PCOS and struggles to conceive
PCOS is more common than most people realise, in fact it is thought 1 in 5 women have the condition. However those with mild symptoms are unlikely to realise they have PCOS particularly if they are using a hormone contraceptive which can mask irregular or no periods for years as it artificially allows for a monthly bleed.
This means that PCOS is often not diagnosed until women struggle to conceive. If you are worried that you may have signs of PCOS you can download my patient resource just here
Why does PCOS cause fertility problems?
For most women regular unprotected sex with their male partner is the best chance of conception. This allows for good quality sperm to be present (they can live for between 2 and 3 days) when the egg is released through ovulation.
In this way 8 out of 10 couples will become pregnant within a year and 9 out of 10 within 2 years where the woman is less than 40.
Ovulation occurs when the ripest of your mature eggs in your ovaries is released but in PCOS the follicles are unable to develop and mature so there is no release of eggs. This is called anovulation and it is the reason why about 33% of couples attend fertility clinics.
Irregular periods in PCOS are another challenge. This is caused because a lack of ovulation means that the womb lining is exposed only to oestrogen which means it continues to thicken and thus become more fragile. Ultimately this will spontaneously and unpredictably shed from the uterine wall which is why PCOS women will have no periods for several months and then a very heavy bleed.
Unfortunately even if ovulation does occur the lining of the uterus may not develop sufficiently to allow the implantation of a mature egg.
How can your chances of conception be improved?
If your BMI is over 30 you will be advised to lose weight. This is because fat cells store sex hormones and excess fat cells cause an excess storage of sex hormones. As the female reproductive system is self-managing this means that other hormones are adjusted and eventually the reproductive system can shut down.
A normal BMI is considered to be between 18.5 and 24.9 and one study showed that the more overweight a woman is the lower her chances of pregnancy. In fact the correlation was identified as this
- For every BMI unit over 29 the chance fell by 4%
- For a BMI of between 35 and 40 the chance fell between 23% and 43%
PCOS is linked with weight increase because there is often a higher level of insulin in the blood. For this reason a diet and exercise programme is recommended to increase insulin sensitivity. Please see this blog post Losing weight may in fact kick start ovulation but it will also help with the effectiveness of medication.
Managing stress can also help with fertility as ongoing stress increases cortisol in the body which may also trigger increasing levels of insulin which in turn leads to an imbalance in female hormones. Unbalanced hormones will cause ovulation and menstruation to be irregular making it more difficult to get pregnant.
Managing stress is of course more tricky when, despite PCOS, you are trying to monitor ovulation and time sex around this to improve your chances of becoming pregnant. Regular periods are of course one sign of ovulation but there are also ovulation prediction kits and a simple thermometer will measure your body temperature which spikes just before ovulation. If you are not getting signs that you are ovulating you should speak to your doctor.
What medication is used to help with PCOS?
The first line of treatment is usually Clomiphene citrate which is taken orally for a maximum of 6 cycles. This stimulates the hormones which support the growth and release of a mature egg. The drug Letrozole is also sometimes used.
After the first cycle you will have a transvaginal scan to see if this is the correct dose for you. This uses painless ultrasound to examine the pelvic organs from inside the vagina which involves a special, smooth, thin handheld device called a transducer.
If you also have insulin resistance you will also be put on Metformin which increases the sensitivity of the liver and muscle cells to insulin and allows those cells to more effectively remove sugar from the blood.
About 20% of women are resistant to Clomiphene Citrate so if it doesn’t work you may be offered three courses of action:
- Gonadotrophins - a fertility drug given via injection which mimics the two hormones produced in your pituitary gland. These are luteinizing and follicle stimulating hormones commonly referred to as LH and FSH
- A minimally invasive surgery called an LOD (or laparoscopic ovarian drilling) whereby the thicker than normal membranes surrounding the ovary are punctured. This lowers the over high amount of testosterone that is being produced and aims to restore the menstrual cycle and ovulation. About 50% of women who have not responded to Clomiphene may be able to become pregnant in the first year after this process.
- IVF whereby a retrieved egg is fertilised outside the body.
What is the success rate of conceiving with PCOS?
Cases are obviously highly individual but most women with PCOS will be able to have a baby with fertility treatment and the chances of this improve for women aged below 35. It is worth saying that the journey through treatments can be a long, complicated and anxious process so it is good to have a support network. You may want to check out the PCOS charity Verity which has online resources, local groups and an active social media presence.
There is also a national charity to support those with fertility problems called Fertility Network which can be found here
I hope this is helpful please feel free to share this blog post with anyone who may find this information useful.
Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.
As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link
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