Fertility, Pregnancy and Polycystic Ovary Syndrome

Polycystic ovary syndrome can negatively affect fertility since it can prevent ovulation. Some women with polycystic ovary syndrome have menstrual periods, but do not ovulate. A woman with polycystic ovary syndrome may be able to take fertility drugs, such as Clomid, or injectable fertility medications to induce ovulation. To help ovulation occur, women also can take insulin-sensitizing medications or steroids (to lower androgen levels). Some research also shows that taking low doses of aspirin, which helps prevent blood clotting in the uterine lining and improves blood flow, can improve chances of pregnancy.

There appears to be a higher rate of miscarriage in women with polycystic ovary syndrome (possibly by 45%). The reason for this is being studied. Elevated levels of leuteinizing hormone, which aids in secretion of progesterone, may play a role. Elevated levels of insulin and glucose may cause problems with development of the embryo. Insulin resistance and late ovulation (after day 16 of the menstrual cycle) also may reduce egg quality, which can lead to miscarriage. The best way to prevent miscarriage in women with polycystic ovary syndrome is to normalize hormone levels to improve ovulation, and normalize blood sugar, glucose, and androgen levels. Recently, more doctors are prescribing the drug metformin to help with this.

Since polycystic ovary syndrome causes high glucose levels, it can be helpful for pregnant women with polycystic ovary syndrome to have earlier screenings for gestational diabetes during pregnancy. Gestational diabetes occurs when a woman’s ability to process glucose is impaired. The baby also has trouble processing glucose, which can lead to a large baby, immature lungs, and birthing problems. Although a carefully balanced diet and/or insulin injections have been used to control gestational diabetes, there is new evidence that high insulin levels also can be damaging. Some doctors allow pregnant women with polycystic ovary syndrome to continue taking metformin in pregnancy, while others won’t prescribe it to women trying to conceive. There is no evidence that it causes birth defects, but the long-term effects on the baby are not known. Women and their doctors should discuss the risks and benefits of medications. Women taking medication usually are monitored more closely. After pregnancy, many women with polycystic ovary syndrome develop normal menstrual cycles and find it easier to become pregnant again.