PCOS and Fertility #26
Is it harder to get pregnant with PCOS?
Hello,
How was your week?
In today’s newsletter, we discuss fertility. I recognise that this can be an extremely sensitive subject, especially if you are currently trying to conceive. If you consider this topic triggering, consider skipping today’s newsletter. I also found it quite a difficult subject to research. I aim to cover some facts so we can prepare ourselves for when that time comes.
This week’s question
Is it harder to get pregnant with PCOS?
This newsletter will remain free as I believe access to research and information shouldn’t have barriers. However, if you’d like to support my writing for the cost of a coffee per month, I would appreciate it. I dedicate most of my weekends and free time to this project, and your support will mean the world to me.
Why is Fertility a concern in PCOS?
Fertility is a concern for women with PCOS because of failed ovulation. Ovulation fails because our ovaries mature too many follicles at the same time, but none release an egg. Without ovulation, no egg can be fertilised to create an embryo that can grow into a baby.
Given that the main system that PCOS affects is our reproductive system, fertility and conceiving are expected to be harder for us. Unfortunately, the prevalence of infertility in women with PCOS varies between 70% and 80%. I want to clarify that infertility means not being able to get pregnant after one year of trying, and it doesn’t mean we can never have children.
These statistics can sound scary. However, the way I look at it is empowering and motivating. I don’t want to discourage you, as I have seen numerous women with PCOS conceive without issues. However, for me, these motivate me to take care of my body and keep track of where this condition is at.
My recommendation if you are considering becoming a mum
I recommend giving yourself a year to work on your lifestyle and nutrition. This mindset prepares you for this important step in your life and has enough time to improve ovulation and blood markers. I recognise it is easier said than done, especially if having a baby is something you have always dreamed of.
If your periods are irregular, getting some important blood tests and scans done so you understand where you are at is the first step. From there, it is about trying to get your ovulation back. I am working on this with nutrition and supplements, but medication is also available.
Available treatment options
Lifestyle changes
The first line of treatment is lifestyle changes: physical activity, losing weight, improved nutrition and supplementing with Folic Acid.
The NHS recommends all women who are trying to conceive to take a 400 micrograms folic acid tablet every day before they're pregnant and until they're 12 weeks pregnant. Folic acid can help prevent birth defects.
Metformin might also aid ovulation for insulin-resistant PCOS women by reducing insulin levels and decreasing androgens.
Clomiphene citrate
This is the first drug that is recommended to aid ovulation. This drug aims to help reach an ideal hormone balance that a follicle matures enough to release an egg. This drug is relatively efficient. In six cycles, 60-70% of women get pregnant.
Laparoscopic ovarian surgery
15% of women who take Clomiphene citrate seem resistant to the drug. The next line of treatment is something called Laparoscopic ovarian surgery. 4 to 6 holes are drilled in each ovary using an electric current. The aim is to destroy the tissue-producing androgens (male hormones). Pregnancy rates are between 54 and 70% 12 months after the procedure.
IVF
If the above hasn’t worked, in-vitro fertilisation is the next step. During IVF, an egg is removed from the woman's ovaries and fertilised with sperm in a laboratory. The fertilised egg, called an embryo, is then returned to the woman's womb to grow and develop.
These are some of the top options, but your doctor will be able to help clarify the best path for you.
The last pieces of the puzzle
There are some other pieces of the puzzle we need to discuss:
Age and Ovarian reserve: a side of research suggests that we might benefit from an extended fertility window. Given some women with PCOS see their symptoms improve after 35 years old, it is thought that we can get better outcomes in IVF and conceive later down the line. This argument is being debated, and I wouldn’t rely on it to delay conception. It is well-known that the younger you have children, the higher the chance. Measuring AMH and your ovarian reserve should be your priority if you want to have children later in life.
Male Fertility. In the last 50 years, average human sperm concentrations dropped by 51.6 per cent, and total sperm counts dropped by 62.3 per cent. This is an alarming stat, and checking your partner's fertility should be as important as ours.
Vitamin D. I have spoken about this vitamin in many newsletter issues. That’s because it’s such an important vitamin for the well functioning of our body. It has been shown that each unit (nmol/L) increase in vitamin D increases the probability of clinical pregnancy by 2.4%. Please have this vitamin checked.
I hope this made you feel empowered and not scared. If you have PCOS and are trying to conceive, or you have already, please drop a comment below with your experience, so all of us who started planning for a baby can learn from your experience.
If you want personal support, my online clinic is open, and I take one-to-one consultations. If you are interested, please drop me an email at: francesca@pcos-clinic.com
See you next Sunday with a lovely guest post from Eden.
Francesca
1 Sources
References
Mann, U., Shiff, B., & Patel, P. (2020). Reasons for worldwide decline in male fertility. Current Opinion in Urology, 30(3), 296–301. https://doi.org/10.1097/MOU.0000000000000745
Melo, A. S., Ferriani, R. A., & Navarro, P. A. (2015). Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics (Sao Paulo, Brazil), 70(11), 765–769. https://doi.org/10.6061/clinics/2015(11)09
Van der Spuy, Z. M., & Dyer, S. J. (2004). The pathogenesis of infertility and early pregnancy loss in polycystic ovary syndrome. Best Practice & Research. Clinical Obstetrics & Gynaecology, 18(5), 755–771. https://doi.org/10.1016/j.bpobgyn.2004.06.001
Várbíró, S., Takács, I., Tűű, L., Nas, K., Sziva, R. E., Hetthéssy, J. R., & Török, M. (2022). Effects of vitamin D on fertility, pregnancy and polycystic ovary syndrome-A review. Nutrients, 14(8), 1649. https://doi.org/10.3390/nu14081649
Website, N. H. S. (n.d.). Vitamins, supplements and nutrition in pregnancy. Nhs.uk. Retrieved July 1, 2023, from https://www.nhs.uk/pregnancy/keeping-well/vitamins-supplements-and-nutrition/
Well-researched and well-written as always❤️