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How to Get Pregnant with

PCOS
A Complete Guide
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PCOS & FEMALE INFERTILITY

What Is PCOS?

Polycystic Ovary Syndrome (PCOS) is the most common hormonal

imbalance condition affecting women in their reproductive years. More
than 5 million women, suffer from PCOS which can cause a range of
symptoms such as; irregular periods or menstruation, skin or hair
changes and for some, difficulty in getting pregnant. It is not a disease of
the ovaries. If the hormone levels associated with PCOS can be reduced
or controlled, the ovaries can often function normally.
 Prevalence Of PCOS
Statistics In India 2019

• Around 1/7 women suffer from PCOS

• Between 70 to 80 percent of women with PCOS report having
periods less than monthly (less than eight periods per year).
• People with PCOS are more prone to miscarriages.
• When you have PCOS, your ovaries are larger than normal
• Vitamin D supplements can help increase the chance of ovulation

How To Get Pregnant With PCOS & Irregular Periods?

Can you get pregnant with PCOS? Yes, certainly. 3/10 women with
PCOS experience some difficulties in getting pregnant. It may take
longer, but with appropriate changes in diet, lifestyle, exercising
regularly and medical treatments, conception is not difficult if PCOS is
detected & treated early. Women suffering from PCOS & irregular
periods find it harder to time sex to fertile days of their menstrual
period. But, surprisingly, women with PCOS have a similar number of
children as women without PCOS.

So How Does Polycystic Ovaries Affect Fertility?

Myth: “Poly” means “many”. Polycystic Ovaries Syndrome means many
cysts in the ovaries.
Fact: Many people are of the opinion that Polycystic refers to multiple
cysts in the ovaries. But that’s not necessarily true. It actually refers to
the imbalance in the hormonal levels. An ultrasound suggests that dark
areas on the ovaries are follicles occurring due to under-developed eggs
which affect fertility as they don’t mature every month.
What Causes Imbalance In The Ovaries?

There are two main hormones associated with PCOS –

Insulin
Androgens

An imbalance of these in the ovaries causes the eggs struggle to function

normally.

Causes Of PCOS/PCOD

The exact cause of PCOS varies from person to person & despite of
advancement in technology & treatment options like IUI & IVF, doctors
are unable to ascertain the exact cause. However, some main causes are
known to us.
Genetics
Genes & hormones are carried down generations. An elevated hormonal
level before birth in the womb, at birth or early childhood development
plays a major role. Scientists say that Women with PCOS are 55% more
likely to have a mother / sister or an aunt suffering from PCOS in

relation to those without PCOS. Women from Asia, Africa & Aboriginals
are more prone to PCOS than women from other ethnic backgrounds.

Lifestyle
Unhealthy eating habits, poor nutrition and consumption of junk food,
erratic schedule (eg. Night shift jobs for women), sedentary lifestyle, lack
of exercise or low physical activity causes increased risk of PCOS.
Increased weight (Body Mass Index (BMI)

PCOS Symptoms & Pregnancy

There are various symptoms of PCOS with irregular periods which differ
between individuals & vary at different stages of life. They affect three
main areas: reproductive, metabolic and psychological health.

Irregular periods or menstrual cycles (duration of the cycle or

frequency of occurrence. The average menstrual cycle lasts about
28 days, although it’s normal for it to be a bit shorter or longer
than this.
Difficulty in getting pregnant
Excess weight gain despite the consumption of same calories
everyday
Increased BMI – Body Mass Index > 30
Very heavy or light bleeding
Excessive hair on face, stomach, back
Oily skin or severe acne or pimples that may not wear away with
adolescence
Health complications during pregnancy such as gestational
diabetes
Reduced periods cycles: 0-8 periods per year
Loss of hair in the frontal portion or the top of the head. Thinning
of hair.
Emotional challenges (depression or anxiety)
Increased risk of diabetes
Sexual health challenges
Low self-esteem & poor body image
 Tests For Diagnosis Of PCOS

Diagnosis of can be done either by a blood test or an ultrasound.

