How PCOS Affects Pregnancy

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 hungry and needing extra calories. But after weaning my son two years later, the weight stayed. No matter how many workouts I squeezed in, I couldn't lose a single pound. So I had to buy a whole new wardrobe.

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, it was enough for her to diagnose me 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. Read on to learn about PCOS and how it impacts your cycle and future potential pregnancies.

What Is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder that impacts 5-10% of people with ovaries between the ages of 15 and 44. The condition is characterized by reproductive hormone imbalance, which creates problems with the ovaries. These problems often lead to the following symptoms:

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

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

These imbalances can lead to higher levels of androgens—hormones such as testosterone and dehydroepiandrosterone (DHEA)—in the body, explains Anne Hussain, N.D., 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 a treatable cause of infertility, according to the Office on Women's Health. Treatment usually involves helping you ovulate to increase your chances of getting pregnant.

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:

1. Elevated androgens
2. Lack of or irregular ovulation
3. Polycystic ovaries

Thanks to refined technology, it's getting easier for doctors to spot ovarian cysts and make diagnoses, but many people still experience a delay.

Why PCOS Diagnosis Matters

Whether or not you're hoping to get pregnant, knowing 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, for example. And 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 Insitute of Child Health and Human Development (NICHD), people with PCOS also have an elevated risk of developing the following health conditions:

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

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

How to Increase Odds of Pregnancy When You Have PCOS

Changing your diet and exercise habits can help you manage PCOS and, by extension, help you conceive. In addition, some medications can also help.

Lose excess weight if you can

Losing even 5% of your weight can kick-start your menstrual cycle, says Carolyn Cokes, M.D., M.P.H., 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, per the American College of Obstetricians and Gynecologists (ACOG), weight loss can lower androgen levels and cause your period to return. Since fat tissue creates its own estrogen, losing a small amount of weight might affect 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, R.D., a registered dietitian and founder of the PCOS Nutrition Center in Bryn Mawr, Pennsylvania. (She also happens to be a mom of two who has PCOS herself.)

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

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

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 lack fiber, as these can increase glucose and insulin and impact fertility, Grassi adds.

Consider medication

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

Since every person and every case of PCOS is different, Dr. Cokes stresses the importance of seeking care from an experienced provider.

Risks of Pregnancy With PCOS

If you get pregnant, talk to a health care provider about the risks associated with a PCOS pregnancy. According to the NICHD, the following risks are associated with a PCOS pregnancy:

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

People with PCOS are three times as likely to experience an early miscarriage. 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 could also contribute.

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, M.D., 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.

The Bottom Line

Getting pregnant with PCOS is not impossible, but it may take some additional support. Once you become pregnant, a health care provider should keep a close eye on your pregnancy and offer extra monitoring to help ensure the best chance of a safe and healthy pregnancy.