Polycystic ovarian syndrome

Getting pregnant with PCOS

Polycystic Ovarian Syndrome, commonly known as PCOS, is a chronic hormonal condition which affects a woman’s reproductive cycles. It can impact on a woman’s fertility, her menstruation, weight maintenance, appearance and even her body’s insulin production.

PCOS also contributes to the production of high levels of male sex hormones. A common outcome of this can be irregular menstrual cycles, excessive amounts of facial and body hair, oily and coarse skin with the development of acne, excess weight gain and irregular ovulation patterns. Another common result of PCOS is that the body produces too much insulin for its requirements. This has an impact on digestion and the normal metabolism of food.

How common is PCOS?

It is currently estimated that PCOS affects between 12-18% of women who are still within their reproductive years. Of these women, it is thought that around 70% are not correctly diagnosed with PCOS. Women will commonly pass off their symptoms as being vague and not connected to each other.

What causes PCOS?

The exact cause is unclear and though there have been a lot of theories put forward, a definitive set of causes has not been identified.

• There is probably a genetic influence on whether a woman is more at risk of developing PCOS.
• Because so many women with PCOS are overweight there is thought to be a relationship between insulin production and this condition.
• Some women only experience PCOS when they are overweight. As their weight returns to a healthy range, their symptoms disappear.

What are the symptoms of PCOS?

• Abnormal or irregular menstrual cycles.
• Infrequent or absent ovulation.
• Excess weight with a higher BMI. This is not always in relation to eating behaviours. Commonly, women with PCOS report having a normal appetite and diet though seem to gain weight more easily.
• Bloating and a feeling of heaviness in the lower abdomen.
• Development of Type 2 diabetes.
• High blood cholesterol.
• Hypertension and problems with regulating blood pressure.
• Skin pigmentation which is darker, especially in the groin, in the folds of the neck and the upper arms.
• Abnormal amounts of facial and body hair, acne, oily skin with a rough texture.
• Hair on the head can become thin.
• Mood swings and depression. This can be impacted by a poor self image.

Treatment for PCOS

Treatment options vary depending on the severity of the condition and the symptoms. Some women are able to tolerate having PCOS better than others. The impact on fertility is a major reason for seeking treatment, and often it is not until a woman and her partner experience problems conceiving that a diagnosis of PCOS is made.

Treating PCOS and managing its symptoms can take a fair bit of trial and error. Just as normal menstrual cycles can cause a variance in mood and outlook, with PCOS the emotional cost can be also be significant. It is important to factor this in when talking with your health care professional about treatment options. 
There can be an emphasis of focus on managing the physical symptoms, though the less obvious, psychological effects are too important to ignore.

NB Some of the medications which are prescribed for treatment of PCOS are dangerous to early foetal development. It is important that you advise your prescribing doctor if you are trying to conceive or need contraceptive advice.

Common treatment options

• Improving the diet and general lifestyle behaviours. Having a regular exercise pattern is generally beneficial. Aiming to reduce weight, increase exercise and improve sleeping behaviours all support a reduction in symptoms.
• Occasionally, the oral contraceptive pill is prescribed. This helps to regulate the periods and has the additional benefit of improving the skin and reducing excess hair growth.
• Occasionally, it is necessary to take diabetic medication which helps to control the excess production of insulin and stabilise the blood sugar. A diabetic diet can also be useful because of its focus on reducing the intake of sugars.
• If excess hair growth is distressing and having an impact on a woman’s self esteem, then laser or electrolysis hair removal can be low risk and very effective.
• In women who are keen to conceive, medication can be prescribed which prompts ovulation. The risk of taking this is that the chances of having a multiple pregnancy are increased.
• One commonly prescribed medication is Clomiphene Citrate – also known as Clomid. This helps to increase the number of eggs which are matured and released by the ovaries.
• Ovarian surgery is sometimes recommended. The aim is to reduce the size of the ovary and remove sufficient tissue which is producing too much male hormones (androgens) whilst not compromising future ovarian function and ovulation. This is known as “ovarian drilling”.
• If the effect of PCOS is so significant that it is affecting conception, then fertility assistance may become necessary.

How is PCOS Diagnosed?

• Through careful history taking, PCOS can often be suspected. Often there is a pattern of symptoms which include menstrual problems, weight gain and problems conceiving.
• Charting the menstrual cycles, patterns of ovulation and bleeding history can all provide valuable information regarding fertility.
• Blood tests measure the levels of insulin, sugar, hormones and thyroid function. They can also provide valuable information on how the endocrine glands are functioning.
• An ultrasound of the uterus and ovaries is commonly ordered. It is possible to see the fluid filled cysts on the ovaries which are characteristic of this condition.
• A laparoscopy is a surgical procedure which involves a doctor inserting a small camera, via an abdominal cut and looking at the reproductive organs. Many fluid filled cysts on the ovaries as well as tissue samples can confirm the diagnosis of PCOS. Laparoscopy can help to free up adhesions, open the fallopian tubes and remove endometrial cells.

What happens if I do conceive?

Apart from having an impact on the chances of conceiving, PCOS increases the risks of miscarrying. This is because of the influence of hormones which are produced by the ovaries and help to sustain early pregnancy.

There is also an increased risk of the following:

• Pregnancy induced hypertension (PIH)
• Developing Gestational Diabetes
• Premature delivery of the baby and the associated risks of this occurring

What’s the point of doing anything about PCOS?

Even if you’ve been able to conceive without any problems and your PCOSis not adversely affecting you, there are still benefits to having it treated. Women who have PCOS appear to have an increased incidence of developing ongoing health complications.

Diabetes, hypertension, heart disease as well as an increased incidence of endometrial cancer are all reason enough to seek professional advice. It is thought that PCOS is connected to insulin resistance and is a precursor to developing Type 2 Diabetes.

Other tips to help increase the chances of conceiving with PCOS

• Get as much support as possible to establish a healthy lifestyle. Losing weight, regular exercise, sound mental health and realistic goal setting all help.
• Establish a good network of medical support. There are gynaecologists who specialise in treating women with PCOS. Capturing the “window of time” when maternal age impacts so strongly on fertility is important.
• Quit smoking. 
• Stop using recreational drugs and limit your alcohol intake.
• Limit your caffeine intake – a high intake of caffeine has been proven to increase the risk of miscarriage in early pregnancy.
• Taking and recording the basal body temperature can give an indication of when ovulation is close. It’s worth remembering that women with PCOS can have very erratic ovulation patterns so there may not be a rise in temperature at all.
• Some researchers believe there are benefits for women to stay on the pill until right before they want to conceive. Ceasing it and then aiming for a pregnancy immediately afterwards can maximise the chances of conceiving because of the “fertility spike” which can occur.
• It is important not to assume problems with conception are solely related to the woman. Sperm analysis can provide important information about sperm quality, numbers, motility and health. All of these factors contribute to the overall likelihood of successful conception.
• Keeping a healthy mental attitude is always useful. Some couples benefit from supportive counselling and group sessions.