regularly because your menstrual cycle will be disrupted, resulting in irregular periods – and some women with the condition don't ovulate at all. Remember though, that an irregular period is not a diagnosis in itself. It’s really important to not rely on Doctor Google here and self-diagnose, but if you’re having fewer than eight periods a year, you should talk to your GP.

If the condition is suspected, your doctor might run blood tests to check your hormone levels. They may also perform a pelvic exam and, depending on the results, send you for a transvaginal ultrasound scan in order to check for enlarged ovaries.

Do you know when you're ovulating?

Try our ovulation calculator

PCOS symptoms

The PCOSAA says: “Women with PCOS typically have irregular or missed periods as a result of not ovulating. Although some women may develop cysts on their ovaries, many women do not.” Other symptoms include:

  • excess hair growth on your body
  • hair loss on your head
  • acne
  • weight gain and difficulty losing weight
  • thin hair (on your head, alas)
  • pelvic pain
  • dark patches of skin in your groin, neck and armpits (acanthosis nigricans)
  • depression
  • mood swings

These symptoms (particularly depression) can be caused by other issues, so if you're struggling with any of them, pop to your GP anyway and keep an open mind.

My doctor prescribed me a higher dose of metformin when I got pregnant because of the risk of miscarriage. The increased risk is very low. The biggest challenge is getting pregnant – so I wouldn't panic.

It is also possible to have polycystic ovary syndrome that goes unnoticed because you're not showing the typical symptoms, so if you've come off a contraceptive pill and trying to get pregnant for a while to no avail, then it’s still worth mentioning your concerns to your GP. If you've come off the pill and are having trouble conceiving, it's natural to wonder if the pill caused your polycystic ovaries. While the condition is not actually caused by taking the pill, it is possible that the pill masked the symptoms while you were on it, meaning that you didn't realise you developed it until afterwards.

What causes it?

The exact cause is unknown, but it is thought to be a result of abnormal hormone levels. Many women with the condition are found to have an imbalance in the following hormones:

  • testosterone – a hormone often thought of as a male hormone, although all women usually produce small amounts of it. Women with the syndrome often have an abnormally high level of testosterone
  • luteinising hormone (LH) – this stimulates ovulation, but may have an abnormal effect on the ovaries if levels are too high, which is often the case for women with polycystic ovaries
  • prolactin – some women have raised levels of this hormone, which stimulates the breast glands to produce milk in pregnancy

Also, it often causes low levels of sex hormone-binding globulin (SHBG), a protein in the blood which binds to testosterone and reduces its effect.

The exact reason why these hormonal changes occur isn't known. It's thought that the problem may start in the ovary itself, in other glands that produce these hormones, or in the part of the brain that controls hormone production.

Abnormal hormone levels can also be caused by resistance to insulin. Insulin is a hormone which regulates the amount of sugar in the blood. if you are resistant to insulin, then your body has to produce more in order to compensate. High levels of insulin can cause more testosterone to be produced, which we know can cause polycystic ovary syndrome. Also, high insulin levels can lead to weight gain, which in turn can make the symptoms worse – more excess fat on the body can mean even more insulin is produced.

Is it genetic?

It can sometimes run in families. If your mother, sister, aunt or another female relative has polycystic ovaries, then you will likely have an increased chance of developing it.

Although there may be a genetic link, specific genes linked with the condition haven't been identified yet.

Polycystic ovaries and pregnancy

A diagnosis does not mean the end of your chances of conceiving naturally – if anything, it's only the beginning of your journey to becoming a parent. Thousands of women with polycystic ovary syndrome deliver healthy babies all over the world every day. Conceiving might take a little longer – but it definitely does happen.

The PCOSAA says: “While it is a leading cause of fertility problems, a diagnosis does not mean that you are infertile. It is treatable and many women with the condition do get pregnant naturally or with the help of fertility treatments.”

PCOS treatment

It has a number of treatment options. Whilst there's no cure for the condition per se, its symptoms can be managed to improve your fertility and allow you to become pregnant without the need for more complicated fertility treatments.

What can my doctor do?

