How to Get Pregnant With PCOS

Polycystic ovarian syndrome (PCOS) is one of the most common causes of female infertility, affecting an estimated 5 million women. But you can get pregnant with PCOS. There are a number of effective fertility treatments available, from Clomid to gonadotropins to IVF.

Most women will be able to conceive with a combination of lifestyle changes and fertility drugs. While some women with PCOS will need IVF, the great majority will get pregnant using lower-tech fertility treatments. Here are some of the options you and your doctor can explore.

Many (but not all) women with PCOS struggle with obesity. This is because PCOS negatively affects how your body processes insulin, which can, in turn, cause weight gain.

One of the main reasons women with PCOS can’t conceive is they don’t ovulate, or they don’t ovulate regularly. Women with PCOS who are overweight are more likely to experience more severe anovulation, going months between periods.

Studies have found that losing some of the extra weight may bring back ovulation. You don’t have to lose all the weight. According to the research, losing 5% to 10% of your current weight may be enough to jump-start your menstrual cycles.

Unfortunately, there’s not much evidence to say losing weight will help you conceive on your own. You may still need fertility drugs. Research has found that women who have lost weight have a great chance of having fertility treatment success.

Losing weight isn’t easy for anybody, and it may be even more difficult for those with PCOS. Also, not all women with PCOS are overweight. If that's your situation, weight loss isn't a solution to help with fertility.

Make sure your doctor tests your insulin levels. If you’re insulin resistant, taking the diabetes drug metformin can treat the insulin resistance and may help you lose that extra weight. It may also help you conceive.

Eating a healthy diet is really important for women with PCOS. This is partially due to the higher risk of becoming overweight, and partially due to their bodies’ trouble with insulin regulation. Is there any one diet that is best for PCOS? That’s a matter of debate.

Some studies have claimed that a low-carb diet is the best one for PCOS, but other studies have not found a low-carb advantage. The most important thing is to make sure your diet is rich in nutrient-rich foods and adequate protein and low on high sugar foods. Avoiding junk food and processed foods is your best bet.

Regular exercise has also been found to help with PCOS symptoms. In one study, a combination of regular brisk walking and eating a healthier diet improved menstrual cycle regularity by 50%.

Whether diet and exercise alone will help you conceive isn’t clear. However, a healthy lifestyle may help your fertility treatments work better, and it will certainly help you feel better overall. Like weight loss, it’s worth the effort if you want to get pregnant.

Metformin is a diabetes medication used to treat insulin resistance. It is sometimes prescribed to women with PCOS, even if they aren’t actually insulin resistant. Using metformin for PCOS is considered off-label use. However, the drug is relatively safe and may help women with PCOS get pregnant.

According to the research, metformin may:

• Help you lose weight
• Restart regular menstrual cycles
• Improve the effectiveness of some fertility drugs
• Reduce the rate of miscarriage (only in those with repeated miscarriage)

Can metformin alone help you get pregnant? This is unlikely. While earlier research found that metformin increased the odds of a woman ovulating on her own, further studies have not found an increase in pregnancy or live birth rates. In other words, the improvement with ovulation didn't lead to increased fertility.

Clomid is the most commonly used fertility drug overall, and also the most commonly used treatment for women with PCOS. Many women with PCOS will conceive with Clomid.

Unfortunately, it’s not successful for everyone. Some women with PCOS will experience Clomid resistance. This is when Clomid does not trigger ovulation as expected. Studies have found that a combination of metformin and Clomid may help beat Clomid resistance.

If this is not successful, your doctor may consider the drug letrozole.

Letrozole, also known by its brand name Femara, is not a fertility drug but is frequently used as one in women with PCOS. Letrozole is actually a cancer medication. However, studies have found that it may be more effective than Clomid at stimulating ovulation in women with PCOS.

Don’t be scared off by the fact that the drug is originally intended as a cancer drug. The side effects are relatively mild, and it has been heavily researched in women trying to conceive. 

If Clomid or letrozole is not successful, the next step is injectable fertility drugs or gonadotropins. Gonadotropins are made of the hormones FSH, LH, or a combination of the two. Brand names you may recognize are Gonal-F, Follistim, Ovidrel, Bravelle, and Menopur.

Your doctor may suggest a combination of oral and injectable fertility drugs. For example, Clomid with a “trigger” shot of LH mid-cycle. Another possibility is a cycle with just gonadotropins.

Or, your doctor may suggest gonadotropins with an IUI (intrauterine insemination) procedure. IUI involves placing specially washed semen directly into the uterus via a catheter. The semen may be from a sperm donor or your partner.

One of the possible risks of gonadotropins is ovarian hyperstimulation syndrome (OHSS). This is when the ovaries overreact to the fertility medication. If untreated or severe, it can be dangerous. Women with PCOS are at a higher risk of developing OHSS. Your doctor may use lower doses of the injectable fertility drugs to avoid this. Ideally, your doctor should use the lowest effective dose.

During treatment, if you have any symptoms of OHSS, make sure to tell your doctor. 

If gonadotropins are not successful, the next step is IVF or IVM.

You’ve likely already heard of IVF, or in vitro fertilization. IVF involves using injectable fertility drugs to stimulate the ovaries so that they will provide a good number of mature eggs. The eggs are retrieved from the ovaries during a procedure known as an egg retrieval. Those eggs are then placed together with sperm into Petri dishes. If all goes well, the sperm will fertilize some of the eggs.

After the fertilized eggs have had between 3 to 5 days to divide and grow, one or two are transferred into the uterus. This procedure is known as an embryo transfer. Two weeks later, your doctor will order a pregnancy test to see if the cycle was a success or not.

As with gonadotropin treatment alone, one of the risks of IVF, especially in women with PCOS, is overstimulation of the ovaries. That’s where IVM comes in.

IVM stands for in vitro maturation. Instead of giving you high doses of fertility drugs to force your ovaries to mature many eggs, with IVM you receive either no fertility drugs or very low doses. The doctor retrieves from the ovaries immature eggs, which they then mature in the lab. Hence the name in vitro (in lab) maturation (to mature).

IVM is not offered at all fertility clinics. This is something to consider when choosing a fertility clinic.

It's highly unusual for women with PCOS to require an egg donor, unless there are additional fertility issues at hand, like advanced age. However, women who have had ovarian procedures like ovarian drilling or ovarian wedge resection to treat their PCOS may have lower ovarian reserves. In this case, an egg donor may be recommended. This is one reason why surgical treatment for PCOS is not recommended.