PCOS and Getting Pregnant: Proven Steps That Help You Conceive

Polycystic ovary syndrome (PCOS) affects roughly one in ten women of reproductive age, and the World Health Organization estimates that up to 70% of them have never been diagnosed. It is also the most common cause of irregular ovulation, which is why many women first hear the term at a fertility clinic. The encouraging news is that PCOS and getting pregnant can go together. Most women with the condition do conceive, often with simple treatment.

What PCOS is

PCOS is a hormonal condition. The ovaries produce higher levels of androgens, and the body often responds poorly to insulin. As a result, eggs do not mature and release on a regular schedule.

Doctors diagnose it when two of these three features are present:

• Irregular or absent periods
• Signs of high androgens, such as excess facial or body hair, acne or thinning scalp hair
• Polycystic ovaries on an ultrasound scan

The name is misleading. The “cysts” are small, immature follicles, not growths that need surgery. PCOS runs in families. It is not caused by anything you did, and it is not a curse.

Signs that you might have PCOS

Many women live with PCOS for years before anyone names it. Common signs are:

• Periods that have been irregular since the teenage years
• Coarse hair on the chin, upper lip, chest or abdomen
• Persistent acne beyond adolescence
• Weight gain around the waist, or difficulty losing weight
• Dark, velvety patches of skin on the neck or in the armpits
• Thinning hair on the scalp

However, slim women can have PCOS too. To confirm the diagnosis, a doctor will order hormone tests, a blood sugar test and a pelvic scan. Thyroid problems and a raised prolactin level cause similar symptoms, so these are checked at the same time.

How PCOS affects fertility

Without ovulation, there is no egg to fertilise. Fewer than eight periods a year, or cycles longer than 35 days, suggest that you are not ovulating regularly. However, the eggs and the womb are usually healthy. That is exactly why treatment works so well.

PCOS and getting pregnant: six steps that work

• Start with lifestyle. If you are overweight, losing 5 to 10% of your body weight can restore ovulation. Regular exercise and fewer sugary drinks and refined carbohydrates improve insulin response, even without weight loss.

• Take folic acid. Begin a daily supplement at least three months before trying to conceive.

• Confirm ovulation. Home ovulation kits can mislead in PCOS. Instead, your doctor can check with a blood test or scan.

• Use ovulation tablets. Letrozole is now the recommended first choice, and clomiphene is an alternative. You take them for five days early in the cycle, under a doctor’s supervision.

• Consider metformin. It may be added, especially if you have insulin resistance.

• Move to the next stage if needed. Options include hormone injections, a minor ovarian procedure or IVF.

In addition, both partners should be assessed. A semen analysis and a check of the fallopian tubes prevent months of treatment aimed at the wrong problem.

What to expect from ovulation tablets

 

For most women, tablets are the first medical step in PCOS and getting pregnant. Here is how a typical cycle works. You take the tablets for five days, starting early in your period. The doctor then arranges one or two scans to see whether a follicle is growing. Once it is ready, you are advised when to have intercourse.

Most women ovulate on these medicines, and many conceive within three to six cycles. Side effects are usually mild and include hot flushes, headaches and mood changes. There is also a small increase in the chance of twins.

A warning is needed here. Clomiphene is widely sold over the counter in Nigeria, and many women take it without supervision. This is risky. It may be the wrong treatment if the tubes are blocked or the partner’s sperm count is low. It can also over-stimulate the ovaries, and using it for too many cycles lowers the chance of success.

Eating and moving for better ovulation

No single diet treats PCOS. Instead, the aim is steadier blood sugar and a healthy weight, both of which help with PCOS and getting pregnant.

• Reduce refined carbohydrates. Cut back on sugary drinks, white bread, pastries and very large portions of white rice, garri or pounded yam.
• Fill up on fibre and protein. Beans, vegetables, oats, brown rice, eggs and fish keep you full for longer.
• Do not skip meals. Long gaps lead to overeating later.
• Move for 150 minutes a week. Brisk walking counts, and adding strength exercises twice a week improves the effect.
• Protect your sleep. Poor sleep worsens insulin resistance.

Aim for gradual change. Losing about 5% of your weight over six months is realistic and effective. Avoid slimming teas and crash diets, which disturb the cycle further.

When to see a specialist

The usual advice is to seek help after 12 months of trying if you are under 35, or after six months if you are 35 or older. However, if your periods are irregular or absent, do not wait. See a doctor as soon as you decide to try for a baby.

Pregnancy with PCOS

Women with PCOS have a higher chance of diabetes in pregnancy, high blood pressure and premature birth. Therefore, book antenatal care early and ask about a glucose test. With good care, most women deliver healthy babies.

The emotional side

The journey of PCOS and getting pregnant affects more than the body. Anxiety and low mood are more common in women with the condition. Unwanted hair, acne and weight gain can damage confidence. On top of this, questions from relatives about when a baby is coming add pressure every month.

These feelings are valid, and they deserve attention. Talk openly with your partner, and consider a support group or counsellor. Involving your partner in clinic visits also helps, because the journey is a shared one.

Timing when cycles are irregular

Calendar methods work poorly when periods are unpredictable. A simpler approach is to have intercourse every two to three days throughout the cycle. This ensures that sperm are present whenever ovulation happens. It also removes the stress of trying to identify a single “right” day.

Three myths to ignore

Misinformation about PCOS and getting pregnant is everywhere, so be careful what you believe.

“PCOS means you cannot have children.” This is false. Most women with PCOS become mothers.

“Herbal cleansers will dissolve the cysts.” There is no evidence that any womb flush or herbal mixture treats PCOS. Some of them damage the liver and kidneys, and all of them cost you time.

“The pill causes infertility.” It does not. The contraceptive pill regulates periods, and fertility returns after you stop taking it.

Looking after the rest of your health

PCOS is a lifelong condition, not only a fertility issue. It raises the risk of type 2 diabetes, high blood pressure and low mood. For that reason, check your blood sugar and blood pressure regularly, even after you have completed your family.

Frequently asked questions

Can I get pregnant naturally with PCOS?

Yes. Many women do, especially those who ovulate some of the time. It may simply take longer.

Is metformin enough on its own?

Sometimes. It can restore ovulation in some women, but ovulation tablets are more effective when pregnancy is the goal.

Does PCOS increase the risk of miscarriage?

The risk is somewhat higher, largely because of excess weight and insulin resistance. Good control before conception lowers it.

Will PCOS go away after I have a baby?

No. It is a lifelong tendency, although symptoms often change with age and may ease after pregnancy.

How long should I try before moving to IVF?

That depends on your age and the other test results. Many couples try ovulation tablets for up to six cycles before discussing the next step.

A realistic outlook

PCOS and getting pregnant is a challenge with well-tested solutions. Get a proper diagnosis, have both partners assessed and follow each step under medical supervision. Most women who do this go on to hold their own baby.

Getting help

If questions about PCOS and getting pregnant are on your mind, you do not have to carry them alone. HubPharm pharmacists support women on fertility medicines every day, with discreet delivery and clear dosing guidance. Read more about female fertility, or see the World Health Organization’s PCOS fact sheet.