Your doctor can determine the best course of treatment for you, but you may be recommended any of the treatments below. Oral contraceptives can also provide some protection against endometrial cancer when used long-term, and your doctor will be able to advise which of the following treatments will best suit you:

  • Clomifene – a drug that stimulates ovulation. Its success in stimulating egg release will usually be monitored through ultrasound scanning.
  • Metformin – can be prescribed to control your insulin levels. It's normally used for type two diabetes – but can be used 'off-label' to help with PCOS-related insulin resistance. The PCOSAA points out that: "Many women who are diagnosed with PCOS are often automatically prescribed metformin. However, it's important to have a reason for taking metformin and not be on it just because of your diagnosis.” So it's worth checking with your doctor that it's the right treatment for you.
  • Provera and other hormonal treatments – can be prescribed to stimulate your period.
  • Letrozole and Tamoxifen – these are two breast cancer drugs that can also be used 'off-label' if the doctor deems the benefits to outweigh any side effects or risks. They can be taken to treat the condition before trying to conceive. Use a non-hormonal contraceptive when you're taking them, as Tamoxifen can harm your baby, so you really must follow your doctor's advice on this one – and if you do become pregnant, stop taking it immediately and see your GP.
  • Gonadotrophin injections – help stimulate the ovaries to produce an egg if oral medications haven't worked. However, they can cause multiple pregnancies due to the risk of overstimulation, which might seem like good news but also might be more than you bargained for.
  • Laparoscopic ovarian drilling – this is a surgical procedure, which is nowhere near as bad as it sounds. The surgeon will make a small cut in your stomach, insert a thin tube into your ovary and remove some of the affected tissue.

Lifestyle changes that could improve fertility

Healthy eating for PCOS

Small changes to your lifestyle can play a big part in improving your fertility, including:

  • Losing weight – being overweight can have a huge impact on your fertility. Losing as little as 5% can improve your chances enormously, according to NHS Choices
  • Regular exercise – along with eating a healthy diet, staying active helps lower blood sugar levels and reduce your chances of developing type two diabetes
  • Eat five portions of fruit and vegetables a day and a healthy, balanced diet – this pays dividends into your fertility, and since women with polycystic ovaries are more likely to develop heart disease and high cholesterol, it's essential for your general health, too
  • Avoid caffeine and alcohol (yes, 'fraid so)

And besides, you'll feel better about the stress of trying to conceive once you've got some kale down you as well. (We'd prefer doughnuts, but doctor's orders 'n all.)

It's perfectly understandable to feel like you've got a bum deal when it comes to conceiving, especially when it seems like everyone and her sister is pregnant. Polycystic ovary syndrome affects every woman differently – but don't worry, you're not alone. You can chat to the leagues of friendly Mumsnetters who've also got the condition on Mumsnet's talk boards, or there are charities including Verity and PCOS UK where you can find support, too.

The result of my successful pregnancy is currently one day old and sleeping on my chest. I had a very easy pregnancy with no problems and a very easy birth too.

PCOS diet – what should I eat or avoid to improve my fertility?

A healthy, balanced diet is proven to improve your fertility. There are some foods you should aim to eat more of and some you should try to limit or avoid. Aim to:

  • Eat less meat – reduce your intake of meat and when you do eat it, try to eat good quality, organic meat. Too much meat can worsen any imbalance in your estrogen levels
  • Eat more plant-based protein – try to up your intake of beans, nuts, legumes and other non-meat sources of protein
  • Include Omega 3 fats in your diet- they have been shown to lower testosterone levels
  • Eat a little bit of full-fat dairy – although you should avoid consuming too much dairy, a small amount of full-fat, good quality dairy can actually be beneficial
  • Take supplements – a lack of certain vitamins and minerals can negatively affect your ability to conceive. Your doctor can advise you which supplements you may need to take

How to stay healthy during pregnancy

If you've successfully managed to conceive despite your diagnosis, then you've definitely got through the trickiest bit – but unfortunately, you're not completely out of the woods yet.

The bad news is, you will probably be poked and prodded a little more frequently than women who don't have the syndrome, but the good news is, you might well see your baby sooner, as earlier scans are advised to check that you have a healthy pregnancy and everything is just tickety-boo.

They will advise on an early scan to check everything is where it should be and then treat it as a regular pregnancy.

Women with polycystic ovaries are at higher risk of pregnancy and delivery complications. There is a higher risk of miscarriage in the first three months and pre-eclampsia later on. You should also have your blood glucose checked regularly as you have a higher risk of developing gestational diabetes (if you don't already have type two diabetes as part of your condition). It can also put you at increased risk of developing high blood pressure in pregnancy and the baby being born prematurely.

Do I have to have a c-section if I get pregnant?

If you have polycystic ovary syndrome, then you are more likely to need a c-section – but only because you are at an increased risk of complications. The condition itself will not mean you need one – you can still deliver vaginally if you choose to. And of course, if you decide you'd actually rather have a c-section, then that's fine as well.