Can You Get Pregnant with PCOS? Yes, And Here's How
PCOS, or polycystic ovarian syndrome, is a constellation of symptoms that can have an impact on the menstrual cycle and reproduction. A misnomer, given that it does not lead to "cysts" despite being called "polycystic" ovarian syndrome, PCOS can affect several systems: reproductive, metabolic, endocrine, menstrual, mental health, dermatologic – the list goes on! Clearly, this is a syndrome that can have a big impact on women's health.
PCOS is mainly characterized by irregular cycles, infertility (due in part to the irregular cycles) and often high androgen levels. This can present as coarse facial hair, cystic acne, body hair, or high androgens in the lab work. PCOS can also be associated with metabolic disorder. This tends to present as weight gain around the midsection, higher chance of pre-diabetes or diabetes, and difficulty losing weight, even with diet and exercise. GLP-1 agonists are a newer drug category that present a reasonable option for many patients with PCOS as part of their weight loss plan prior to trying to conceive.
Irregular menstrual cycles in PCOS are the primary cause of infertility with this condition. These irregular cycles usually begin in the teenage years when the birth control pill is often prescribed to regulate the cycle and allow for monthly periods. Once stopping the birth control, many women notice that their period is still irregular and knowing when to time ovulation can be challenging. Periods may be too frequent, too infrequent, have a pattern, be completely irregular or sometimes non-existent. Furthermore, PCOS is often accompanied by a high luteinizing hormone, or LH, level. This is the level tested in home ovulation strips. Due to the high baseline level, the home test strips cannot discern an elevation if and when ovulation does occur, making home testing for ovulation an additional challenge.
When a patient sees her OBGYN or REI to discuss possible PCOS and infertility, especially with irregular periods, first and foremost a thorough fertility evaluation is warranted. This includes an ultrasound to check the uterus as well as the ovaries, lab work, an assessment of the fallopian tubes to make sure they are open, and a semen analysis to test the sperm. If everything else is normal, ovulatory function must be restored. This can be accomplished more "naturally" usually by moderate weight loss. However, that can be time consuming and challenging. We often prescribe a medication, such as letrozole, to help ovulation occur. It's a medication taken for 5 days, and we perform an ultrasound a few days after the last dose to check for a response to see if one of the follicles that contains an egg is growing and is almost ready for ovulation. At that point, we recommend a 1-3 day window for timed intercourse. Success rates are age-based but can be up to 20-25%. If pregnancy does not occur, there is a menstrual period 2 weeks later at which point the medication can be taken again to try for another month.
One important consideration with PCOS is, in fact, the high baseline egg count. Despite irregular ovulation, there are typically many eggs in the ovaries, even higher than expected for age. This can have a few implications. One, the medication given to induce ovulation can lead to more than one follicle growing and therefore more than one egg releasing, which can lead to twins. We observe this by checking the number of follicles on the ultrasound. Another consideration is what to do if ovulation induction cycles are not successful. In this case, in vitro fertilization, or IVF, may be recommended. IVF can lead to greater success rates due to selection of a genetically normal embryo. Patients with PCOS require an IVF protocol that aims for an optimal number of eggs to be retrieved.
In summary, yes (!) it is very possible to get pregnant with PCOS. Each patient with PCOS deserves a thorough evaluation and personalized treatment plan. With the right approach, PCOS can be managed, and you can achieve your family building goals.