How PCOS Affects Pregnancy

Unless you have polycystic ovary syndrome (PCOS), you may not know what PCOS is or how it impacts pregnancy and fertility. However, this condition is a leading cause of infertility—and you can have it without even realizing it.

Shortly after I gave birth to my first son, I lost 30 pounds of the baby weight and figured I was on my way to my pre-birth pant size. Instead, those 30 pounds crept back on, plus 30 more. I figured it had to do with breastfeeding, which left me famished and needing extra calories. But after weaning my child two years later, the weight stayed, no matter how many workouts I squeezed in.

My period hadn't come back either, which I found strange. Wasn't it supposed to return after I stopped breastfeeding? And while I wanted to get pregnant again, that wasn't happening either. Before long, another strange symptom showed up: a crop of black hairs grew on my chin and along the edges of my cheeks.

Frustrated, I finally saw a nurse practitioner. Blood tests revealed I had a hormonal imbalance—elevated testosterone levels and low progesterone—linked to a lack of regular ovulation. Combined with the weight gain, extra facial hair, and absence of periods, I was diagnosed with polycystic ovary syndrome (PCOS). A year later, an ultrasound revealed cysts all over my ovaries, which further cemented the diagnosis.

Since I wanted to get pregnant again, my diagnosis left me with many questions and concerns. Luckily, I wasn't alone in this challenge, and if you're struggling with these issues, know that you aren't either. Read on to learn more about PCOS and how it impacts your cycle, fertility, and potential future pregnancies.

What Is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder that impacts 6% to 12% of people with ovaries during reproductive age in the US. The condition is characterized by reproductive hormone imbalance. The imbalance creates problems with the ovaries and the menstrual cycle, and often leads to the following symptoms:

• Absence of ovulation
  
• Acne
• Excess facial and body hair
• Irregular menstrual periods
• Ovarian cysts
  
• Thinning scalp hair
• Skin darkening
• Skin tags
• Weight gain
  

Experts aren't entirely sure what causes PCOS, but the heredity, imbalance of reproductive hormones, and insulin resistance—essentially when your body makes insulin but isn't able to use it effectively—are likely all at play.

These imbalances can lead to higher levels of androgens—hormones such as testosterone and dehydroepiandrosterone (DHEA)—in the body, explains Anne Hussain, ND, a naturopathic doctor based in Ontario, Canada.

PCOS is a common cause of irregular menstrual cycles due to anovulation, or the absence of ovulation. Since your body needs to ovulate to produce progesterone and ultimately to conceive, PCOS is a common cause of infertility.

But even if you have PCOS, you can get pregnant. In fact, PCOS is considered a treatable cause of infertility. Treatment usually involves losing weight and helping you ovulate to increase your chances of getting pregnant.

PCOS Diagnosis Can Be Difficult

Over the years, several different sets of criteria have been used to diagnose PCOS. Some standards require a person to show signs of both elevated androgens and an absence of ovulation. But the most current set of criteria involves having two of these three symptoms:

• Elevated androgens
• Lack of or irregular ovulation
• Polycystic ovaries

Thanks to refined technology, it's getting easier for health care providers to spot ovarian cysts, but many people still experience a delay before getting a confirmed diagnosis.

Why PCOS Diagnosis Matters

Whether or not you're hoping to get pregnant, knowing if you have PCOS is important. In addition to issues with fertility, PCOS can mean serious health problems down the road if left untreated.

Insulin resistance can increase the risk of type 2 diabetes, as well as gestational diabetes during pregnancy. In fact, the Centers for Disease Control and Prevention (CDC) estimates that over half of people affected by PCOS develop type 2 diabetes by age 40. Diabetes impacts your health and if left unchecked, potentially your fertility as well.

