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The challenge of pregnancy with PCOS

September is PCOS Awareness Month and we are encouraging you to share your knowledge of PCOS (polycystic ovarian syndrome) with others. Last week we took an overview of PCOS and touched briefly on PCOS and pregnancy. Today we delve deeper into the treatment options to achieve pregnancy.

PCOS is the most common hormonal disturbance to affect women, with some studies indicating that it affects 20-30% of women. For women who aren’t ovulating but haven’t hit the menopause, experts believe 90% may have PCOS.

How does PCOS affect fertility?

Ovaries contain thousands of eggs, which diminish over time and each egg is enclosed in its own little cyst. If a woman’s menstrual cycle is regular, one of these cysts will release an egg once a month. With PCOS eggs do not reach mature size and ovulation does not occur. The ovaries also produce higher amounts of male sex hormones, causing skin excess body and facial hair. The biggest problem in terms of fertility is the lack of ovulation.

A PCOS diagnosis is not all bad news. If you are in your 20’s/30’s and are in a normal weight range then you have a good chance of conceiving. However, you will need guidance, advice, appropriate treatment and care along the journey to parenthood.

Lifestyle

There are two main issues to consider in this area weight and physical exercise:

  • Weight: One of the challenges of PCOS is that it affects metabolism, causing weight gain. So it is important to take advice on diet
  • Exercise: an exercise regime can speed up metabolism and help with diet to achieve and maintain a healthy weight. Ideally, 30 minutes of vigorous exercise, 6 times per week, should be the target. 

Medical intervention

The first medical treatment step for PCOS sufferers who are not ovulating is to ensure two things:

  • To check that the female fallopian tubes are open
  • To check that the male partner’s sperm is of the right quality

Stimulating ovulation

PCOS patients that are not ovulating can take medication such as clomiphene or letrozole. This works for around 75% of PCOS patients. This provides those 75% with the same chance of conceiving as women without PCOS!

Hormone injections

There is also the option of hormone injections for those PCOS patients who do respond to the ovulation-stimulating medication. These are taken daily and monitored by your healthcare professional. This method is successful in inducing ovulation in 80% of women who did not respond to the initial medication.

Ovarian diathermy

Surgery is another option that is used occasionally. Keyhole surgery can destroy the tissue in the ovary responsible for production of male hormones. This can also result in ovulation success in up to 80% of PCOS patients.

IVF

Only 5% of PCOS sufferers will actually need IVF, and this is only considered when all other treatment options have been exhausted.

Conceiving isn’t the end of the story as there are other considerations for PCOS sufferers once pregnancy is underway. Your healthcare provider will devise a specialist treatment plan for your entire pregnancy.

A diagnosis of PCOS need not be the end of your dreams of parenthood.

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