Tests For Diagnosis Of PCOS

A blood test will measure the level androgens (called testosterone
in men) and other hormones.
An Ultrasound is performed if there is no hormonal imbalance of
Androgens. If there are 20 or more dark fluid filled sacs on the right
or left ovary, indicating partly matured eggs, you are suffering from
PCOS.

Is It Difficult To Diagnose PCOS?

Not really. But if you are taking contraceptive pills, you should stop
taking the pill for three months beforehand. In early teens, your 1st or
2nd year may have irregular periods until your body normalizes to the
hormonal changes in your body. But it’s common for PCOS to occur at
young age.
 Do I Have PCOS? How Will I Know? When To Test For
PCOS?

If your condition is mild, you may realize only if you are unable to
conceive and your weight fluctuates.

Administration of a combined oral birth contraceptive pill can cease

evident signs of PCOS because:

Many of these have a pill-free 7 days every month followed by a

withdrawal bleed, which is often mistaken for a period. It is a false
period as it is unrelated to egg production or shedding of the
endometrium lining. The pills can improve acne and lessen excess
hair growth.
A trans-vaginal scan (in which a wand is put inside your vagina)
showing polycystic ovaries.
An increase in facial or body hair or test results showing you have
excess levels of testosterone (male hormone).
 How To Detect Pregnancy with PCOS

There are 3 easy ways to detect pregnancy with PCOS. Pregnancy with
PCOS may be difficult to detect accurately due to irregularity in periods.

Home Pregnancy Test

It is recommended to wait for 7-10 days after a missed period to take a
home pregnancy test. Levels of hCG (human chorionic gonadotropin) can
also be measured by a blood test in a laboratory. If you get a negative
result, you can recheck after a week or so until the hCG levels rise.
Recognize The Early Signs & Symptoms Of Pregnancy

Some of common signs of pregnancy with PCOS include

Missed periods
Sore and tender breasts / engorgement
Abdominal bloating
Nausea and extreme fatigue
Mood swings & food aversions
Elevated body temperature
Back pain & frequent head ache

Regulating Your Cycle

Keep track of your menstrual periods and note the dates. If you have
been able to regularize them, a missed period for 7-10 days can possibly
mean you are pregnant if intercourse occurred on the suggested dates.

How Long Does It Take To Become Pregnant With PCOS

For most women it takes about 3 months to get pregnant. However, if
you have Polycystic Ovarian Syndrome and you want to get pregnant
quickly, you may take 6months or more depending on –

Your age and weight

Stage of PCOS (Severity)
Health complications if any
Mode of medication – oral administration, IUI or IVF
Regularity of periods
Lifestyle and diet

It takes at least 3 months for an egg or ova to mature and be released

from your ovaries. So, altering your diet before trying to conceive will be
really helpful when you are trying to conceive.

Infertility & Chances Of Pregnancy With PCOS

Since over 30% of women with PCOS experience some difficulties in

getting pregnant, it’s highly recommended you start planning a family
early as the chances of pregnancy with PCOS declines after 35. Elevates
levels of male hormones prevent the release of egg(ovulation).

PCOS Complications During Pregnancy

An increased risk of developing gestational diabetes due to insulin

resistance – Prediabetes or Type 2 Diabetes.
Miscarriage during pregnancy
Likelihood of caesarian delivery – Pregnancy with PCOS may lead
to high blood pressure which will hinder a natural birth. At this
i t d t ill i i t C S ti
 point, your doctor will insist on a C-Section.

