One in 10 women of childbearing age in the U.S. is diagnosed with a condition called Polycystic Ovary Syndrome (PCOS). This condition can impact how someone looks and feels—as well the ability to conceive without medical intervention. PCOS is one of the most common reasons for infertility, but it’s also highly treatable. And—importantly—having a diagnosis of PCOS doesn’t have to mean giving up on trying to start a family! Here’s what to know about PCOS and pregnancy.

What is PCOS?

PCOS is a hormone condition that causes ovarian cysts and boosts the level of androgens (the male sex hormone) in the body. As a result, PCOS can cause facial hair growth, baldness, and missed or irregular menstrual cycles, which is one reason why it can affect fertility. PCOS has also been associated with an increased risk of heart disease and has been linked to diabetes.

PCOS Symptoms

PCOS can come with a variety of painful and unpleasant symptoms that include:

• Irregular periods: This could mean an absence of periods, periods that are super frequent (every 21 days or more often) or infrequent (less than eight a year), unpredictable periods, or very heavy periods.
• Fertility issues: PCOS is one of the top causes of female infertility.
• Weight gain or difficulty losing weight: As many as 4 in 5 women with PCOS are classified as obese.
• Oily skin and acne: Severe acne, acne that lasts longer than the teen years, and acne that doesn’t respond to typical treatment can be a symptom of PCOS.
• Hair loss: Thinning hair on the scalp may resemble male pattern baldness.
• Abnormal hair growth: “Hirsutism”—where hair grows on the face, chin, and other parts of the body where men typically grow hair—affects up to 70% of folks with PCOS.
• Dark or thickening of the skin: Typically skin changes are seen on the neck, arms, thighs, and chest.
• Skin tags: These tend to show up on the neck and armpits.

What causes PCOS?

Researchers haven’t pinpointed the exact cause of PCOS, but they think a few factors are at play, including:

• Androgen levels: Folks with PCOS typically have higher than normal levels of this typically male hormone, which is thought to prevent the ovaries from releasing an egg during each cycle. Androgens are also likely the culprit behind PCOS-related hair loss/growth and acne.
• Insulin levels: Chances are you’ve heard of insulin—it’s the hormone that controls your blood sugar. Insulin resistance—which is when the body’s cells don’t respond normally to insulin, leading to higher insulin levels—is common among people with PCOS.

Pregnancy Complications With PCOS

PCOS can add a layer of stress to an expecting parent because it is associated with some distressing complications during pregnancy for both Parent and Baby. PCOS pregnancy complications include:

• Gestational diabetes
• Preeclampsia
• Pregnancy-induced high blood pressure
• Miscarriage
• Pre-term birth (baby born before 37 weeks)
• NICU stay

Getting Pregnant With PCOS

PCOS can make it tricky to conceive spontaneously since PCOS can make your period irregular or nonexistent, which means the body may not be producing eggs regularly either. In fact, though PCOS can strike any time after puberty, most folks who are diagnosed with this condition find out because they go to the doctor after having trouble getting pregnant. The fertility issues with PCOS stem from lack of ovulation, the goal of infertility treatments for PCOS is to spur ovulation.

 Fertility Treatments for PCOS

• Clomiphene Citrate (aka Clomid): This “first-line” fertility treatment is a pill that is used to boost the production of hormones that kickstart ovulation. It’s not always successful in folks with PCOS, and might work better when used along with metformin, according to research published in the International Journal of Gynecology & Obstetrics. Speaking of...
• Metformin: This insulin-sensitizing drug has been shown to improve a number of PCOS symptoms, including irregular periods. And, as mentioned, may make Clomid more effective!
• Letrozole: Technically a cancer medication, letrozole doubles as an ovulation-stimulator.
• Gonadotropins: Considered a “second-line agent,” this drug is used when the above methods aren’t able to get ovulation going.  
• Laparascopic Ovarian Drilling: As the name suggests, this method isn’t as easy as swallowing a pill. The surgical procedure involves applying heat or a laser to the ovaries with a laparascope (a teeny camera) passed through a tiny incision. It’s thought that this can help ovaries produce eggs.
• In Vitro Fertilization (IVF): If fertility drugs do not work, then a next step is often IVF, which uses injectable fertility drugs to stimulate the ovaries enough to create ‘good’ eggs that are then surgically removed and placed in a petri dish along with sperm that fertilizes the egg. This fertilized egg becomes an embryo and is then transferred into the uterus where the fetus will be closely monitored throughout the pregnancy.    

