PCOS and trying to get pregnant
What can I do if I want to get pregnant?
- The fertility drug clomifene is usually the first step, as it can stimulate ovulation. If it doesn’t work then you may be offered gonadotrophins. However, gonadotrophins are more likely to overstimulate your ovaries and cause you to have a multiple pregnancy.
- If you are obese or resistant to clomifene, the diabetes drug metformin may help. It increases your body’s sensitivity to insulin so your insulin and your testosterone levels fall. This helps your body to ovulate normally. This is a controversial treatment as the benefits may not outweigh the risks. It has unpleasant side effects, such as nausea and vomiting, but may help if used in combination with clomifene.
- Surgery on your ovaries. A technique called laparoscopic ovarian drilling (LOD) can help some women to conceive if clomifene hasn’t worked for them. LOD is an effective, lower risk alternative to gonadotrophins.
LOD destroys the tissue on the ovaries that is producing testosterone. The effects may not last, but can improve the hormone imbalance long enough for you to conceive.
If you are overweight, your doctor is likely to ask you to reach a healthy BMI before trying fertility drugs or treatments. Even if you lose a little weight it can help your insulin levels get nearer to normal and get ovulation going again, if it has stopped.
What should I expect from fertility treatments?
Clomifene has a good record for stimulating ovulation. It gets ovulation going again for about 70 per cent of women, and studies suggest that about 29 per cent of women who start taking clomifene go on to have a live birth.
However, success depends on how long you take clomifene and other factors, such as whether you are overweight. For about a third of women with PCOS, clomifene isn’t the answer. Having a BMI (body mass index) greater than 25 makes clomifene less likely to work for you.
If you have clomifene, your medical team will check how your body is responding through ultrasound scans. If you’re ovulating but have not become pregnant after six months of treatment with clomifene, you will be offered other treatments. These are likely to include intrauterine insemination (IUI) or laparoscopic ovarian drilling (LOD) or assisted conception treatments, such as IVF.
Finding which treatment works best can be a long and complicated process. For some couples, the treatment puts a strain on their relationship. Try to support each other as much as you can through the consultations and treatment regimes.
How can I take care of myself?
Your doctor will want to monitor any changes in your ovaries or uterus caused by irregular bleeding. She may also want to test your blood at intervals to keep an eye on your hormone levels. Try to go to all your screening appointments, so you can be sure you’re doing what you can to protect your long-term health.
Try to keep your lifestyle as healthy as possible. Losing weight before you conceive can also reduce your risk of weight-related pregnancy complications, such as gestational diabetes. Starting pregnancy at a healthy weight, and managing your weight during pregnancy, is also better for your baby, as it reduces his risk of all the health problems in later life that are related to obesity.
What happens if I have PCOS and I get pregnant?
You’ll have extra care during your pregnancy. That’s because having PCOS increases your chances of weight-related pregnancy complications including:
- gestational diabetes
- high blood pressure
Sadly, your chances of experiencing miscarriage are higher too. Being a healthy weight when you conceive can reduce these risks.