Polycystic Ovarian Syndrome & Pregnancy

Pregnancy is a wonderful time of life with a mix of feelings. A healthy pregnancy is nothing less than a blessing but some gynecological disorders can seriously affect your ability to conceive.

PCOS is one of the health conditions not only decrease the chances of getting pregnant but also causes complications during pregnancy. Keep reading to know the impact of PCOS on woman health.

What is polycystic ovarian syndrome (PCOS)?

Polycystic ovarian syndrome, also known as an ovarian syndrome, is a gynecological condition in which the hormonal imbalance affects the overall health of a woman. The excess estrogen production is the hallmark of PCOS.

This excess estrogen makes it difficult for the ovaries to release eggs, as they would do every month, to keep up with a healthy menstrual cycle.

Ovaries may develop numerous small collection of fluid (follicles). 25% of the women have polycystic ovaries seen on the ultrasound, it is always not associated with the full syndrome.[1]

Why this is called syndrome?

It is called syndrome because you may have multiple symptoms and you may not have all the symptoms. One person with PCOS may have a certain set of symptoms and other women have a completely different set of symptoms but they all fit in a syndrome that has been defined as PCOS.

Sign & Symptoms of PCOS

The symptoms of PCOS may affect you differently at different stages of life. When you are a teenager, acne may freak you out. When you get older, you are uncertain about your periods’ exact timing. The sequence and occurrence of symptoms vary in different women.

Women with PCOS may experience following signs and symptoms

  1. Menstrual irregularities, periods may be irregular or absent (less than 8 per year)
  2. Hirsutism is the excessive amount of hair on face and chin and other parts of the body where men usually have hair – male pattern hair. 70% of the women with PCOS have hirsutism [2]. So you get regular appointments of laser treatment which cost you too much and you are not satisfied with your treatment which add anxiety in your life.
  3. Acne on the face, chest and upper back and oily skin is a big social problem.
  4. Hair loss: It may also cause cosmetic effects of having hair thinning and losing hair from your scalp, is the big stress for you.
  5. Subfertility: Many women with PCOS having trouble getting pregnant.
  6. Women with PCOS have an increased risk of type 2 diabetes and cardiovascular problems [3].
  7. Sleep disturbance: You may have trouble getting sleep or when you do sleep you may not feel well-rested after you wake up.
  8. Headache: Women may also complain of headaches which is due to hormonal imbalance in PCOS.
  9. Other clinical manifestations of PCOS include obesity, acanthosis nigricans (area of increased velvety skin pigmentation occur in the axillae, underneath the breast and other flexures).

PCOS may also be asymptomatic. Your risk of PCOS may be higher if you are obese and if you have mother or sister or aunt with PCOS.

PCOS & Subfertility

PCOS is the most important but treatable cause of subfertility in a woman of reproductive age. At least 75% of the women every year came in gynecological clinics due to subfertility as a cause of PCOS [4].

Androgens are also called male hormone but they are also present in small amount in all women. Women with PCOS may have more than a normal concentration of androgens in their plasma [5]. Increase amount of androgen interferes with the growth of the follicle and release of an egg [6].

The mature follicles do not rupture to release the egg rather stay in the ovary as cystic structures. This failure to release an egg is called anovulation. Anovulation leads infertility because there are no eggs released to be fertilized by a sperm.

Ovulation in PCOS women is less frequent or absent. Even if these women get pregnant, they are more prone to miscarriages, which is why PCOS is the most common cause of subfertility.

The growing cysts in the ovaries resulting in a number of effects on the hormonal levels, fertility, and weight. The increasing weight in PCOS women results in insulin resistance.

The body starts producing excess insulin to overcome insulin resistance and this excess insulin increases the androgen production, causing difficulty with ovulation [7].

How to restore fertility

If you have PCOS, it does not mean that you cannot get pregnant. Your doctor will advise methods to help you ovulate and to raise your chance of getting pregnant. Here are some ways which might help you:

Medical options:

  1. Lifestyle changes: Dietary modification and exercise are important in PCOS women as most of them are obese. Lifestyle modification helps these people to lose weight which may help them to restore their fertility. Try to take a diet which is rich in nutrients and adequate proteins. Foods which are rich in high sugar should be avoided. Avoiding junk and processed food is your best bet. Aerobic exercise has been shown to improve insulin resistance, so the ovulation.
  2. Lose weight to restart the ovulation. Moderate regular exercise can improve the fertility and chance of having a baby. Exercise is especially important for obese and overweight women with PCOS.
  3. COCP: To help regulate your periods your doctor may recommend you combined oral contraceptive pills. Cyclic oral progesterone is used to regulate withdrawal bleed.
  4. Metformin: if regular exercise is not helping, your doctors may prescribe you Metformin to help you lose weight. Metformin is used for people with PCOS to stimulate the ovulation [8].
  5. Ovulation induction: Your doctor may prescribe Clomiphene and letrozole which induce ovulation. Clomiphene blocks the body’s response to estrogen while letrozole suppresses the production of estrogen. Decrease estrogen response produces more FSH which promotes the growth of follicles within the ovary. Both medications should not be used for more than 6 months as it can hot flushes as side effects.
  6. GnRH analogues with low dose HRT: This regime should be reserved for the women intolerant of other therapies.

If all of the above options are not successful, then you can opt for surgical treatment.

Surgical Options

  1. Ovarian drilling: a laparoscopic procedure to destroy some of the ovarian stroma with heat or electrolysis or laser that may prompt ovulatory cycles.
  2. In vitro fertilization (IVF): In this procedure, the eggs are extracted from ovaries surgically and retrieve sperm sample, combined them in the test tube to create an embryo that is then transferred to the uterus.

Some herbs and dietary supplements have been shown to help with fertility.    

PCOS pregnancy complications

Women with PCOS are more prone to complications of pregnancy and delivery than women without PCOS. Pregnancy complications related to PCOS are:

  1. Miscarriage or an early loss of pregnancy: 40% to 80% PCOS women miscarry mostly in early pregnancy. 
  2. Gestational diabetes (diabetes during pregnancy) which can lead to a large hypoglycemic baby.
  3. Preeclampsia which is characterized by a sudden increase in blood pressure and body swelling after the 20th week of pregnancy [9].
  4. Preterm birth, delivery before 37 weeks of pregnancy.
  5. Cesarean or C-section delivery.

Being a healthy weight before getting pregnant and limiting the amount of weight gain during pregnancy can help avoid these complications. Your OB/GYN or fertility expert will anticipate these potential complications and will be vigilant with your pregnancy.

You may need more antenatal visits than usual to ensure the health of the baby. There are women who have had successful pregnancies with healthy babies so having PCOS is not the end of everything 🙂

References

  1. https://www.jcpsp.pk/archive/2015/Jan2015/07.pdf
  2. https://www.ncbi.nlm.nih.gov/pubmed/27510481
  3. https://www.ncbi.nlm.nih.gov/pubmed/20536945
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063802/
  5. https://www.ncbi.nlm.nih.gov/pubmed/19390322
  6. https://www.nih.gov/news-events/news-releases/gene-linked-excess-male-hormones-female-infertility-disorder
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018970/
  8. https://www.ncbi.nlm.nih.gov/pubmed/22419702
  9. https://www.ncbi.nlm.nih.gov/pubmed/18181085
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