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Pregnancy loss is awful for everyone, but what about people dealing with conditions like Polycystic Ovary Syndrome (PCOS)? Not only does PCOS cause a slew of aggravating symptoms, but it also can have a serious impact on your fertility and any potential pregnancies.
PCOS is a hormone imbalance affecting 1 in 10 menstruating people, or about 7 million women of reproductive age in the United States. The hormonal imbalance can mess with ovulation by interfering with the growth and release of eggs from the ovaries. Common symptoms include irregular or absent periods, difficulty losing weight, and insulin resistance (when the body doesn’t respond properly to insulin, a hormone essential for regulating blood sugar levels). Other PCOS symptoms include acne, hair loss, hirsutism (excessive hair growth), and mood disturbances. If you are experiencing any of these symptoms, make an appointment with your healthcare provider, who can diagnose you accordingly.
Should you receive a PCOS diagnosis, know that it is a manageable condition through medication, lifestyle changes, and fertility treatment (when necessary).
At the same time, even though a PCOS diagnosis shouldn’t stop you from growing your family, the condition does put you at a certain risk for pregnancy complications and loss. So it’s important to educate yourself on what is a myth, and what is a fact when it comes to miscarriage and PCOS. Rescripted spoke with Cordelia Nwankwo, M.D., a board-certified OB/GYN based in Washington, D.C., who answered all of our pressing questions on the subject.
Fact: PCOS increases your chances of having a miscarriage
So, the not-so-great news is a PCOS diagnosis does increase your chances of miscarriage. This is because “the same hormone imbalances and insulin resistance that come with PCOS can affect both egg quality and implantation [which can] increase miscarriage risk,” explains Dr. Nwankwo.
But she’s also quick to remind readers that, unfortunately, “there’s always the possibility of miscarriage even without PCOS.” Remember that about half of early miscarriages occur because the embryo doesn’t develop properly, regardless of conditions like PCOS.
Myth: PCOS prevents you from having a viable pregnancy
The good news is, just because you are at an increased risk of miscarriage and complications does not mean a viable pregnancy is impossible. It just may "take more effort to ensure a healthy pregnancy,” says Dr. Nwankwo, so PCOS patients do need to prepare for the possibility of a longer fertility journey. The first thing she advises is for patients to “optimize [their] health before trying to conceive.” This includes addressing insulin resistance, working on healthy lifestyle habits (Dr. Nwankwo recommends a well-balanced diet of low-inflammatory foods), addressing weight management, and, if needed, getting to a healthy weight. Depending on your PCOS symptoms, she also advises seeking medical assistance “to ensure regular ovulation.”
Fact: Pregnancy with PCOS can be considered high-risk
Be advised that this fact comes with a caveat: Yes, pregnancy with PCOS can be considered high-risk, but this is primarily “in the setting of insulin resistence and obesity,” says Dr. Nwankwo. This is because both symptoms are factors for pregnancy complications like gestational diabetes and preeclampsia.
Pregnant PCOS patients are also at risk of preterm birth (birth before 37 weeks of pregnancy) or C-section due to obesity, diabetes, or high blood pressure. If you are experiencing any of these three PCOS complications, speak with your healthcare provider about creating a management plan.
Fact: Having a PCOS plan of action can help increase your chances of a successful pregnancy
As with most medical conditions, your treatment plan will depend on your symptoms, but here are some of typical options for PCOS patients who are trying to conceive:
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Weight loss: For overweight or obese patients, losing weight through healthy eating and exercise habits can help regulate your menstrual cycle, which can improve your fertility.
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Medication: If you have irregular or absent periods, Clomiphene (Clomid) is sometimes prescribed to help you ovulate.
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Intrauterine insemination (IUI): In addition to ovulation medication, your healthcare provider may recommend trying a form of assisted reproductive technology called IUI. This procedure entails a physician placing separated sperm directly into a woman’s uterus while she’s ovulating.
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In vitro fertilization (IVF): If medication and IUI don’t work, IVF is a common next step. The sperm and egg are fertilized outside your uterus (in a lab), then placed in your uterus as an embryo.
Once you're pregnant, it will be critical to listen to your healthcare provider's advice: "Taking care of yourself and making certain changes can help decrease miscarriage risk,” advises Dr. Nwankwo. She also encourages PCOS patients to get the ball rolling on those healthier lifestyle habits even before TTC: “Set up a preconception visit with your provider to find out how to best optimize your health and PCOS to increase chances of a viable healthy pregnancy.”
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Threads.