Women with PCOS
Fertility for Women with PCOS, continued
What are the treatment options for women with PCOS who want to have a baby?
It is possible for women with PCOS to get pregnant—sometimes naturally, sometimes with help. The number-one recommendation of health care providers for women with PCOS is lifestyle changes, such as eating a lower calorie diet, losing weight, and getting more physical activity, which can trigger body changes that improve pregnancy rates as well as diabetes management. Even a ten percent loss in body weight can restore a woman's normal period and make her cycle more regular.
Because there is no cure for PCOS, managing the disease is necessary to prevent further problems. Controlling symptoms of PCOS at an earlier age can help reduce the chances of developing PCOS complications such as heart disease and diabetes. Treatment goals are based on symptoms, aspirations of pregnancy, and lowering chances of PCOS complications.1 Health care providers will generally recommend weight loss and other lifestyle changes before adding medications, or possibly surgery, to see if fertility returns and pregnancy occurs naturally. In one study, lifestyle changes alone restored ovulation and improved pregnancy rates in women with PCOS.
- Fertility medications. Several medications that stimulate ovulation can help women with PCOS become pregnant. For most patients, clomiphene citrate (Clomid, Serophene) is the first choice therapy to stimulate ovulation. If this fails, metformin taken with clomiphene is usually tried. When metformin is taken along with fertility medications, it may help women with PCOS ovulate on lower doses of medication. Gonadotropins can also be used to stimulate ovulation and are given as shots, but are more expensive and there are greater chances of multiple births compared to clomiphene. Another option is in vitro fertilization (IVF), which offers the best chance of becoming pregnant in any one cycle and gives doctors better control over the chance of multiple births, but is very costly.
- Diabetes medications. Metformin is used to treat type 2 diabetes and has also been found to help with PCOS symptoms (although it is not FDA-approved for the treatment of PCOS symptoms). Abnormal hair growth may slow down and ovulation may return after a few months of using metformin, as it affects the way insulin controls blood glucose and lowers testosterone production. Recent research also shows that metformin can be beneficial in decreasing body mass and improve cholesterol levels.
- Surgery. "Ovarian drilling" is a surgery that brings on ovulation and is sometimes used when a woman does not respond to fertility medications. The doctor makes a very small cut above or below the navel and inserts a tool that acts like a telescope into the abdomen (also known as laparoscopy). The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary and can lower male hormone levels in addition to helping with ovulation. But these effects may only last a few months.
How does PCOS affect a woman while pregnant?
Women with PCOS who do get pregnant are at higher risk for pregnancy complications and should work with their health care providers to plan for ways to promote a healthy pregnancy and delivery. Many of these complications are similar to those common in women with diabetes, probably because of the higher occurrence of diabetes in women with PCOS; there appears to be higher rates of miscarriage, preterm birth, and cesarean delivery.
- Miscarriage or early pregnancy loss. The exact reason women with PCOS are at a higher risk for miscarriage is uncertain. Because obesity is an independent risk factor for miscarriage, it is not clear whether it is the PCOS or the obesity common in women with PCOS that contributes to miscarriage. Because many women who are obese are also insulin resistant, researchers are exploring whether or not reducing insulin resistance can improve pregnancy outcomes. The National Institute of Child Health and Human Development-supported research has shown that treatment with the insulin-sensitizing drug metformin can significantly reduce the risk of miscarriage in pregnant women with PCOS.
- Preterm birth. Preterm birth is defined as delivery before 37 weeks of gestation. Many researchers believe that the higher risk of preterm birth is the result of more pregnant women with PCOS having preeclampsia. Preterm infants are at risk for a number of health problems, including low birth weight and underdeveloped lungs, to name a few.
- Cesarean delivery. This surgical type of delivery may be more common among women with PCOS because they are more likely to deliver preterm, they are more likely to be obese (sometimes a reason for this type of delivery), and they are more likely to have pregnancy-induced high blood pressure. Because it is a surgical procedure, recovery from cesarean delivery can take longer than recovery from vaginal birth.
How can women cope with the emotional effects of PCOS?
Having PCOS can be difficult. Many women are embarrassed by their appearance because of symptoms such as abnormal hair growth (facial hair) and acne, while others may worry about being able to get pregnant. Some women with PCOS might get depressed, but finding treatment can help with these concerns and help boost a woman's self-esteem. Support groups, as well as online support, are located across the United States. You can find out more by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662.
1 - The National Women's Health Information Center, U.S. Department of Health and Human Services. Polycystic Ovary Syndrome (PCOS). www.WomensHealth.gov. (Accessed December 29, 2009).
2 - U.S. Department of Health and Human Services. Beyond Infertility: Polycystic Ovary Syndrome (PCOS). National Institutes of Health. www.nichd.nih.gov (Accessed December 29, 2009).
3 - Eunice Kennedy Shriver National Institute of Child Health and Human Development. Polycystic Ovary Syndrome (PCOS). National Institutes of Health. www.nichd.nih.gov/health/topics/Polycystic_Ovary_Syndrome.cfm (Accessed December 29, 2009).
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