Many women who have problems getting pregnant can trace them back to polycystic ovary syndrome, or PCOS. Understood to be the most common female hormone condition  affecting 1 in 10 women in the UK, it has been identified since 1935 and one particular presentation of the condition was formerly known as Stein-Leventhal syndrome.
With its name referring to the surplus of ‘cysts’ in each ovary that characterises the condition ( many more than in ovaries without PCOS), it can be a confusing term – as the ‘cysts’ in question are not cysts at all but simply immature follicles (that contain the eggs) which do not develop to maturity. This confusion is enough to prompt ongoing calls for the name to be changed .
Despite the difficulties in becoming pregnant with the condition, it is common for women with PCOS to become pregnant with the right treatment. Here, the experts at Fertility Family not only explain the basics of PCOS and how it affects fertility but offer answers and practical advice for before and after becoming pregnant with PCOS.
What are the symptoms of PCOS?
According to the NHS, there are three main ways  in which PCOS tends to manifest itself in women. These are:
- Irregular or infrequent periods, meaning that your ovaries do not regularly release eggs
- Higher-than-average production of androgen, a ‘male’ hormone that may cause physical symptoms such as excessive body hair
- Polycystic ovaries, which are enlarged and contain many of the fluid-filled follicles (sacs) mentioned above
The presence of at least two of these signs may lead to a diagnosis of PCOS, but in addition, PCOS can also cause symptoms including weight gain, inappropriate hair distribution (unwanted hair growth, thinning hair or hair loss), and oily skin. PCOS may also be associated with other health problems such as type 2 diabetes in later life.
What impact does PCOS have on pregnancy?
As part of the menstrual cycle, follicle-stimulating hormone (FSH) is secreted by the brain and selects one of the follicles within the ovary to mature and ovulate, eventually releasing an egg. However, follicles do not mature with PCOS, instead accumulating without maturing – meaning that ovulation does not take place when it should. This is why PCOS causes difficulties getting pregnant.
What happens if you have PCOS and go off birth control?
There are a number of things that may happen when you come off birth control pills if you have PCOS. Your periods may return to an irregular pattern that you may have seen previously , and other PCOS symptoms may worsen. Birth control helps to balance out hormone levels in the body, and stopping it may reintroduce the types of hormonal imbalance that are characteristic of PCOS and can manifest themselves in physical changes.
How does PCOS affect ovulation tests?
With PCOS, ovulation tests are much more likely to give an inaccurate result , as they are not designed to account for the irregularities that can be caused by a condition like PCOS. Because of the hormonal imbalances it causes, women with PCOS can have a consistently high level of LH (luteinizing hormone), which means the surges in LH that are usually detected by ovulation tests may not be accurate.
How to prevent miscarriages with PCOS
It is often difficult to determine the causes of miscarriage in women with PCOS or otherwise, but one possible cause can be the types of hormonal imbalance associated with the condition. Studies show that miscarriages occur in roughly 30 to 50% of women with PCOS compared with 10 to 15% of women without PCOS.
While there is no single prevention method, making the same kinds of lifestyle changes – such as increased exercise and a balanced diet that increase the chance of pregnancy with PCOS may also help to decrease the risk of miscarriage.
When to take a pregnancy test with PCOS
Many of the symptoms that indicate pregnancy are similar to those that come from the onset of a period – with the exception, of course, of the missed period which is the key sign. However, if you have irregular periods due to PCOS you may not have these indicative symptoms.
If you have PCOS it is not advisable to take an ‘early result’ pregnancy test as false negatives with these can be relatively common. If you had unprotected sex two to three weeks ago and have not had a period, it is worth taking a test even if you are not expecting a period or have not had one for a long time.
What estrogen levels do women with PCOS have?
One of the problems caused by PCOS is a hormonal imbalance, which can manifest itself in a number of ways such as a surplus of androgen. For this reason, it is surprising to note that estrogen levels for those with PCOS can often be within the normal range for a post-pubescent and premenopausal woman.
Getting pregnant with PCOS if you are overweight
Getting pregnant is by no means impossible for women with PCOS but there are a number of factors that can make it more difficult, and one of these is your weight. Hormonal imbalance can contribute to weight gain, but losing weight with PCOS can make it that bit easier to conceive.
There are a number of changes to your diet that you can make in order to help you lose weight:
- Reducing carbohydrate intake via a low-glycemic index diet that can help balance insulin levels – cutting out bread, white rice and processed cereals
- Eating more at breakfast time than at dinner time
- Including lean protein and healthy fats (nuts, seeds, olive oil, oily fish)
- Including fibre, non-starchy vegetables and fruit
Increasing your exercise – even just taking a brisk walk each day – can make a real difference too.
PCOS after pregnancy
Much of the advice and coverage around PCOS is focused on getting pregnant, but what happens to your PCOS symptoms after pregnancy?
It is important to remember that some of the symptoms of PCOS, such as hormonal imbalance and associated weight gain, can return and even worsen after pregnancy – and that being pregnant and successfully giving birth does not mean that PCOS has gone away.
For this reason, it is especially important to maintain a healthy weight and diet during pregnancy in order to prevent these from spiraling during the postpartum phase and making insulin resistance a bigger problem. PCOS women have a higher risk of developing gestational diabetes (diabetes during pregnancy).
PCOS is a lifelong but highly manageable condition, and if you have any concerns you should seek medical advice from your GP.