PCOS and getting pregnant
PCOS is a common and annoying condition, especially if you want to become pregnant. In many cases PCOS is associated with a cycle disorder. Ovulation does not occur or occurs irregularly, which reduces the chance of a pregnancy. How does PCOS arise and what can you do about it?
What is PCOS?
The abbreviation PCOS stands for Poly Cysteus Ovary Syndrome. Literally translated, this means: many (poly) fluid blisters (cysts) in the ovary (ovary). It is a hormonal disorder in which there is no proper maturation of ova in the ovaries. The eggs remain at a certain maturing stage, so that there is an irregular or no ovulation at all . The consequence of this is that many women with PCOS have problems getting pregnant. It is a condition that is fairly common: about 5 to 10% of all women of childbearing age have some form of PCOS ranging from mild to severe.
Relationship with overweight
There is a clear link between body weight and the presence of PCOS. The chance increases sharply with a BMI higher than 29. Of all women who have the syndrome, 60 to 70% are overweight . Losing weight can cause the symptoms to decrease, or sometimes even disappear.
PCOS and getting pregnant
If you have PCOS and an irregular menstrual cycle, it can be a lot harder to get pregnant. With a normal menstrual cycle, one follicle (egg bubble) grows in the first half of the cycle to a size of approximately 20 millimeters. This is done under the influence of the follicle-stimulating hormone (FSH) and the routinizing hormone (LH) . This mature egg then leaves the ovary during ovulation . The egg goes through the Fallopian tube to the uterus, where it can possibly be fertilized. If you have PCOS, this process is different. A large number of follicles are present in the ovary. Because the hormones in PCOS are out of balance, these follicles do not continue to grow well. The follicles do not mature or very irregularly. As a result, ovulation does not occur or occurs irregularly. These follicles are present on the ovary as a kind of ‘beaded wreath’. This is visible with a gynecological ultrasound. Because no ovulation or irregular ovulation takes place, women with PCOS often do not have their periods for a long time. Women with a normal cycle have their period on average every 28 days, while women with PCOS often have more than six weeks between two periods. Sometimes menstruation stays away even longer than half a year, or you don’t get your period at all.
Cause of PCOS
The exact cause of PCOS is unknown, but scientists think heredity, obesity and insulin resistance play a role. PCOS mainly occurs in overweight and diabetic women, and it also appears to be a family ailment.
What is clear is that women with PCOS all have a different hormone balance, namely:
an increased value of testosterone
a too high value of the LH hormone
a slightly increased value of estrogen
a too low value of the FSH hormone, which stimulates the maturation of follicles.
and sometimes also an increased insulin value, the hormone that keeps your blood sugar level in balance.
Excess hair, baldness and acne
If you have PCOS, your ovaries can produce large amounts of the male sex hormone testosterone. In some women with PCOS there is little noticeable and the high testosterone level can only be measured with a blood test. With other women it expresses itself in over-hair, for example on the chin and upper lip, abdomen or back or on the forearms and thighs. On the other hand, some people suffer from hair loss. Acne is also a consequence of the excess testosterone.
Most women only discover that they have PCOS when they stop taking the pill and their menstrual period does not start properly, or when they try to conceive. Your natural fertility drugs is reduced due to irregular or non-recurring periods . Do you have an irregular menstrual cycle or are you not having your period? Then PCOS may be the cause, but you don’t have to. There may also be something else going on: read more about the absence of your period here . If, in addition to the irregular menstrual period, you are also suffering from over-hair, overweight or acne, then PCOS could sometimes occur. Discuss your worries about your irregular or lack of menstrual period with your doctor. By looking at your cycle, doing a blood test and making an ultrasound of your ovaries, you can determine whether you actually have PCOS. Blood tests can be used to determine whether your FSH, LH and testosterone levels differ. With the help of the ultrasound a doctor or gynecologist can see if there are many follicles in the ovaries, the aforementioned ‘beaded wreath’. If more than twelve fluid blisters are visible in one of the ovaries, this is called PCOS. For comparison: in women without PCOS there are generally three to eight vesicles in an ovary.
PCOS, what now?
Many women who are diagnosed with PCOS are worried about whether they can ever get pregnant. Fortunately, there are a number of ways to treat the condition and increase the chance of a pregnancy. 60% of women with PCOS even manage to become pregnant naturally without medical assistance. Unfortunately, that does not apply to everyone, but there are also various methods to get it done with medical supervision. If you have PCOS, that does not mean that you are infertile. It may take longer before you succeed in becoming pregnant, and you may need medical support.
Step-by-step plan at PCOS
The treatment plan consists of the following steps:
In the case of overweight: try to lose weight.