Premature or preterm birth – A baby is considered to be preterm

when the mother gives birth within 37 weeks of pregnancy. This is
one of the biggest complications of pregnancy with PCOS.
Higher chances of newborn fatality or admission into NICU –
Newborn Intensive Care Unit
Preeclampsia – Preeclampsia is the condition of high blood
pressure, especially after the 20th week of pregnancy.
Larger than normal babies
Cardio-vascular disease (it can be caused due to high blood fats or
bad cholesterol, low density lipoprotein cholesterol, high levels of
inflammatory proteins, which can alter the function of blood
vessels and increase insulin resistance).
Metabolic syndrome (generally having at least two of the following
– impaired glucose intolerance, high blood pressure, high
cholesterol, obesity, high fasting blood glucose)
Endometrial Cancer – Irregular periods, chronic anovulation (lack
of eggs being produced) causes the endometrium to thicken as
these is no shedding of the endometrial lining which can develop
into cancerous or malignant cells.
Sleep apnea

Chances Of Pregnancy After Miscarriage With PCOS

Women with PCOS experience fertility Issues including Miscarriage.

The miscarriage rate for women with PCOS can be as high as 30-50%.
They have a 2-fold increase of miscarriage relative to those without
PCOS. If you are undergoing assisted reproductive therapies such IVF or
IUI, you 50% more likely to have a miscarriage.

If you have had recurrent miscarriages in the past the likelihood of

miscarriage is a whooping 40-80%. So, it is better that you start planning
early so you have enough time and age by your side.
 Getting Pregnant With PCOS Based On Age

What Is Ovulation

All women have 2 coin sized ovaries lying on the either side of the
uterus. These ovaries store eggs (ova) and produce various hormones
such as oestrogen and progesterone. These hormones help in developing
breasts & normalize the menstrual cycle. Additionally, they also produce
small amounts of male hormones (androgens) such as testosterone.
PCOS Ovulation

Ovulation normally occurs once a month when an egg (ovum) travels

through the fallopian tube into the uterus to fertilize with the sperm if
sexual intercourse has occurred in that period. Before an egg is released
at ovulation, it develops within a little swelling of the ovary, called a
follicle (a fluid filled sac). Every month several follicles start to develop
but normally just one fully develops and releases its egg from the ovary
into the fallopian tube. An egg may be released or no eggs in that cycle
may be released (anovulation). Contraceptive pills are still recommended
for women with PCOS who don’t want to be pregnant.

Getting Pregnant With PCOS In Your 20s

For women suffering from PCOS in their twenties, there is still light at
the end of the tunnel. In fact, the sooner you start trying to conceive,
the better. By beginning in your twenties, you are giving yourself a
higher chance of getting pregnant as opposed to waiting until you turn
30. Women in their 20 have a very small chance of being infertile – a
mere 6%, whereas this number increases to 64% for a 40 year old
woman. If you are a young 20-something year old, struggling to
conceive, health experts recommend trying naturally at first before
approaching doctors for more medically advanced techniques.
Getting Pregnant With PCOS After 30
Can I still get pregnant if I have PCOS? Yes, you definitely can. It may
take longer than usual, but early detection and cure can help you sail
through smoothly. Does PCOS make you a high risk pregnancy? Women
who are in the clutch of PCOS or PCOD, in their 30’s may have a higher
risk age related birth defects such as chromosomal abnormalities. Body
fat redistribution along with slight height loss explains why women with
PCOS had larger waist circumference measurements and increased BMI
values as they got older. How To Get Pregnant With PCOS After 30?
What are the chances of pregnancy with PCOS after 30? It is difficult to
give statistics as each case varies. However, women over 30-35 have a
higher risk of delayed pregnancy. Planning early especially if you have
detected PCOS gives you more room for early treatment.
Getting Pregnant With PCOS After 40

Over 30% of women between 40-45years experience infertility. Your

chances of conceiving in any given month are also lower once you pass
the big 40. A 40 year old woman only has a 5% chance of getting
pregnant naturally every month. Getting pregnant after 40 has more
risks in general related to birth defects like Spina Bifida or Down’s
Syndrome.

Ovarian Cyst Symptoms & Signs

Ovarian cysts are fluid-filled sacs in the ovary. If they are few or small
you may not see any visible symptoms. Some of the common ovarian
cyst symptoms include lower abdominal pressure, bloating, swelling or
sharp/dull pain.

Ovarian Cyst Rupture Symptoms

You will experience sudden, severe, acute pain alongside nausea and
vomiting.

