Many women are diagnosed with PCOS, and worry about them being infertile and not being able to get pregnant. However, the truth is PCOS does not make you infertile. There are plenty of treatment options that your doctor can suggest to improve your chances of conceiving.
However, with PCOS, not just getting pregnant but there can also be complications in staying pregnant if the underlying hormonal imbalances are not corrected beforehand. This makes it important to work closely with your doctor and have your pregnancy monitored closely.
Fertility and PCOS
PCOS can reduce fertility in some women which can make it difficult to get pregnant. The underlying hormonal imbalance of two hormones – androgen and insulin levels can affect your menstrual and ovulation cycle.
In a regular menstrual cycle, which can range from 28 to 32 days, ovulation usually occurs 14 days before your next period starts, in a 28-day cycle.
Ovulation occurs once a month and is the process of release of a mature egg from the ovary.
This egg then travels to the uterus to be fertilized by a sperm, if sexual intercourse has taken place. If not, the endometrial or uterine wall is shed, which is called menstruation.
In PCOS specifically, due to the elevated levels of hormones, the follicles (fluid-filled sac which contains an immature egg) don’t get the right amount of stimulation for it to grow and release an egg. This leads to many immature and small follicles developing on the ovary. In an ultrasound scan, this is often seen as ‘cysts’ which are nothing but follicles that failed to mature.
PCOS can make your cycles anovulatory which means ovulation does not occur on a regular basis. Ovulation can either entirely stop or become irregular. This can make it difficult for women to get pregnant because, without ovulation, no egg is released for fertilization.
Gestation and PCOS
The same factors that make it difficult for women with PCOS to get pregnant can also cause problems during pregnancy. Women with PCOS have a higher risk of developing certain complications during pregnancy as opposed to women without PCOS. This is mainly because of the hormonal imbalances in androgen and insulin levels that can increase the risk of complications that can affect both the mother and the baby.
Some of the pregnancy complications include:
- Gestational diabetes: Many women with PCOS struggle with insulin resistance – the risk of developing gestational diabetes increases because of this. The risk can also increase if you are overweight during pregnancy. Although women can recover from gestational diabetes once the baby is born, they can still be at a higher risk of developing type 2 diabetes later in life if lifestyle changes are not followed
- Miscarriage: Women with PCOS have a higher risk of having a miscarriage or an early loss of a pregnancy during the first trimester. Although you cannot prevent a miscarriage from happening, following a healthy lifestyle before and even during pregnancy can help reduce the risk of a miscarriage.
- Preeclampsia: This is characterized by a sudden increase in blood pressure which can affect the brain, kidneys, and liver. Preeclampsia can be dangerous to both the mother and the baby
- High blood pressure: Increase in blood pressure can lead to preeclampsia, if not treated on time. This can also affect the mother and the baby during delivery
- Preterm birth: Preterm birth is considered if the baby is born before 37 weeks of pregnancy. Premature babies maybe at risk of developing health problems later in life
How PCOS is affecting a woman’s postpartum
Even after pregnancy, it is important to take care of your PCOS symptoms and continue to follow a healthy lifestyle. This is because women with PCOS may experience complications during their postpartum periods such as postpartum depression, gestational diabetes, or high blood pressure.
Although many women with PCOS have no problem with milk supply while breastfeeding – some women have reported issues with low milk supply. Certain studies have reported that hormonal imbalances and high body mass index (BMI) can complicate breastfeeding in some mothers with PCOS. In such cases, speak to a doctor about some of the strategies you can adopt to improve milk supply. Usually, nutritional support and supplementation can help improve milk supply. Also, inform your doctor of any medications that you took during pregnancy that could be passed on to your baby through breastfeeding. Although medications like metformin are generally considered safe, it is best to discuss this with your doctor too.
How to ensure a healthy pregnancy with PCOS
Before you plan on starting a family with PCOS, it is important to first treat the underlying hormonal imbalance. Insulin resistance can not only affect androgen levels but also put you at risk of developing gestational diabetes. Although your doctor will advise you on what is the best treatment plan and closely monitor your pregnancy, here are certain things you can do to ensure a healthy pregnancy with PCOS:
Since women with PCOS are at a higher risk of developing gestational diabetes, one of the ways to manage it is by eating a balanced and healthy diet. With or without PCOS – eating well is one of the best things you can do to maintain a healthy pregnancy. The best foods for PCOS are the ones that can help control your hormonal imbalance. Your diet should be composed of whole grains, proteins, fruits, vegetables, and dietary fiber. Eat small meals throughout the day to maintain blood glucose levels. Avoid having processed, packaged, sugary, or unpasteurized foods.
If you are healthy and your pregnancy is normal, doing regular exercise can help in maintaining weight, reduce the risk of gestational diabetes, eases back pain, and improves your overall fitness levels. It is recommended to get at least 30 minutes of exercise every day. Walking, swimming, modified yoga, and stationary cycling are great low-impact workouts. Avoid any activity that puts you at risk of falling, or puts pressure on your abdomen.
Most doctors prescribe prenatal supplements before conception or shortly afterward to meet any nutritional deficiencies. However, they are never a replacement for a healthy diet. An important supplement that all women are asked to take is folic acid. Folic acid supplementation helps prevent birth defects of the brain and spinal cord. Other important prenatal vitamins include iron, vitamin D, vitamin C, and calcium.
Managing your stress and sleep is equally important to control PCOS symptoms. Ding yoga, meditation, and practicing mindfulness, can all help lower the stress hormones and help in your PCOS journey. Getting 7 to 8 hours of quality sleep each night also helps your body recover from stress and improves your overall health
Every woman is individual in her experience and every pregnancy will be different too. How PCOS can affect a woman during pregnancy may look different in different women. But making the required lifestyle changes and taking medications where required is important for managing PCOS. Proper PCOS management can greatly reduce the risk of developing complications during and even after pregnancy.