Pregnancy and polycystic ovarian syndrome
Polycystic ovarian syndrome is a state of hormonal imbalance which affects the fertility of a woman. As a result, if you are trying to get pregnant and have been diagnosed with this condition, you may need to take certain steps to ensure that you do get pregnant. Drugs are prescribed to induce ovulation and to lower the effects of the male hormone androgen which is produced in excessive quantities if you have the disorder. In addition, most doctors suggest certain lifestyle modifications like control of weight in order to improve the chances of conceiving.
About 10% to 12% of women of reproductive age (between 12 and 45) suffer from a hormonal imbalance which is known as polycystic ovarian syndrome. In this condition, the male hormone androgen is produced in excess amount. As a result, you may suffer from problems like excess growth of hair. But the real impact is on the ovaries. They fail to produce the eggs properly. Instead, follicles dry up and remain as cysts in the ovary. The main symptom of this condition is irregular menstruation and sometimes no menstruation for considerable period. The cause of the condition is not known, though genetic factors are thought to play an important part.
Why difficulties in conceiving if you have polycystic ovarian syndrome?
Before you try to find out the treatments, you need to know how this disorder can cause problems if you are trying to conceive. The main prognosis of the condition is that your body begins to produce an excessive amount of male hormone called androgen. This affects your fertility. Ovulation is the process by which your ovaries produce an egg once a month. As the egg matures, it is dropped and carried to the uterus by the fallopian tubes. But, when an excess of androgen is secreted, this process of ovulation is severely hindered. Either the eggs are not produced at all or produced irregularly or they do not mature resulting in the numerous cysts that are detected by Ultrasonography. This irregularity of ovulation results in the disturbance of the menstrual cycle.
So, if you are suffering from polycystic ovarian syndrome, it is very difficult for you, if not impossible, to determine which are your fertile periods. You cannot prepare a fertility chart and so cannot pinpoint the most suitable time for conception. Actually, a vast number of women try to conceive for months or even years before they consult a doctor and come to know that they suffer from this disorder.
Treatments to get pregnant with PCOS
Actually, even if you have polycystic ovarian syndrome, you can get pregnant by proper treatment. The problem is that many women keep on trying to conceive for months before they seek medical counsel.
The following treatments are suggested for this condition:
- The primary aim is to stimulate ovulation. Unless your ovaries produce the egg properly, fertilization is not possible. On your first visit to the doctor, a number of blood tests are performed. Special attention is paid to the levels of blood sugar and insulin in the body as they have a direct relationship with the disorder. Fertility checks are also done on the mate of the woman to rule out any other fertility problems. It is necessary to identify the PCOS as the cause of difficulty in conception before any treatment is started.
- The first order of business is to induce regular menstruation. Otherwise it is impossible to chart the fertile period. A number of medications are used to induce regular menstruation. The most common drug which is used for this purpose is Provera. It is a form of female hormone progesterone and its principle function is to induce ovulation.
- Once the period is regularized, different drugs are given to help in conception. The clomiphene citrate drugs like clomid that stimulate ovulation are often the treatment of choice. It has been seen that use of these drugs result in conception in 70% of the cases.
- Metformin is another widely prescribed drug to stimulate regular ovulation. In one study, it was seen that 40% of the women who were prescribed metformin began to ovulate normally and of them, 79% conceived successfully.
- For best results, metformin and clomid are given together. This raises the chances of getting pregnant to 89%.
- Several blood tests are done once the treatment starts to see if ovulation is occurring. If this is positive, a test is done later for pregnancy. If there has been no successful conception, the treatment is repeated for the next cycle.
- In general, a doctor starts with the lowest possible doses of medication. If no conception occurs even after three months of treatment, the dosage is gradually increased.
- If still no conception occurs, then some doctors can prescribe in vitro fertilization methods. Even in such cases, the patient is put on a dose of metformin a month before the procedure as this increases the chance of success of IVF by about 20%. The drug is also said to considerably lower the possibilities of miscarriage – a common problem in women with PCOS.
Lifestyle modification for PCOS
Most doctors recommend certain lifestyle modification measures before putting you on a fertility treatment. These are as follows:
- Weight management is the most important factor. In a study, it was shown that 40% of obese patients who lost even 5% of their body weight could conceive spontaneously without any intervention even when they have polycystic ovarian syndrome. Moreover, unbalanced levels of insulin also lead to difficulties in conception. So, exercise and proper healthy diet which can help you to lose weight are important steps.
- Quit smoking. It does nothing to help your chances of conception.
- Alcohol, caffeine and recreational drugs are all obstruction to normal pregnancy.
- According to some researchers, if you keep taking the birth control pills right up to the time when you want to conceive and then stop, this causes a fertility spike and increases your chances of conception. These pills are often prescribed as treatment for PCOS.
Pregnancy complications and polycystic ovarian syndrome
Even if you are suffering from polycystic ovarian syndrome, you may become pregnant. This may occur naturally, though the chances of that happening are low. Medication and lifestyle modification can help you to conceive. But in women with this disorder who do actually conceive, the incidence of pregnancy complications are higher. Some of these are as follows:
- According to two different studies by Boomsma (2008) and Jakubowicz (2002), women who are suffering from this disorder are three times as likely to miscarry as compared to those who are not suffering.
- Gestational diabetes is a common complication in pregnancy in women with PCOS. Such women have a higher chance of developing Type II diabetes later in life as does the baby. Moreover, this leads to too big baby and a C-section is often necessary.
- Similarly, there is a higher incidence of pregnancy induced hypertension and preeclampsia in women with PCOS who manage to conceive. Both these conditions can lead to serious complications affecting the heart and the kidneys of the mother.
- The likelihood of preterm birth and delivery by C-section is also higher in women with polycystic ovarian syndrome.
Polycystic ovarian syndrome, pregnancy and some challenges
Studies show that if you want to get pregnant, then you probably will, even with the polycystic ovarian syndrome. But, here are some challenges which you have to tackle first:
- Treatment starts with the lowest doses. If no success results, the dosage is increased and the final step is the in vitro fertilization. But it can be a harrowing roller coaster ride emotionally to wait every month to see if the treatment is successful or not. But if you tense up, your body will have lesser chance of conception. So, support and therapy are suggested so that you can remain relaxed and let your body do its job.
- Fertility drugs are expensive.
- In vitro fertilization is the most expensive method of treatment and there is no guarantee that you will conceive on the first cycle.
- Fertility treatments and drugs are not covered by health insurance policies. This aggravates the cost issue.
- Finally, though herbs and natural remedies are available, most doctors advice against them as they can have an antagonistic reaction with the fertility drugs that you are taking.