PCOS and Pregnancy: Embracing the Unique Path to Motherhood

Polycystic Ovary Syndrome (PCOS) is a common, if complex, hormonal disorder affecting people with ovaries, primarily during their reproductive years, that can cause infertility and impact overall physical and emotional well-being. Characterized by a constellation of symptoms, including irregular or absent ovulation, PCOS is a global public health concern that affects 5-15% of women and people assigned female at birth (AFAB). Strikingly, according to the best available estimates, 50-70% of women with PCOS remain undiagnosed—and suffer unnecessarily because of it.

Hopefully these numbers get your attention. Many people are struggling with PCOS—including struggling to get pregnant and get answers—and the social stigma its diagnosis often carries. But if you learn one thing from this article, let it be this: while PCOS is one of the leading causes of infertility and isn’t curable, it is manageable and treatable. You can get pregnant if you have PCOS. You can have a healthy pregnancy. And you can deliver a healthy baby.

At Tia, our team of collaborative care experts understands the unique needs of people with PCOS and the importance of personalized care that empowers women to navigate their fertility journeys on their terms and without pressure, fear, or judgment. Keep reading to learn more about PCOS and Tia’s holistic, personalized approach to this notoriously complicated condition.

Understanding PCOS and its effects on pregnancy

PCOS is a common endocrine disorder that disrupts the delicate balance of hormones involved in ovulation and menstruation, and it manifests with a combination of symptoms related to these hormonal imbalances. PCOS is characterized by irregular or absent menstrual cycles, elevated androgen levels (a male sex hormone present in small amounts in women), and the presence of numerous small cysts on the ovaries. Despite its name, not all women with PCOS develop ovarian cysts. And, confusingly, some women with ovarian cysts don’t meet the diagnostic criteria for PCOS.

While the exact cause of PCOS remains unclear, it likely involves a combination of genetic and environmental factors, including insulin resistance and inflammation. Importantly, women with a family history of PCOS or type 2 diabetes seem to be at a higher risk for developing PCOS.

One hallmark feature of PCOS is its significant impact on fertility. The hormonal imbalances seen in PCOS often disrupt the normal ovulatory process, which leads to irregular or absent ovulation. Since ovulation is the process that releases a mature egg from the ovaries and makes it available for fertilization by sperm, it’s easy to understand why unpredictable or absent ovulation makes pregnancy difficult, if not impossible, to achieve without proper counseling and treatment.

Besides infertility, PCOS can present with several other symptoms:

• Irregular menstrual cycles. Women with PCOS might have missed, unpredictable, or absent periods—though it’s not uncommon for them to experience heavy and long periods as well.
• Hirsutism. Excessive hair on the face, chin, chest, back, or parts of the body where men usually have hair is often seen in people with PCOS.
• Acne and/or male-pattern baldness. Hirsutism, acne, and male-pattern baldness are most likely due to excess androgen levels that often accompany PCOS.
• Weight gain, especially around the belly.
• Polycystic ovaries that might feel large on exam or appear large on imaging.
• Skin tags or small pieces of excess skin on the neck or armpits.
• Dark or thick patches of skin particularly along neck creases, in the groin area, in the armpits, or underneath the breasts.

With appropriate medical management aimed at reducing symptoms and improving ovulation, women with PCOS can get pregnant—but they may face certain challenges during pregnancy that require careful monitoring and possible medical intervention.

Some of the potential complications associated with pregnancy in women with PCOS:

• Gestational diabetes. People with PCOS have an increased risk of developing gestational diabetes. While poorly understood, researchers postulate that fluctuating hormones caused by pregnancy make it more difficult for the body to process blood sugar effectively.
• Preeclampisa. There’s a strong association between PCOS and preeclampsia, a potentially dangerous condition characterized by high blood pressure and proteins in the urine, which can cause organ damage. Regular prenatal visits and routine monitoring are crucial to protect both the parent and baby and prevent preeclampsia from developing into a life-threatening condition called eclampsia.
• Preterm birth. There is an increased risk of preterm birth in women with PCOS.
• Miscarriage. People with PCOS have a slightly higher risk of miscarriage compared to those without the condition.
• Increased C-section rates. Those diagnosed with PCOS have a higher likelihood of delivering via Cesarean section, often due to complications related to gestational diabetes, preeclampsia, and fetal distress.
• Neonatal complications. Babies whose parents have PCOS often experience complications, like respiratory distress syndrome, that necessitate admission to the neonatal intensive care unit.
• Long-term health implications. Children born to parents with PCOS have a higher risk of developing certain chronic health conditions later in life, such as obesity and diabetes.

