Polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility, affecting about 5 million women. But you maybe pregnant with PCOS. There are several 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 majority will get pregnant using lower-tech fertility treatments.
Lose weight to restart ovulation
Many (but not all) women with PCOS struggle with obesity. This is because PCOS negatively affects the way your body processes insulin, which, in turn, can cause weight gain.
One of the main reasons women with PCOS can’t conceive is that they don’t ovulate or don’t ovulate regularly. Women with PCOS who are overweight are more likely to experience severe ovulation, which lasts months between periods.
Studies have found that losing weight can bring ovulation back. According to research, losing 5% to 10% of your current weight may be enough to start your period.
Unfortunately, there’s not much evidence that losing weight will help you conceive on your own. You may still need fertility drugs. Research has found that women who lose weight have a better chance of successful infertility treatment.
Losing weight is not easy for anyone and can be even more difficult for people with PCOS. Also, not all women with PCOS are overweight. If that’s your situation, losing weight is not a solution to help increase fertility.
Diet, exercise and PCOS
Eating a healthy diet is important for women with PCOS. This is partly due to their higher risk of being overweight, and partly because their bodies have trouble regulating insulin. Is there a best diet for PCOS? That is a matter of debate.
Several studies have stated that a low carb diet is the best diet for PCOS,but other studies have not found an advantage of low-carb. The most important thing is to make sure your diet is rich in nutrient-dense foods, with enough protein, and low in foods high in sugar. Avoiding junk food and processed foods is your best bet.
Fertility-friendly eating tips for PCOS
- Eat a larger breakfast and a smaller dinner.
- Add more protein and green vegetables.
- When you eat carbohydrates, turn them into complex carbs (like whole grains and beans).
- If you eat sweets or high-carb foods, pair it with healthy fats (avocados, olive oil, nuts) or protein to slow sugar spikes.
Regular exercise has also been found to help reduce PCOS symptoms. In one study, a combination of regular brisk walking and a healthier diet improved menstrual cycle regularity by 50%.
Whether diet and exercise will help you conceive is still unclear. However, a healthy lifestyle can help your fertility treatments work better and it will certainly help you feel better overall. Like losing weight, you have to put in a lot of effort if you want to get pregnant.
Some people with PCOS will need medication to treat the condition and/or to help them conceive.
Ask your doctor to check your insulin levels. If you are insulin resistant, taking the diabetes drug metformin can treat insulin resistance and may help you lose weight. It can also help you conceive.
Metformin is sometimes prescribed to people with PCOS even if they are not truly insulin resistant. Using metformin for PCOS is considered off-label use. However, the pill is relatively safe and can help you conceive. According to research, metformin can:
- Promote weight loss
- Restart your menstrual cycle
- Improves the effectiveness of some fertility drugs
- Reduced miscarriage rate (in people with multiple miscarriages)
Can metformin alone help you get pregnant? This is unlikely to happen. While earlier research found that metformin increased the odds of women ovulating on their own, further studies have not found an increase in pregnancy or live birth rates. In other words, an improvement in ovulation does not lead to an increase in fertility.
Overall, Clomid is the most commonly used fertility drug and also the most commonly used treatment for women with PCOS. Many women with PCOS will conceive with Clomid.
Unfortunately, it doesn’t work out for everyone. Some women with PCOS will develop resistance to Clomid. This is when Clomid doesn’t trigger ovulation as expected. Studies have found that the combination of metformin and Clomid can help defeat Clomid resistance.
If metformin and Clomid are unsuccessful, your doctor may consider letrozole. Also known by the brand name Femara, it is not an aid in fertility but is commonly used as a medication in women with PCOS. Letrozole is actually a cancer treatment drug. However, studies have found that it may be more effective than Clomid at stimulating ovulation in women with PCOS.
Don’t be alarmed by the fact that this drug was originally intended as a cancer treatment. The side effects are relatively mild and it has been well studied in women trying to conceive.
If Clomid or letrozole is unsuccessful, the next step is an injection of fertility drugs or gonadotropins. Gonadotropins are made from the hormones FSH, LH, or a combination of the two. Brand names you might recognize are Gonal-F, Follistim, Ovidrel, Bravelle and Menopur.
Your doctor may recommend a combination of oral and injectable fertility drugs (for example, Clomid with a midcycle LH trigger injection). Another possibility is a cycle with only gonadotropins.
Or, your doctor may recommend gonadotropins with an IUI (intrauterine insemination) procedure. IUI involves placing specially washed semen directly into the uterus through a catheter. Semen can be from a sperm donor or your sexual partner.
One of the possible risks of gonadotropins is ovarian hyperstimulation syndrome (OHSS). This is when the ovaries overreact to fertility drugs. If left untreated or severe it can be dangerous. Women with PCOS have a higher risk of developing OHSS.
Your doctor may use lower doses of fertility drugs to avoid this. Ideally, your doctor should use the lowest effective dose. During treatment, if you have any symptoms of OHSS (such as rapid weight gain, abdominal pain, bloating, or nausea), tell your doctor.
If gonadotropins are unsuccessful, the next step is IVF (in vitro fertilization) or IVM (in vitro maturation). You may have heard of IVF. It involves the use of injectable fertility drugs to stimulate the ovaries so that they produce a good number of mature eggs. Eggs are taken from the ovaries in a process called egg retrieval.
Those eggs are then placed with the sperm in a Petri dish. If all goes well, the sperm will fertilize some eggs. After the fertilized egg has three to five days to divide and develop, one or two will be transferred to the uterus. This procedure is called an embryo transfer. Two weeks later, your doctor will ask you to take a pregnancy test to see if your cycle was successful.
As with gonadotropin-only treatment, 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 grown in a test tube. Instead of giving you high doses of fertility drugs to force your ovaries to mature into many eggs, with IVM you won’t get fertility drugs or very low doses. The doctor takes immature eggs from the ovaries, and then matures these eggs in the laboratory. IVM is not offered in all fertility clinics. This is something to consider when choosing a fertility clinic.
Will you need an egg donor?
It is very unusual for women with PCOS to ask for an egg donor, unless there are additional fertility-related problems, such as advanced age. However, women who have had procedures such as ovarian drilling or ovariectomy to treat PCOS may have lower ovarian reserves.In this case, an egg donor may be needed. This is one reason why surgical treatment for PCOS is not recommended.
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