Obesity is one of the causes of PCOS. Women who are predisposed to PCOS, for example because it occurs in the family, often get the syndrome when they become overweight. Research shows that if you lose around 5 to 10% of your body weight, ovulation can already recover. Weight loss is therefore an important first step if you are struggling with PCOS and being overweight.
Stimulating ovulation with medication
If losing weight does not help to get the menstrual cycle back on track, or if you are not overweight, there are various means that can help to stimulate follicle maturation. This is also called ovulation induction . In the first instance, tablets are used for this. If that doesn’t help, injections are the next step. Women with PCOS have an average of 80% chance of becoming pregnant within a year, when ovulation with medication comes back regularly.
IUI (Intrauterine Insemination)
If after 1 year regular menstruation, no pregnancy has occurred then IUI is the following option: IUI stands for intrauterine insemination. This means that with this treatment sperm cells are inserted high into your uterus just before or after ovulation. This is often combined with injections that stimulate ovulation.
IVF or ICSI
If the above steps have not led to a pregnancy, fertility treatments such as In Vitro Fertilization (IVF) and Intra Cytoplasmic Semen Injection (ICSI) may be helpful.
The first option that is tried is treatment with clomiphene citrate tablets . These tablets ensure that more LH and FSH hormones are produced, which causes a follicle to grow in the ovary. At the start of the menstrual cycle you take the medication for five consecutive days. When a follicle is growing, it will have to continue to grow after stopping the medication, until ovulation eventually occurs. If you do not become pregnant, menstruation follows and you can swallow the tablets again the next cycle. Sometimes it is necessary to increase the dosage of the medication before it works properly. In 80% of women, menstrual periods become regular when you use these medicines. After 12 treatment, 80% of women become pregnant. Because with the help of these drugs several follicles mature at the same time, their use gives an increased chance of a multiple birth .
Cloisonne tablets do not work for some women. The next step is then treatment with hormone injections with FSH. You can administer these injections yourself: they only need to be injected just under the skin. FSH is a follicle-stimulating hormone and will stimulate a follicle to mature. The chance that several follicles mature at the same time is greater with these medicines than with taking tablets. This means strict hospital checks are necessary to control the growth of these follicles. The intention is for one follicle to mature at a time. When several follicles mature at the same time, treatment can be stopped to prevent the risk of a large multiple pregnancy.
Metformin is an agent used in the treatment of diabetes. The drug affects insulin sensitivity. A lot of research has been done into the use of Metformin in women with PCOS because many women with PCOS are also less sensitive to insulin. Women with PCOS who do not have diabetes could possibly benefit from taking misinform, often in combination with the cloisonne tablets. The studies show that the use of Metformin does not increase the chance of a pregnancy. This is the reason why it is not advised with PCOS in the Netherlands.
IUI, IVF and ICSI
If the medication does not help you become pregnant, you can opt for fertility treatment such as IUI, IVF or ICSI. Such a treatment does not guarantee pregnancy, but it does increase the chance: The chance that IUI leads to a pregnancy is around 10% per treatment. So often multiple treatments are needed. After 6 IUI treatment, 35% of women are pregnant. IVF is the next step. Of all couples undergoing IVF treatments, an average of 25 to 30% is pregnant after one treatment. If you are not yet 35 years old, the chance that you are pregnant after an attempt is around 30-40%, while after the age of 40 you have only around 10% chance.
Operation on the ovary
There are also fertility enhancing operations that can lead to an increase in ovulation: called ‘ovarian drilling’ or ‘LEO’ (Laparoscopic Electrocoagulation of the Ovaria). During this viewing operation, small holes are made in the surface of your ovary and some tissue is removed. Because the volume of the ovary is smaller after the operation and there are fewer follicles present, this causes a change in hormone production, so that ovulation occurs regularly for a large proportion of women. There are risks associated with the operation: scarring can occur around the ovaries, resulting in adhesions. This can give an increased chance of ectopic pregnancy . Unfortunately, the effect of this operation is temporary. If pregnancy is not forthcoming after this operation, menstruation will gradually become more irregular again. This method is not used in all hospitals.
Consequences of PCOS in the long term
It is important to know that PCOS also has a number of possible long-term consequences. For example, women with PCOS have an increased chance of getting later in life (usually after the transition) from:
diabetes type II (age-related diabetes)
heart and vascular disease
These problems are also related to the overweight that many women with PCOS have and the insulin resistance. That is why it is all the more important to try to get your hormone balance and blood sugar back into balance, so that you minimize the damage in the long term. Many women achieve this by losing weight until they reach a healthy BMI.