Optimizing fertility with PCOS

Not everyone with PCOS will experience these complications, and it’s worth repeating that many women with PCOS have successful, healthy pregnancies. Thankfully, there are several commonsense and effective strategies, including lifestyle modifications and medications, that can greatly increase the likelihood of ovulating and becoming pregnant if you suffer from PCOS.

Lifestyle modifications almost always begin with getting regular exercise and eating a healthy diet, generally full of protein-rich, low-carbohydrate foods; high-fiber fruits and vegetables; whole grains; and healthy fats and oils. Cutting out caffeine, nicotine, and alcohol are also common recommendations. Weight management through exercise and dietary changes can vastly improve insulin sensitivity and hormonal imbalances, stabilize blood sugar levels, and make fertility easier to achieve, often without additional intervention.

When lifestyle changes alone don’t lead to pregnancy, healthcare providers often recommend medication to improve fertility and promote ovulation, including metformin and/or clomiphene citrate (Clomid) alone or in combination. Metformin, an insulin-lowering drug and mainstay in type 2 diabetes management, has been shown to improve fertility and ovulation, and reverse endocrine abnormalities in women with PCOS. .Metformin is also a drug-of-choice for women with PCOS because it also has positive effects on other PCOS symptoms, including menstrual irregularities, anovulation (lack of ovulation), hirsutism, and obesity. And during pregnancy, metformin might also be protective against insulin resistance, gestational diabetes, and a first trimester pregnancy loss. Clomiphene citrate (Clomid) is an important ovulation induction agent that works by stimulating hormones necessary for follicle development. Letrozole, another medication that induces ovulation, is sometimes used when clomiphene citrate is ineffective.

Seeking preconception care

As always, it’s important for people with PCOS to consult with an experienced and trustworthy healthcare provider before trying to conceive. Your provider can help assess your fertility status, manage PCOS symptoms, and address underlying health conditions to improve your chances of getting pregnant, staying pregnant, and having a healthy pregnancy. And since PCOS is associated with other long-term health risks, like type 2 diabetes, endometrial cancer, and cardiovascular disease, it’s even more critical for these people to share their fertility journeys and health histories with their provider before conception so they can make the best and most informed decisions about their health and care.

Pregnancy care for people with PCOS

Close collaboration with a healthcare provider, strict adherence to prenatal care, lifestyle management, and taking a prenatal vitamin that offers folic acid are key components of ensuring a healthy pregnancy for women with PCOS. Since women with PCOS who become pregnant are more vulnerable to certain pregnancy-related complications, like gestational diabetes and preeclampsia, regular prenatal office visits and routine screenings are essential for recognizing the earliest signs of these conditions. Your care team will closely monitor your blood pressure, blood glucose levels, and weight gain, measure the progression of your pregnancy, and address any issues that might contribute to miscarriage or preterm labor.

Next steps for PCOS treatment

PCOS is a complex and prevalent condition that requires a comprehensive and personalized approach. The impact of PCOS extends beyond the bounds of reproductive health, it impacts metabolic and cardiovascular health too. Some symptoms, like infertility, obesity, and unwanted hair growth, can lead to social stigma and even cause anxiety and depression. Consultation with a healthcare provider or fertility specialist is essential for a thorough evaluation, diagnosis, and a personalized treatment plan aimed at restoring hormonal balance, managing symptoms, and regulating ovulation.

So, whether you’re already pregnant, trying, undecided, or not planning to have kids, your journey matters—and so does your story.