In addition, according to the National Institute of Child Health and Human Development (NICHD), people with PCOS also have an elevated risk of developing the following health conditions:

• Heart disease
• High blood pressure
• Inflammation
• Metabolic syndrome
  
• Mood disorders like depression and anxiety
• Obesity
• Obstructive sleep apnea
  

If you feel like you may have PCOS but don't have a diagnosis, seek out an OB-GYN or endocrinologist. These medical professionals have experience diagnosing, treating, and working with people with the condition.

How to Increase Your Odds of Pregnancy When You Have PCOS

PCOS makes it more challenging to conceive. However, there are steps to take to increase your odds of getting pregnant. Changing your diet and exercise habits can help you manage PCOS and, by extension, help you conceive. In addition, some medications and surgeries can help.

Aim to lose weight

Losing even 5% of your weight can kick-start your menstrual cycle, says Carolyn Cokes, MD, MPH, an OB-GYN with the Metropolitan OB-GYN group, a Baltimore-based practice affiliated with Mercy Medical Center.

Research has found that obesity and insulin resistance are associated with resistance to ovulation, lower pregnancy rates, and a higher risk of pregnancy complications.

Additionally, according to the American College of Obstetricians and Gynecologists (ACOG), weight loss can lower androgen levels and promote the return of menstruation. Since fat tissue creates its own estrogen, losing a small amount of weight might help balance the ratio of estrogen and progesterone, enabling ovulation, adds Dr. Cokes.

Focus on your diet

"Eating whole-grain foods that don't spike up glucose and insulin can help regulate hormones and lower inflammation, which can play a role in fertility," says Angela Grassi, RD, a registered dietitian and founder of the PCOS Nutrition Center in Bryn Mawr, Pennsylvania. (She's also a mom of two who has PCOS herself.)

Grassi advises focusing on the following food groups during meals and snacks:

• Beans and lentils
• Fat
• Fruits
• Protein
• Vegetables
• Whole Grains

She often recommends a balanced plate method: half vegetables, a bit of fat, one-quarter protein, and one-quarter high-fiber carbs (like quinoa, beans, and brown rice).

Unsaturated fats, such as the omega-3s found in avocado, nuts, seeds, and fish, could help lower androgens and improve fertility, too, she says.

Try to minimize your consumption of foods that are high in sugar and low in fiber, as these can increase glucose and insulin and impact fertility, recommends Grassi.

Consider medication or surgical intervention

If lifestyle changes aren't working on their own, there are medications such as metformin (a diabetes medication that helps control blood sugar) that can help, says Dr. Cokes. Research supports the following medicines for anovulation associated with PCOS:

• Clomiphene, a medication that induces ovulation
• Gonadotropins, an ovulation inducer
• Letrozole, a breast cancer drug that can induce ovulation in people with PCOS

Additionally, there are a few surgical procedures that can jumpstart ovulation as well. Discuss these options with a fertility specialist. Since every person and every case of PCOS is different, Dr. Cokes stresses the importance of seeking care from an experienced health care provider.

Risks of Pregnancy With PCOS

If you have PCOS and get pregnant, talk to a health care provider about the potential complications of a PCOS pregnancy. According to the NICHD, there are risks associated with a PCOS pregnancy, including:

• Cesarean section
  
• Gestational diabetes
• High blood pressure
  
• Miscarriage
• Preeclampsia
• Preterm birth
  

People with PCOS are three times as likely to experience an early miscarriage, according to the NICHD. It's unclear why miscarriage is a risk associated with PCOS, but insulin resistance and imbalanced progesterone levels could be at play. Some researchers also think that PCOS causes a state of chronic, low-grade inflammation, says Dr. Cokes, so that issue could also contribute to higher rates of pregnancy loss.

With a PCOS pregnancy, you're also more likely to develop gestational diabetes, pregnancy-induced high blood pressure, preeclampsia, or preterm birth, adds Alan Copperman, MD, medical director at Progyny and fertility specialist at RMA of New York. The hallmarks of PCOS, including hormonal imbalance and insulin resistance, contribute to these risks.