PCOS Treatments and Pregnancy 

There are a few types of medications used to treat PCOS—but not all of them are compatible with being or trying to get pregnant. For example, hormonal birth control is often prescribed to tackle symptoms like irregular periods, excess hair, and acne. Of course, because it also prevents ovulation, it’s not the right route for folks trying to conceive. Likewise, there are anti-androgen medicines that can block the impact of androgens, helping to reduce acne and irregular hair growth or loss. But they’re not approved by the FDA for PCOS—nor are they pregnancy-friendly!

Metformin for PCOS During Pregnancy

One PCOS treatment that has been researched for use during pregnancy and deemed safe and effective for addressing insulin resistance is metformin, an insulin sensitizing drug. Insulin-sensitizing drugs are usually used for diabetes or PCOS. They help the body respond normally to insulin, and in those with PCOS, they can help lower androgen levels to improve ovulation, making periods more predictable. Beyond that, metformin has shown some especially promising results related to pregnancy for those with PCOS, with a 2019 study finding that it might reduce the risk of late miscarriage and preterm birth. 

Weight Loss as a PCOS Treatment

Because there’s a link between abdominal adiposity (aka belly fat) and insulin resistance, doctors sometimes recommend a low-calorie diet and/or exercise to patients with PCOS. Research indicates that lowering body fat by just 5% can significantly reduce symptoms of PCOS. And with that, studies suggest that losing body fat could help jumpstart ovulation for those who have major lags between periods. However, it’s unlikely that weight loss alone will be a silver bullet solution, which is why it’s important to work with a healthcare provider.

PCOS and Pregnancy: Final Thoughts

Though PCOS can make conceiving and pregnancy challenging, rest assured plenty of people with PCOS successfully get pregnant, have smooth pregnancies, and welcome healthy babies! If you’re pregnant with PCOS or trying to get pregnant with PCOS, talk to your provider about your options. They can help you prevent and work through some of the potential pregnancy complications associated with PCOS and point you to the right specialist, if needed.

More on Pregnancy & Fertility:

• Your Guide to Pregnancy After 35
• Making Sense of Secondary Infertility
• How Infertility Impacts Mental Health
• After PCOS, One Woman Found Solace in Others' Stories

 

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REFERENCES

• U.S. Department of Health & Human Services Office on Women’s Health: Polycystic Ovary Syndrome
• Cardiovascular Risk in Women With PCOS. International Journal of Endocrinology and Metabolism, September 2012
• Polycystic Ovary Syndrome and Type 2 Diabetes Mellitus: A State-of-the-Art Review, World Journal of Diabetes, January 2022
• National Institutes of Health: Polycystic Ovary Syndrome (PCOS)
• Pregnancy Complications in Women With Polycystic Ovary Syndrome, Human Reproduction Update, June 2015
• Pregnancy Complications in Women With Polycystic Ovary Syndrome, Seminars in Reproductive Medicine, January 2008
• National Institutes of Health: Does PCOS Affect Pregnancy?
• American College of Obstetricians & Gynecologists: Polycystic Ovary Syndrome (PCOS)
• Short-Term Metformin Treatment for Clomiphene Citrate–Resistant Women With Polycystic Ovary Syndrome, International Journal of Gynecology & Obstetrics, June 2009
• Metformin in Pregnancy and Risk of Adverse Long-Term Outcomes: A Register-Based Cohort Study, BMJ Open Diabetes Research and Care, January 2022 
• Metformin in Pregnancy: Mechanisms and Clinical Applications, International Journal of Molecular Sciences, July 2018
• Use of Metformin to Treat Pregnant Women With Polycystic Ovary Syndrome (PregMet2): A Randomised, Double-Blind, Placebo-Controlled Trial, The Lancet Diabetes & Endocrinology, April 2019
• Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies, Clinical Medicine Insights: Reproductive Health, September 2019
• Getting Pregnant With PCOS, A Case-Based Guide to Clinical Endocrinology, 2015

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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.