Last updated Feb. 16, 2018.
A lot of pieces have to fall into place in order for you to get pregnant. You have to be ovulating, the sperm and egg have to come together at the right time and in the right place, the fertilized egg has to travel down to the uterus, and then it has to implant. It’s a complicated process and there are lots of different health conditions that can make it even harder to conceive. One of the most common is PCOS — polycystic ovary syndrome. It’s a hormonal imbalance that may hold up one of the most crucial ingredients of the conception process: the egg.
So, what’s the deal with PCOS and pregnancy? Here are the highlights:
- PCOS affects up to 12% of women in the U.S.
- Symptoms include ovarian cysts, excess body hair, hormonal acne, and infrequent ovulation.
- PCOS increases your risk for other health problems, including obesity, type 2 diabetes, heart disease, and endometrial cancer.
- PCOS is the top cause of anovulatory infertility in the U.S.
- PCOS increases the risk of pregnancy complications; women with PCOS are 3 times more likely to have a miscarriage during early pregnancy.
- Babies born to mothers with PCOS may be at a higher risk of having a birth defect.
- Lifestyle changes and medications may help balance your hormones and promote ovulation. You may also seek treatment for specific symptoms like excess body hair and acne.
What is PCOS?
Polycystic ovary syndrome (PCOS) is a condition caused by a hormonal imbalance. Its name comes from one of its most common symptoms — cysts (fluid-filled sacs) in one or both ovaries. Other common symptoms include signs of high levels of androgen hormones (like excess body hair or hormonal acne) and infrequent or absent ovulation.
The symptoms of PCOS are a result of having too much testosterone and estrogen in your system, but the cause of that excess is not well understood. Current research suggests that excess insulin or low-grade inflammation may be what provokes the extra hormone production; heredity may also play a role.
PCOS in and of itself isn’t particularly dangerous, although symptoms like acne, excess body hair, weight gain, and irregular or very heavy menstrual cycles can be unpleasant and inconvenient. However, it does increase your risk of developing other health problems, including obesity, type 2 diabetes, insulin resistance, heart disease, mood disorders, and endometrial cancer. It can also impact your ability to get pregnant.
PCOS and Fertility
PCOS is actually the top cause of “anovulatory” (meaning you don’t ovulate) infertility. Because of the hormonal imbalance, your ovaries may not release eggs regularly; some women with PCOS don’t ovulate at all. Without that egg, conception isn’t possible. In fact, many women only learn that they have PCOS when they have trouble getting pregnant — the other symptoms may not be noticeable or may have other potential explanations. If you’ve already been diagnosed with this condition, remember that PCOS and pregnancy aren’t necessarily mutually exclusive. Many women with PCOS have no trouble conceiving.
If you’re having trouble getting pregnant, your doctor will look into a number of different causes, including PCOS. Testing includes blood work to measure your hormones, a pelvic exam to look for any abnormalities, and a vaginal ultrasound to look for cysts in your ovaries. Some women have tons of tiny cysts while others have just a few and the cysts themselves are harmless — they’re just a sign that you may have PCOS. There’s no single test for PCOS, but having several of the main symptoms makes it a likely diagnosis.
In general, the first step toward treatment is lifestyle changes, most commonly weight loss. In many cases, even losing a small amount of weight can really help. In general, a healthy diet promotes fertility and the healthier you are, the lower your risks of pregnancy complications. If that’s not enough, then you may need medication. If you’re not trying to get pregnant, treatment for PCOS often includes birth control to help regulate hormones, plus acne medication and treatments for extra body hair if need be.
If you are trying to get pregnant, there are a number of medications that can help stimulate ovulation. The first line of defense is generally clomiphene, a drug that limits estrogen production, and sometimes also metformin to manage insulin production. If those aren’t enough, there are stronger medications that are administered by injection.
PCOS and Pregnancy
We know that PCOS can affect your ability to get pregnant, but how does it affect the pregnancy itself? First, it increases the risk of gestational diabetes, which can cause your little one to have a high birth weight (which makes for a more difficult and dangerous delivery, including babies developing asphyxia during labor). PCOS also increases the risk of preeclampsia, or high blood pressure during pregnancy, which can be extremely dangerous and even fatal for both mother and child.
In general, higher rates of complications are associated with PCOS and pregnancy. Women with PCOS are 3 times as likely to miscarry in early pregnancy than women without the condition. The risk of preterm birth is also higher if you have PCOS and you’re more likely to need a C-section.
PCOS and Birth Defects
PCOS unfortunately may not just affect mom-to-be. In a 2015 study, maternal PCOS was linked to giving birth to children who were in poorer health than those born to women who didn’t have PCOS. Congenital anomalies, or congenital disorders, were more prevalent in children of affected mothers, who also were 14% to 69% more likely to be hospitalized for various health conditions through at least early adulthood.
The study, published in the journal Obstetrics & Gynecology, also noted:
In addition, the offspring of mothers with PCOS had significantly higher adjusted risks for hospitalizations beyond the perinatal period for a variety of diagnoses, including endocrine, nutritional, and metabolic disorders (44% higher), digestive disorders (14%), metabolic disorders (43%), neurologic conditions (17%), psychological development issues (69%), asthma (32%), and male genital conditions (38%).
Study limitations suggest taking this information with a grain of salt, however. Being an overweight or obese mother may be a confounding factor, as many women with PCOS tend to have higher weights. The study also identified women with PCOS through hospitalizations, so their cases may have been more severe.
Still, treatment for PCOS — and losing weight — could help improve the odds of giving birth to a healthy baby.
Managing PCOS During Pregnancy
That all sounds scary, but having PCOS doesn’t mean that you can’t or shouldn’t have children. It just means that you’ll need to work closely with your doctors to monitor your pregnancy and make sure you and your growing little one are healthy.
Have you had PCOS while becoming pregnant? If you had a difficult delivery because of it, and something happened to your baby, you have legal resources. Contact Safe Birth Project today to learn more.