Other symptoms of ovarian cysts in extreme cases may include:

 Pelvic pain and lower back ache
Bloating
Frequent urination. Incomplete bladder or bowel excretion
Pain during sexual intercourse or menstruation
Abnormal vaginal bleeding
Breast tenderness

Ovarian Cancer Symptoms

Ovarian cancer often is undetected until it has spread to the pelvis and /
or abdomen, making it even more difficult to treat.

Ovarian Cancer treatment includes surgery and chemotherapy.

Ovaraian cancer signs & symptoms –

Lower abdominal bloating, pain, discomfort or swelling

Feeling of fullness while eating & upset stomach

Unexplained weight loss
Frequent urination, constipation and bowel changes
Extreme tiredness,
Back pain
Pain during intercourse
 Changes in menstruation – frequency, flow of bleeding and
occurrence.

Endometriosis Cyst & Treatment

This is a painful disorder that causes uterine endometrial cells to grow

outside your uterus instead of inside in the endometrium (the inner
lining of the womb). Some tissues can attach to your ovary and form a
growth outside the uterus affecting the ovaries, fallopian tubes, lymph
nodes & the peritonium. Around 7-10% of women are affected by this
condition.

Endometriosis Causes & Risk Factors:

You are prone to endometriosis if you have any allergies or chemical
sensitiveness, breast cancer, ovarian cancer, auto immune disease (or
genetic) or asthma.

Endometriosis Signs & Symptoms

 Severe menstrual cramps, heavy bleeding lasting over 7 days
Lower back and pelvic pain
Bowel and urinary problems including constipation, diarrhea, pain
while excretion, bloody stools and bloating
Fatigue, nausea and vomiting
Pain during intercourse
Spotting or bleeding between periods

Endometriosis Medical Treatment

Endometriosis Pain Treatment – Over-the-counter (OTC) non-
steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
(Advil or Motrin IB) or drugs as prescribed by your doctor for
painful menses.
Endometriosis Hormones Treatment – Birth control pills,
Gonadotropin-releasing hormone (Gn-RH) agonists & antagonists,
Medroxyprogesterone (Depo-Provera) or Danazol. Placement of an
intrauterine device (IUD) may also be recommended.
Endometriosis Surgery Treatment – A small surgery is performed to
remove the areas of endometriosis. A hysterectomy with removal
of both ovaries may be necessary in some cases.
Endometriosis Fertility Treatment – You may be recommended
pregnancy via in-vitro fertilization (IVF).
 Insulin & Obesity

Insulin controls the blood sugar (glucose) levels in the body. Cells need
glucose to produce energy for various activities or store it for future
needs.  If you have PCOS, you are likely to have insulin resistance,
leading to higher levels of sugar in the body thereby increasing the
tendency to put on weight easily. This is more likely to be concentrated
around the abdominal (stomach) region. The excess insulin in the body
also disrupts the hormones produced by the ovaries and pituitary gland,
interfering with ovulation.

Obese women often have fertility issues. Many women with PCOS have
a tendency to put on weight since the condition affects how your body
processes insulin. Obesity also influences irregular periods, missed
periods or anovulation (no production of eggs or ovum).

Getting Pregnant With PCOS Naturally

PCOS Fertility Diet Plan To Lose Weight

PCOS Diet is a proven way to lose weight with no side effects. There are
13 Principles between PCOS Diet & Weight Loss. PCOS diet plan for
Indians may not have some of the foods included below such as Kimchi,
Currants, Zucchini and more. However, many of these are now easily
available but should be incorporated in our diet if possible.

Low Glycemic Foods

Foods with high glycemic levels or can spike up your insulin. Avoid them
as much as you can as they can add to your weight gain and potentially
lead to Type II diabetes. To get you started, avoid foods like white
potatoes, rice, flour, sugary and processed foods, watermelon,
cornflakes, etc. Opt instead for soy milk, oatmeal, legumes, apple juice,
pineapple juice, carrot juice, low-fat yoghurt, whole grain cereals and
multigrain bread.