PCOS Pregnancy
Women with PCOS have a difficult time getting and staying pregnant. A symptom of PCOS is infertility and various infertility treatments may need to be tried before a pregnancy occurs. During the pregnancy there are more elevated risks for a PCOS woman, such as a greater risk of gestational diabetes, high blood pressure, miscarriage and premature delivery.
40 – 80% of women with PCOS will have problems with infertility. This is do to the hormone imbalances preventing ovulation. If the male hormones, androgens, can be reduced and insulin levels lowered, which lowers testosterone, ovulation may start to occur without any other intervention. Losing even 5% body weight will lower insulin levels in the blood. So if you’re overweight or obese, it’s a good idea to try that first before turning to fertility drugs.
If the above methods have not worked, then inducing ovulation is the next step. There are a variety of drugs to try for this. Clomiphene citrate, Clomid, can be taken early in the menstrual cycle to induce ovulation. It should not be taken for more than 6 months. Studies show it provides a 30% chance of getting pregnant. There are a number of side effects and the risk of ovarian cancer can be increased.
Metformin, Glucophage, reduces insulin resistance which in turns increases your fertility. This drug is also used to treat diabetes. It has been found to cause a life threatening illness in some people though.
Human Chorionic Gonadotrophin or hCG stimulates the ovary to release an egg. It must be given by injection and has to be timed so that it doesn’t accidentally block ovulation or form cysts.
Human menopausal gonadotrophin or hMG is taken from the urine of menopausal women. It is a combination of a luteinizing hormone and a follicle stimulating hormone. It is also given by injection. hMG is quite expensive and may result in multiple pregnancies. Too much hMG may cause cyst formation.
FSH or a follicle stimulating hormone may be beneficial for those women that have too much LH.
GnRH is a gonadotrophin releasing hormone. It causes the pituitary gland to release LH and FSH. A pump is worn 24 hours a day that will inject GnRH every 90 minutes. A common side effect is needle site infection. The risk of cysts or multiple pregnancies is reduced with this treatment.
Prolactin inhibiting drugs may also be used to reduce prolactin levels. High prolactin levels block ovulation.
Women who have never been diagnosed with diabetes, or even be overweight, may still get gestational diabetes. The risk is greater for obese women with PCOS and those that needed fertility treatments to conceive. Women with PCOS should make sure they are checked early in the pregnancy for gestational diabetes. If they do have it, a visit with a specialist in pregnancy and diabetes is a good idea.
Unfortunately pregnant women with PCOS do have a higher chance of having a miscarriage. Their chance is 45% compared to 15% for pregnant women without PCOS. Some studies show the risk as even higher than 45%. It seems grossly unfair that after all the trouble to conceive they have almost a 1 in 2 chance of losing the baby. The high levels of insulin in PCOS women raises the risk of blood clots, especially between the uterus lining and placenta. This will prevent nutrients from reaching the developing baby and removal of toxic wastes. A miscarriage will then occur.
If the pregnancy survives to the last trimester there is still an elevated risk for premature delivery to get past.