What to Know About PCOS and Pregnancy

Polycystic ovary syndrome (PCOS) typically affects people in their childbearing years. Unfortunately, hormonal imbalances caused by PCOS can interfere with fertility. However, with the help of a healthcare team, people with PCOS can still get pregnant and have a healthy pregnancy.

This article discusses how PCOS can affect fertility and pregnancy.

PCOS and Fertility

PCOS is a hormonal disorder that causes women to have infrequent or prolonged periods and to produce an excess of male hormones (androgens). It can cause irregular periods, weight gain, thinning hair and hair loss on the head, excess hair growth elsewhere on the body, and oily skin or acne.

The imbalance of reproductive hormones that develops with PCOS, along with a number of small fluid-filled cysts, can interfere with the growth and release of eggs from the ovaries (ovulation) at regular monthly intervals. This decrease—or absence—of ovulation is usually the cause of fertility issues.

Your healthcare provider may recommend that you try weight loss and other lifestyle changes before trying any medications to see if pregnancy can occur naturally. Research has shown that lifestyle changes can help restore ovulation and improve pregnancy rates among women with PCOS. 

Your healthcare provider may also prescribe one of the following treatments to help you get pregnant:

• Clomiphene: This is the most common treatment for infertility in women with PCOS and is recommended by the American College of Obstetricians and Gynecologists (ACOG). Clomiphene indirectly causes eggs to mature and be released.
• Metformin: This is not approved by the Food and Drug Administration (FDA) to treat PCOS, but it is an oral medication that can help control blood sugar levels since people with PCOS often are insulin resistant, meaning they do not use sugar in the body properly. Excess insulin can increase androgen production, causing problems with ovulation.
• Letrozole: This drug quickly slows estrogen production and causes the body to make more follicle-stimulating hormone (FSH), which is needed for ovulation.
• Gonadotropins: These hormones regulate the reproductive system and are given as shots to promote ovulation.
• Surgery: There are surgical options for PCOS, but these are usually a last resort and aren't long-term solutions. In PCOS, the cortex, or outer shell of the ovaries, becomes thickened. This can prevent ovulation. One solution is ovarian drilling, in which tiny holes are made in the surface of the ovary. This treatment can help you ovulate, but it is usually only effective for up to eight months.

PCOS and Gestation

The same issues that cause problems conceiving can create problems during pregnancy. These include altered hormone levels, obesity, and problems with blood sugar control.

Risks

Pregnant people with PCOS have higher rates of complications such as:

• Pregnancy loss
• Gestational diabetes (diabetes diagnosed in pregnancy)
• Hypertension (high blood pressure)
• Preeclampsia (complications such as hypertension, protein in the urine, severe headaches, and swelling)
• Blood clots
• Preterm birth
• Heavier babies (macrosomia)
• The need for neonatal intensive care after birth

Treatment

Generally, if you have PCOS, you will be monitored closely throughout your pregnancy for complications like gestational diabetes, high blood pressure, and the risk of preterm birth. Your healthcare provide may recommend lifestyle changes like eating a healthy diet.

Research suggests that medications to control blood sugar like insulin and metformin may also help control PCOS and prevent future complications for you and your baby.

Other suggestions your doctor may make to control PCOS throughout your pregnancy include:

• Gaining only the recommended amount of weight
• Regulating your blood sugar levels
• Taking vitamins like folic acid

Concerning Symptoms

You will be monitored for a number of complications throughout your pregnancy, and your doctor will tell you which symptoms warrant emergency care. If you have PCOS and problems with your blood sugar or blood pressure, you or your family members may want to watch for signs like:

• Sweating
• Confusion
• Dizziness
• Loss of consciousness
• Sudden headaches

These could be warning signs of hypoglycemia (decrease in blood sugar) or dangerously high blood pressure and require immediate care.

PCOS and Postpartum

Impact on Recovery

PCOS may cause long-term complications for the mother and baby. Women with PCOS are more likely to experience heart and psychiatric complications during the postpartum period. These include postpartum preeclampsia, congestive heart failure (a poorly pumping heart that causes fluid buildup in the lungs), and postpartum depression.

There are long-term developmental risks to babies as well. These include problems with the endocrine system, which regulates brain and nervous system development, and the cardiovascular system, which consists of the heart and blood vessels. Children whose mothers had PCOS may also struggle with high blood pressure, high cholesterol, and weight gain.

Breastfeeding

There is some debate about how much PCOS affects breastfeeding. It's generally accepted that hormonal imbalances from PCOS can affect milk production and make breastfeeding more difficult. However, one study suggests that it's a higher body mass index—not PCOS—that complicates breastfeeding for some mothers.

If you are having difficulty breastfeeding and you have PCOS, you can talk to your healthcare provider about nutritional support or supplements that may help.

You should also talk with your doctor about any medications you took before or during your pregnancy. Medications that may have helped you cope with PCOS before or during pregnancy could be passed on to your baby through your milk. Metformin, for example, is generally considered safe for breastfeeding mothers, but there are exceptions, including mothers of infants with poor kidney function.

Summary

PCOS can interfere with ovulation and make getting pregnant more difficult, but your doctor can recommend the appropriate lifestyle changes. Once you become pregnant, it's important to work with your doctor to keep your condition under control and minimize complications. This should continue during the postpartum period because people with PCOS are at higher risk of heart and psychiatric complications after delivery.

A Word From Verywell

PCOS is a condition that causes a hormonal imbalance. This can affect your ovaries and ovulation, making it more difficult to become pregnant. However, certain lifestyle changes and medications can help you conceive. A healthy diet and regular exercise can go a long way toward helping you reduce complications of PCOS during and after your pregnancy.

Frequently Asked Questions

When should you take a pregnancy test with PCOS?

With or without PCOS, it can take several days to a week after conception for your hormone levels to rise enough to be detected on a home pregnancy test. Follow the manufacturer's instructions on your test, but generally it's best to wait about a week after your missed period. If you have irregular or missed periods because of PCOS, you may want to track your ovulation and conception attempts, taking tests accordingly about two to three weeks after conception.

How can PCOS affect pregnancy?

PCOS can make it difficult to get pregnant because it can affect how you ovulate. During pregnancy, altered hormone levels and metabolism could cause challenges for both you and your baby. If you have PCOS, you may be monitored during your pregnancy for conditions like high blood pressure and gestational diabetes.

When do you stop metformin during pregnancy if you have PCOS?

Talk to your doctor about what medications are appropriate to take during your pregnancy. For example, many women continue to use metformin to control their blood sugar throughout their pregnancy. However, they may stop using it or use it under careful supervision while breastfeeding because low levels can be passed on to their baby through breast milk.

What precautions should you take during pregnancy with PCOS?

Managing your blood sugar with a healthy diet and exercise and possibly medications is key. You should talk to your doctor about what diet and exercise regimen may be best for you during pregnancy. You should also have your blood pressure checked regularly and take supplements like folic acid as directed.